ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, September 3, 1996 TAG: 9609040039
SECTION: EXTRA PAGE: 3 EDITION: METRO
COLUMN: PERSONAL HEALTH
SOURCE: JANE BRODY
Virtually every woman who ovulates experiences premenstrual changes that three-fourths of women recognize as an impending period. For many, these changes involve symptoms, such as breast tenderness, bloating or food cravings, that may be annoying or discomforting but do not disrupt their lives.
Sometimes, however, the physical symptoms of premenstrual syndrome, popularly called PMS, are disturbing enough to prompt women to seek relief. Although women differ in how well they tolerate premenstrual discomfort, it is not ``all in their heads.''
For about 7 percent of women, premenstrual symptoms are more extensive and highly debilitating, involving emotional as well as physical disturbances that can seriously affect the quality of their lives and make it difficult, if not impossible, for them to cope with tasks and stresses that they handle readily during the rest of the month. These women have premenstrual dysphoric disorder, or PMDD, the most severe form of PMS.
In the last 10 to 15 years, enormous progress has been made in the ability to diagnosis PMS accurately and treat it effectively. Various remedies, including antidepressant and anti-anxiety drugs, have been shown to help the vast majority of women with life-disrupting premenstrual symptoms. Experts insist that no woman should now have to risk her job, her personal relationships or her piece of mind because of premenstrual disturbances.
``In years past, when almost nothing had been shown effective in placebo-controlled studies, doctors tended to dismiss PMS patients with the advice that `you've got to learn to live with it,''' said Dr. Jean Endicott, director of the Premenstrual Evaluation Unit at Columbia-Presbyterian Medical Center in New York.
Dr. Steven Sondheimer, medical director of the Premenstrual Syndrome Program at the University of Pennsylvania Medical Center in Philadelphia, said, ``Now that there are proven ways to help women, physicians are paying more attention to patients with disruptive premenstrual symptoms.''
Despite years of research into things such as the possibility of hormonal imbalances or vitamin and mineral deficiencies, there is no known cause or physical test for PMS. Doctors still do not know why one woman hardly notices that she is premenstrual while another finds herself flying off the handle at every little thing or spending days in bed crying and unable to cope with much of anything.
Determining the existence and extent of PMS symptoms and evaluating the effectiveness of various treatments depends on a thorough assessment of which symptoms occur, when they occur and how disruptive each one is. ``This means the women must keep a chart of her symptoms throughout the month and rank them according to the impact each has on her quality of life,'' Sondheimer said.
A recent issue of Patient Care, a magazine for primary-care doctors, listed 11 symptoms of PMS. To be diagnosed with the most severe form, dysphoric disorder, a woman should have five or more of them, including at least one of the first four, during most of the week before her period. She should begin to feel better within a few days of the start of menstrual bleeding, and the symptoms should disappear by the week after the bleeding stops. In addition, the symptoms should markedly impair the woman's normal daily activities and relationships. The symptoms are:
Depression, feelings of hopelessness or self-deprecating thoughts.
Marked anxiety or tension; feeling ``keyed up'' or ``on edge.''
Wide mood swings.
Persistent anger or irritability; increased conflicts with others.
Decreased interest in usual activities.
Difficulty concentrating.
Lethargy, a tendency to become fatigued or a marked lack of energy.
Changes in appetite, overeating or food cravings.
Insomnia or excessive sleeping.
Feeling overwhelmed or out of control.
Physical symptoms such as breast tenderness, headache, joint or muscle pain, bloating or weight gain.
A daily symptom diary kept for two or more cycles may reveal that another condition - such as depression, anxiety, endometriosis or diabetes - is the real cause of a woman's symptoms, though they may get worse before menses. In such cases, the underlying condition must be treated first, which may obviate the need for specific premenstrual therapy. The diary can also help a woman plan challenging or stressful activities for her best time of the month, and it can help her family and friends be more understanding and less demanding when her period approaches.
Every woman disturbed by premenstrual symptoms can benefit from good health habits, such as getting adequate sleep, consuming a healthy diet, exercising regularly and practicing stress-management techniques, said Dr. Andrea Kielich, a Portland, Ore., internist specializing in women's health. Helpful dietary changes include eating four to six small meals a day, or having frequent snacks and fewer larger meals; limiting fat; emphasizing grain-based foods, fruits and vegetables; avoiding sugar and salt (the latter if bloating, headaches, weight gain or breast pain are bothersome symptoms); avoiding caffeine to reduce irritability or anxiety, and limiting alcohol.
When such changes do not provide sufficient relief, medication tailored to the particular woman's problems and needs may do the trick. For physical discomforts such as breast pain, Sondheimer recommends taking a nonsteroidal anti-inflammatory drug such as ibuprofen. Birth control pills, which stop ovulation, are often helpful. For more severe cases, medication that stops both ovulation and menses can be used on a temporary basis; it may continue to provide relief for months after being discontinued.
Most exciting, however, has been the discovery that serotonin-enhancing antidepressants, including Prozac, Zoloft, Paxil, Luvox and Effexor, can relieve emotional, and often physical, symptoms in about 60 percent of the women with severe PMS. The medication is used in doses lower than those needed to treat depression, and it often works if it is taken for only a week or two before menses. If one drug is not effective or produces undesirable side effects, another should be tried because it may work better, Sondheimer said.
Another possibility is the anti-anxiety drug Xanax, taken for seven or eight days before menses, Endicott said. Some women are able to discontinue the medication without experiencing an immediate return of symptoms, though they eventually do come back, she said. But even if medications help, Kielich cautioned against assuming that ``simply taking a pill will make things better.'' She said, ``You still have to pay attention to life style.''
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