Feeling a little cranky and “out of sorts” for a woman prior to her menstrual cycle is not an unusual experience. However, when these feelings of anger, anxiety, “teariness” or depression start to adversely affect a woman’s daily lifestyle and activities, then they become Premenstrual Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD) and need to be evaluated and effectively treated.

PMS and PMDD are real disorders. They are not “In your head”. They are medical disorders that respond very well to the appropriate medical treatment.

In treating a woman suffering from PMS or PMDD, I like to separate her signs and symptoms into 2 categories: 1) physical signs and symptoms and 2) mental and emotional signs and symptoms. I do this because these 2 categories of symptoms have different causes and need to be treated separately and individually in order to be optimally treated.

Unfortunately, many practitioners treating these conditions are “one trick ponies” lumping all the symptoms together and using a shotgun approach for therapy. Their patients are the ones who pay the price for this lack of individual evaluation and treatment.

True PMS/PMDD is a reflection of a mild ovulatory dysfunction resulting in ovarian hormonal imbalances. Specifically, when a woman’s ovulatory function begins to decrease, even though her fertility may not be severely compromised, her ovarian production of the hormones estrogen and progesterone can change.

Estrogen tends to cause the body to retain fluids. Progesterone tends to cause the body to diuress or rid itself of fluids. When the relative balance between these two hormones is disrupted in the 2nd half of the menstrual cycle secondary to decreased ovulatory function and hormone production, a woman tends to experience the physical signs of fluid retention mediated by estrogen. This manifests itself as fluid buildup in the breasts, lower abdomen, and hands and fingers. This results in breast tenderness, lower abdominal bloating that is frequently visible, and swelling in the hands and fingers. Many times, a woman will experience weight shifts of 5 pounds or more between the end of her menstrual cycle and the beginning of her menstrual flow. This is all estrogen mediated fluid retention.

These physical symptoms of fluid retention associated with PMS/PMDD can be easily reversed with a mild diuretic (water pill) used as needed.

Progesterone tends to cause a woman to lose water. It has a natural diuretic effect. Again, as women see a decrease in their ovulatory hormone production, their progesterone levels tend to be low. This also permits the estrogen mediated fluid retention to become much more pronounced and problematic. Unfortunately, measuring absolute blood levels of progesterone are seldom helpful in diagnosing or treating this condition.

The symptoms a woman experiences may vary dramatically with the same relative levels of estrogen and progesterone in their bloodstream. Therefore measurement of these hormones is rarely useful. Instead, the woman needs to be treated based on the response of her symptoms to therapy.

The emotional symptoms of anger, anxiety, “teariness” and depression before menses are the result of a relative progesterone deficiency. This can be addressed very successfully with either supplement or progesterone, looking to bring the woman’s blood levels back to what her body is used to experiencing at that time in her menstrual cycle, or with the use of Fluoxetine, a medication in the family of drugs known as Systemic Serotonin Reuptake Inhibitors (SSRI’s). Serotonin is a neurotransmitter in the brain. This family of medications causes these levels to return to higher concentrations in the brain. However, of all the medications in the class of SSRI’s, Fluoxetine appears to be by far the most beneficial of these medications when used in the treatment of PMS/PMDD. Others, such as Lexapro and Wellbutrin, frequently have little effect on this condition.

Again, a boilerplate, “one size fits all” approach to treating patients with PMS/PMDD is rarely successful. A physician must take the time and have the patience to adequately evaluate the patient’s symptoms and then be willing to individualize therapy and subsequently adjust the therapy as needed based on the individual patient’s response.

PMS/PMDD is a real phenomena with real, effective treatments. It is not “In your head”. In order to successfully treat this disease state, a person needs a physician who believes in them and is willing to take the time and make the effort to treat them as individuals.

If you have further questions or concerns about PMS/PMDD, please do not hesitate to contact me.