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By Melissa Tennen, HealthAtoZ writer
Premenstrual syndrome (PMS) might play more havoc in women's lives than previously thought, a recent study suggests.
Moderate to severe cases might wobble a woman's ability to work effectively and function in everyday life.
"A lot of women think moderate to severe PMS is normal and they have to put up with it," says Kimberly Yonkers, M.D., senior author of the study and associate professor of psychiatry at Yale University School of Medicine in New Haven, Conn. "Many women feel they don't have an option.
"If women can't do the things they want to do, if they can't work as well, if they are not up to socializing, if they think they aren't doing a good enough job with the kids, then that indicates some sort of intervention is needed," she says.
More than 400 women were asked to keep a daily diary for two months to track symptoms. Women rated their levels of irritability, depression, sleep, appetite, lethargy and bloating as well as how their PMS affected productivity at work, how often they had to miss work and how much PMS impaired them.
Women with moderate to severe PMS were:
- Almost nine times more likely to report more than one full week of PMS-related impairment each menstrual cycle.
- Five times more likely to report reduced productivity at work, with more than 80 percent reporting at least one work week of reduced productivity.
- Twice as likely to miss more than two workdays monthly because of health reasons.
Other studies conflict as to how many women actually have PMS. In this study, 30 percent had PMS.
Part of the problem is that women may not be seeing a doctor about their symptoms if they aren't severe enough to hamper their everyday living. Or, other factors than PMS may be at work, says Gurjit Kaur, D.O., women's health internist at the Women's Health Center at the Cleveland Clinic in Cleveland.
"There are so many variations in defining PMS. We currently don't have a uniform definition. It's hard to quantify how many women actually have PMS," Kaur says. "Some people don't believe PMS occurs as often as it does. It could be that anywhere between 30 to 70 percent of women have it."
She says about four out of every 100 women may have premenstrual dysphoric disorder, a severe form of PMS. But it's hard to know just how many women have PMS because many women don't see a doctor.
However, the study addressed this by looking at women who weren't necessarily looking for intervention with their PMS symptoms.
More studies are needed to define PMS because women may have co-existing medical problems, Kaur says. Depression may worsen around the time a woman has her period. No one knows how hormonal fluctuations of the menstrual cycle correspond with serotonin levels that help regulate moods. Also, a woman may have an undiagnosed thyroid condition.
"If a woman begins to have severe PMS when she is 18 or 20 and she menstruates until she is 50, a week every month is a lot of cumulative time over her lifetime," Yonkers says.
PMS can be disabling. Symptoms include bloating, headaches, food cravings, abdominal cramps, headaches, tension and breast tenderness. Emotional aspects include mood swings, irritability and depression.
"It's not unreasonable to speak with your doctor," Yonkers says.
Here are some ways that Yonkers suggests for helping relieve your PMS symptoms:
- Exercise several times a week.
- Eat a healthy diet by increasing complex carbohydrate intake during the week you menstruate.
- Eat foods rich in calcium. Not only can calcium help you feel better, but it also can help your bones stay strong.
- Talk with your doctor about selective serotonin reuptake inhibitors, which are antidepressants.
 Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns with a doctor.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
This article was reviewed and updated June 2007.
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