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Women's Health
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For years women spoke about their menstrual cycles in euphemisms: “time of the month” and “little visitor,” to name a couple. Today’s women speak openly, not only about their periods, but also about those difficult days before. Commonly known as premenstrual syndrome (PMS), symptoms that occur anytime during the last two weeks of the cycle are real and we are no longer being told that it is “all in our heads!” PMS comes in many forms. For some women the symptoms are predominantly physical ones such as bloating or breast tenderness. For others, the symptoms are mood-related, such as anxiety, irritability or depression. Some women may have a combination of symptoms or only one. A menstrual diary can be helpful in determining whether the problem is PMS or may represent other medical conditions. Menstrual symptom charts may be obtained free of charge online (www.mymonthlycycles.com) or from your physician. Many women seeking help from doctors are offered either antidepressants or birth control pills. While these have benefit, depending on specific symptoms, there are other options. The first is lifestyle change. Supportive therapy and social support are key to effective PMS management. Stress reduction through meditation, guided imagery or counseling can help, along with regular sleep. Aerobic exercise and dietary modification are both essential to any program to control PMS symptoms. Women may choose a complex-carbohydrate-rich diet, full of vegetables, whole grains and legumes but watch the calories! If carbs are restricted, I recommend a high-fiber, low-fat vegetarian diet in the duration of premenstrual symptoms. Caffeine intake should be limited and alcohol avoided. Calcium taken twice a day (1,200mg total) has been shown to be very effective, as well. All women of reproductive age should make sure that calcium supplementation is sufficient. Magnesium, vitamin B-6 (no more than 50 mg per day) and vitamin E (400 IU) taken during the PMS phase of the cycle have also shown modest benefit. Let’s take a look at what is available in your local health food store. Studies suggest that the addition of the amino acid L-tryptophan at a dose of 6g per day relieves symptoms. Secondly, an excellent study in the British Medical Journal in 2001 showed that Vitex agnus castus extract (chasteberry) provided significant relief of both physical and emotional symptoms. There are no long-term trials for this herbal remedy, however, and further studies are needed. There may be some benefit for specific symptoms with the following: black cohosh (anxiety, tension, depression); ginko biloba (fluid retention, breast tenderness, weight gain); and St. John’s wort (depression, irritability). Be cautious and do not exceed the recommended dosing on the label. Remember that many of these substances are not strictly regulated, so look for the approval seal of the U.S. Pharmacopoeia (USP). It is important to note once again that long-term safety has not been studied for many of these substances. Some, such as St John’s wort, may have severe interactions with other drugs that a woman might be taking. Use of herbals and botanicals should be under the supervision of an herbalist or doctor of Chinese medicine. You should tell your physician if you use of any of these supplements. Conversely, some substances have been shown NOT to work for PMS. Despite claims to the contrary, the best clinical trials have shown that evening primrose oil is ineffective. A very popular substance is “natural progesterone.” Scientific trials do not support benefit for progesterone suppositories or oral capsules, and I do not recommend them. Studies looking at progesterone creams may have a different result, but currently there are no data to support the use of progesterone for PMS. A final word to any woman who suffers from PMS symptoms: If your symptoms become progressively worse or do not respond to any of the therapies described above, it is important to seek the advice of a physician. Some women have a severe form of PMS known as Premenstrual Dysphoric Disorder (PMDD) and need pharmaceutical intervention and supportive therapy. For most of us, however, it is sufficient to know that we are not alone in our distress, and that there are options available to us for relief of premenstrual syndrome. Dr. Vivian Dickerson is president of the American College of Obstetricians and Gynecologists. She is an OB/Gyn with UCI Medical Center, Orange County’s only university hospital, which has been named one of the nation’s best hospitals for gynecology by U.S. News & World Report. Information: www.ucihealth.com or call toll-free 714.456.2911. |
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