Several women\u2019s health websites place the number of symptoms attributable to premenstrual syndrome (PMS) at 150. I personally think that\u2019s an undercount. I really began to appreciate this some years ago when a young woman came to see me with recurring hives.<\/p>\n\n\n\n
Out of the blue, she\u2019d awaken from sleep covered in large red itchy welts. She was pretty miserable. She\u2019d seen her primary care doc, a dermatologist, and an allergist and was told she had idiopathic urticaria, a diagnosis that translates to \u201cyou have hives and we don\u2019t know why.\u201d She was prescribed an array of antihistamines and steroid creams.<\/p>\n\n\n\n
When I asked if her hives were constant, she first answered yes, but then paused, thought for a moment and said, \u201cNo, sometimes they\u2019re better right after my period. Just for a week or so.\u201d<\/p>\n\n\n\n
With fingers flying, I searched the internet and found no shortage of articles linking PMS and hives<\/a> and yet when I checked one of several PMS symptom lists<\/a> hives wasn\u2019t there.<\/p>\n\n\n\n Although dozens of symptoms are indeed linked to PMS, there are three major themes: Most women with PMS have both. Often my patients with PMS begin by describing their breast tenderness, fatigue, or migraines and don\u2019t mention emotional issues at all until I specifically inquire. To which the answer is invariably \u201cOh, yeah, of course, those.\u201d<\/p>\n\n\n\n As you likely know, the culprit behind PMS misery is the rise and fall of your hormones, the monthly up\/down cycles of estrogen and progesterone. Every month, like it or not, estrogen gets your body ready to become pregnant.<\/p>\n\n\n\n Immediately after you ovulate (release an egg), if the egg gets fertilized a tsunami of progesterone turns your uterus into a comfy spot for the fertilized egg.<\/p>\n\n\n\n But if there is no fertilized egg, your whole system goes through the hormonal shifts anyway. Estrogen and progesterone both drop, and the price of this drop is PMS.<\/p>\n\n\n\n On the other hand, if the egg is fertilized and you\u2019re pregnant you\u2019ll experience all sorts of new and surprising symptoms, but I guarantee you one of them won\u2019t be PMS. With pregnancy, your estrogen level skyrockets and instead of PMS you have first-trimester morning sickness.<\/p>\n\n\n\n You\u2019re right. It\u2019s your hormones.<\/p>\n\n\n\n However, there\u2019s light at the end of the tunnel. After your period, your estrogen and serotonin begin to rise and you start feeling pretty good again. For this reason, most menstruating women feel their best during the week after their period. And then the whole thing starts over again.<\/p>\n\n\n\n Although we attribute premenstrual symptoms to the days just before menstruation (usually no more than four or five), for some women, having PMS for just four or five days would constitute a good month. This group starts having PMS symptoms within a week after the last day of their period, experiences a worsening at mid-cycle during ovulation, and has a couple of calm days after ovulation followed by serious and worsening PMS symptoms, making the 8 to 10 days before their periods start sheer hell.<\/p>\n\n\n\n If, for example, you get diarrhea the third week of every month, that\u2019s PMS and don\u2019t bother with a gastroenterologist. If you\u2019ve been diagnosed with ulcerative colitis and it worsens during the third week of your cycle, that too is PMS.<\/p>\n\n\n\n Working diligently on your PMS will likely improve the overall status of your ulcerative colitis because the symptoms of virtually any chronic illness are worsened by stress. Because during PMS days your stress-buffering serotonin drops, you\u2019re more vulnerable to stress and thus your symptom\/illness worsens.<\/p>\n\n\n\n Personalized tracking is the single most important thing you can do toward making a PMS diagnosis and your first step toward getting relief. Just use any diary or calendar where you have space to write notes. Or check out this link to PMS trackers<\/a>.<\/p>\n\n\n\n Believe me, you can track any symptom. The PMS biggies are pretty obvious (mood, bloating, breast tenderness). But many women get midcycle migraines, for example, that they don\u2019t realize are connected to their hormones. Others see gastroenterologists for irritable bowel syndrome (IBS), dentists for temporomandibular joint (TMJ) problems, ear-nose-throat specialists for chronic sinusitis, dermatologists for rosacea, allergists for asthma symptoms, rheumatologists for joint pain, and psychiatrists for bipolar disorder.<\/p>\n\n\n\n These same women will also endure unnecessary breast biopsies, uterine biopsies, colonoscopies, skin biopsies, and other procedures because the specialist doesn\u2019t realize the symptom is related to PMS. One patient I know underwent totally unnecessary back surgery for her PMS-aggravated fibromyalgia.<\/p>\n\n\n\n Most women will hear \u201cYou\u2019re tests are all normal,\u201d followed by \u201cHere, take this,\u201d a prescription for something to suppress whatever symptom is troubling them.<\/p>\n\n\n\n Then one fine day, if they\u2019re lucky, they\u2019ll appreciate the cyclic nature of their symptoms and this becomes the game changer.<\/p>\n\n\n\n Or if you\u2019re burdened with a chronic health condition–say migraines or an autoimmune disorder–at the very least you\u2019ll experience significant improvement.<\/p>\n\n\n\n One word of advice about PMS. Don\u2019t waste time and energy measuring your hormones since they change from day to day. You could have all the features of estrogen-dominant PMS (breast tenderness, fluid retention) and if your hormone levels are normal, you\u2019d be told not to treat your symptoms as PMS.<\/p>\n\n\n\n But you are not the same as your lab test.<\/p>\n\n\n\n —Basic treatment of PMS is straightforward<\/u>. Your first steps are lifestyle and dietary changes and certain nutritional supplements. Read more about them here.<\/a> If you have estrogen-dominant PMS (breast tenderness) add Progest Assist, a progesterone oil applied to your skin.<\/p>\n\n\n\n —Functional medicine is an excellent resource for anything PMS<\/u>. Remember PMS is not a disease, it\u2019s a dysfunction. You don\u2019t need your symptom suppressed by the big-gun prescription drugs of specialists. You need to learn why your hormones are off kilter. All of our functional medicine practitioners have a lot of experience here (Rachel Gates, APN<\/a>, Caley Scott, ND<\/a>, Parisa Samsami, DC<\/a>, and Wendy Ploegstra, APN<\/a>).<\/p>\n\n\n\n
(1) A cornucopia of unpleasant physical sensations.
(2) A smorgasbord of mood swings.
(3) Both.<\/p>\n\n\n\nHormones control feel-good serotonin<\/strong><\/h3>\n\n\n\n
Is your symptom PMS-related?<\/strong><\/h3>\n\n\n\n
The cyclic nature of PMS symptoms<\/strong><\/h3>\n\n\n\n
For longstanding symptoms, do the following<\/strong><\/h3>\n\n\n\n