June 25, 2001 -- For 10 years, Los Angeles resident Vicky
O'Toole experienced severe cramping, bloating, and nausea related to her
"Doctors kept telling me it was just PMS, but finally I learned
I had endometriosis," a condition in which uterine tissue
grows abnormally outside the uterus, she says. "I kept a careful list of all my
symptoms for two months, and when they occurred. That convinced my doctor to
listen to me. I hope other women will realize these symptoms can be a sign of
significant illness. Discuss them seriously with your doctor, and be sure to
get a thorough exam."
Depression is a symptom that many
women experience during their menstruating years. The key element that sets
apart PMS-related depression from other forms of depression is the timing of
symptoms. More than 150 different symptoms have been ascribed to PMS, but the
hallmark of PMS-related problems is their occurrence during the two weeks prior
to the onset of menstruation (around the time
of ovulation). Women suffering
from PMS-related depression report dramatic relief from their symptoms...
When patients arrive in his office saying they experience
premenstrual syndrome, he first asks them to fill out a detailed questionnaire
about their symptoms, including exactly what the symptoms feel like and when
they occur. Then he takes a medical history, with a focus on previous
obstetrical, gynecological, neurological, and psychological issues. Finally, he
does a thorough physical exam.
"You want to rule out anatomical abnormalities such as fibroids and, of course, a
disease such as endometriosis, which can masquerade as PMS. It is particularly
important to look at the patient as a whole person, not just focus on
gynecological symptoms," says Shifrin, an ob-gyn, associate director of
residency programs at Long Island College Hospital in Brooklyn, and assistant
clinical professor at the State University of New York-Brooklyn.
Look at Your Lifestyle
Once serious disease has been ruled out, the next step is to
try some simple lifestyle changes. For many women, eliciting the relaxation
response will control PMS, according to Alice Domar, PhD, director of the
Mind/Body Center for Women's Health in Boston and author of Self-Nurture:
Learning to Care for Yourself as Effectively as You Care for Everyone Else.
Several different methods can be effective, she says, including progressive
muscle relaxation, meditation, yoga, and guided imagery.
"Ten years ago, we did a randomized, controlled, prospective
study of women with severe PMS," Domar says. Those who simply listened to a
relaxation tape 20 minutes a day had a 57% reduction in both physical and
psychological symptoms. In that study we used a tape that combines
diaphragmatic breathing, breath-focused meditation, and mental images of
walking along a mountain stream."
Many physicians believe dietary changes will do a great deal to
lessen PMS symptoms. Steven Goldstein, MD, says severe salt restriction during
the second half of the menstrual cycle is often helpful. It's not enough to
stop using the saltshaker, he emphasizes. You have to check the labels on all
sorts of prepared foods, and be aware of the high sodium content in many dishes
when you eat out.
"I've had patients come back to me and say, 'I hate your guts.
My diet is bland as hell -- but it does make a difference in my PMS
symptoms,'" says Goldstein, professor of obstetrics and gynecology at New York
University School of Medicine. He also recommends a moderate dose of
water-soluble, time-release vitamin B-6.