Premenstrual Syndrome Essay, Research Paper

For three weeks out of every month you?re energetic, happy, upbeat and even-

tempered, then it happens. A week before your period begins the change into a

?mad women? happens. Your mood swings form frustration to irritability, to

downright anger, even depression. Your breasts become tender to the touch, and

your ankle, feet, hands and stomach swell so much that your clothes become to

tight it?s uncomfortable to move. Somehow, despite the cramps and the

headaches we manage to waddle to and from the refrigerator to satisfy those

?junk food cravings?. Sounds awful? It is but it?s something that we as

women deal with on a monthly basis. The dreaded is known as Premenstrual

Syndrome or PMS. Premenstrual Syndrome is also known as premenstrual tension,

premenstrual dysphoria and most commonly PMS. PMS is a symptom or collection of

symptoms that occurs regularly in relation to the menstrual cycle, with the

onset of symptoms 5 to 11 days before the onset of menses and resolution of

symptoms with menses or shortly thereafter (Yahoo 1). Another source describes

PMS as a disorder characterized by a set of hormonal changes that trigger

disruptive symptoms in a significant number of women for up to two weeks prior

to menstruation. Of the estimated forty million sufferers, moor than five

million require medical treatment for marked mood and behavioral changes. Often

symptoms tend to taper off with menstruation and women remain symptom-free until

the two weeks or so prior to the next menstrual period. These regularly

recurring symptoms form ovulation until menses typify PMS (Lichten 1). The

symptoms that can occur are many. The most common physical symptoms can include

headache, swelling of ankles, feet and hands, backache, abdominal cramps or

heaviness, abdominal pain, abdominal fullness, gaseous muscle spasms, breast

tenderness, weight gain, recurrent cold sores (herpes labialis), acne flare-up,

nausea, bloating, bowel changes (constipation or diarrhea), decreased

coordination, food cravings, decreased tolerance to sensory input like noise and

light, and painful menstruation. Other symptoms not physical can include

anxiety, confusion difficulty concentration, forgetfulness, poor judgment,

depression, irritability, hostility, aggressive behavior, increased guilt

feelings, fatigue, decreased self image, libido changes, paranoia, lethargic

movement low self-esteem (Yahoo 2). The symptoms are obviously many and have a

varying degree of severity. The next question that arises is what the cause

could be. The exact cause of PMS, headaches and depression are unknown. In fact,

it is not known why some women have severe symptoms, some have mild ones, while

others have none. It is generally believed that PMS patients, migraine and

depression come from neurochemical changes within the brain. Hormonal factors,

such as estrogen levels, may also be the cause. The female hormone estrogen

starts to rise after menstruation and peaks around mid-cycle. It ten rapidly

drops only to slowly rise and then fall again in the time before menstruation.

Estrogen holds fluid and with increasing estrogen comes fluid retention; many

women report weight gains of five pounds premenstrually. Estrogen has a central

neurological effect: it can contribute to increase brain activity and even

seizures. Estrogen can also contribute to retention of salt and a drop in blood

sugar. PMS patients benefit from both salt and sugar restriction (Lichten 2).

Another possible cause dates back almost sixty years. In the psychoanalytic

essay on PMS by Karen Horney, she suggested that the tension preceding the

period is caused by the unconscious denial of a desire for a child. In 1942 the

first extensive psychological tests conducted on menstrual and premenstrual

women. ?Therese Benedek an d B.B. Rubenstein examined the emotional an

hormonal swings of the menstrual cycle and found a tendency toward acute

emotional response and dependent behavior during the premenstruum, which they

attributed to changes in the production of estrogen an d to certain

psychological factors. Since 1942, many attempts have been made to evaluate the

premenstrual symptoms, but psychologist Mary Brown Parlee later concluded that

there is no established proof that a measurable PMS even exists. The co

relational studies and the Premenstrual Distress Questionnaire results of Moos

in 1968 often predict, through their wording, the very symptoms that they expect

to isolate. Most of the studies on violence and PMS fail to place women in

appropriate subgroups. And in almost every case that involves proving PMS, a

nonmenstruating control group is absent. Parlee suggests, as do Lennane and

Lennane, that menstrual dysfunctions are more likely to have physiological that

psychological origins (Delaney et al. 71). PMS may be able to be prevented by

making some lifestyle changes. These can include regular exercise 3 to 5 times

per week and a balanced diet. The exercise is important because it reduces

stress an tension, acts as a mood elevator, provides a sense of well-being and

improves blood circulation by increasing the natural production of beta

endorphins (Mayoclinic 2). The diet should include increased whole grains,

vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine. Daily

supplemental vitamins and minerals may be administered to relieve some PMS

symptoms. S multivitamin with B6 (100 mcg), B complex, magnesium (300mg),

Vitamin E (400 IU) and vitamin C (1000 mg) may be recommended to alleviate

irritability, fluid retention , joint aches, breast tenderness, anxiety,

depression and fatigue (Lichten 2). Recognizing that the body may have different

sleep requirements at different times during a woman?s menstrual cycle is also

important. The importance of recognizing sleep requirements is because there is

often increased activity prior to the worse symptoms of PMS. At this time, the

woman may clean the house, function with little sleep, and feel euphoric. This

is followed by the PMS symptoms, fatigue, exhaustion, depression and the

inability to function. Women typically feel ?out of control? at this time

and this can cause the signs and symptoms of depression. Therefore it is

important to get proper rest (Lichten 3). There are no physical examination

findings or lab tests specific to the diagnosis of PMS, although a thyroid test

may rule out a thyroid condition that looks like PMS (St. Lukes 1). It is

important that a complete history , physical examination (including pelvic

exam), and in some instances a psychiatric evaluation may be conducted to rule

out other potential causes for symptoms that may be attributed to PMS. It is

also important to maintain a daily diary or log to record the type, severity,

and duration of the symptoms. A ?symptom diary? should be kept for a minimum

of three months in order to correlate symptoms with the menstrual cycle. The

diary will greatly assist the health care provider not only in the accurate

diagnosis of PMS, but also with the proposed treatment symptoms. Complications

may also occur. PMS symptoms may become severe enough to prevent women from

maintaining normal function. Women with depression may note increasing severity

of symptoms during the second half of their cycle and may require associated

medication adjustments. The incidence of suicide in women with depression is

significantly higher during the latter half of the menstrual cycle. Because of

the severity that PMS can reach there are various treatments that have developed

through the years (Yahoo 3). There are various treatments for PMS and they may

differ according to the individual and severity. Since 1953, hormonal therapies

have been the main treatment. Kathrina Dalton, M.D., a family practitioner in

England, evaluated the effectiveness of a program of aqueous progesterone

suppositories on her own symptoms. When they were relieved, she repeated the

study with 50 patients under the care of a leading gynecologic endocrinologist.

They also experienced improvement. These aqueous progesterone suppositories have

been found effective. They are safe during pregnancy, and can be used well into

menopause. Since 1979, Day and others have reported on the use of low dose

Danazol to control the worst PMS. Danazol is taken all month long and prevents

the rise and fall of estrogen level. In more than 10 medical articles, the

success rate for controlling PMS in more than 80 percent. Although Danazol has

the side effects in some of acne and fluid retention, most are easily treated.

Rarely have there been liver or bone changes with these dosages of medication.

Some patients are so will controlled on hormonal therapy that they are able to

discontinue the medications prescribed by the psychiatrist. SSC Yen in 1985

showed that luprolide acetate, a long-acting agent for endometriosis, can

rapidly eliminate the worse PMS symptoms (Lichten 3). Another treatment is oral

contraceptives. Oral contraceptives stop ovulation so PMS symptoms usually are

relieved. The newest oral contraceptives are very low-dose, so there are few

side effects. Prostaglandin inhibitors, such as aspirin and ibuprofen, may be

prescribed for women with significant pain, including headache, backache,

menstrual cramping and breast tenderness. Diuretics may be prescribed for women

found to have significant weight gain due to fluid retention. Menopause is also

a cure for PMS (Mayoclinic 3). The most important thing to know is that the pain

and mood swings are real. Women need not feel that they are ?going crazy?

for these two weeks every month. They are experiencing an exaggeration of normal

function, for which there is treatment.