PMS

Premenstrual syndrome (PMS) refers to a range of physical and emotional symptoms that occur typically 5 to 11 days before the onset of menses, severe enough to affect life or work, and typically followed by a period of time entirely free of symptoms. Physical symptoms include bloating, headaches, water retention, breast tenderness, thirst and appetite changes, fatigue, lack of energy. Emotional symptoms include tension, anxiety, tearfulness, anger and irritability out of proportion to the stimulus, difficulty concentrating.

Our approach to this problem is either: (1) follow a traditional medical approach of trying anti-depressants, sometimes on a cyclic basis, or (2) to follow a functional medical approach of following estrogen and progesterone levels every few days through a typical cycle. Often we note that estrogen levels are high than usual in the first half of the cycle, and/or that progesterone levels do not increase, or increase sufficiently in the second half. Sometimes, the second part of the menstrual cycle is abbreviated because progesterone levels do not peak high enough or last long enough. Depending on what we see, we may use supplements that drive down estrogen levels by helping the body eliminate it, and/or by adding back progesterone on the days that you need it. This second approach works well for most people with PMS without all the side effects of the SSRIs, although different approaches are needed for different people and situations. For the few for whom it does not, or whose levels are fairly normal throughout the cycle, we have some other pharmaceutical options. Your provider can tell you more.

PMS seems to increase as weight increases and insulin resistance sets in. Lifestyle management can go a long way toward reducing PMS. Since stress often exacerbates PMS, functional medical approaches can be very helpful here too. Adequate hydration and nutrition, particularly B vitamins, play helpful roles as well.