SUNDAY, Nov. 4, 2001 (HealthDayNews) -- Every month, millions of women with premenstrual syndrome suffer a host of frustrating symptoms, from water retention and breast tenderness to food cravings and irritability.
For most, it's an annoyance they could certainly do without. But for a small percentage, the symptoms can interfere with their ability to work and care for themselves and their families.
Between 5 percent and 10 percent of women who have regular menstrual periods meet the criteria for what is known as pre-menstrual dysphoric disorder (PMDD). That's a mood disorder that can cause depression, anxiety, difficulty sleeping and concentrating, and angry outbursts. Its physical symptoms can include bloating, acne and headaches.
And its impact can be all-pervasive.
"PMDD affects marital relationships and the ability to do mothering-type activities," says Dr. David Baron, chairman of the department of psychiatry at Temple University School of Medicine in Philadelphia. "It makes it difficult to do the many, many things women have to do."
Recent research indicates that women suffering from this debilitating form of PMS may produce less of an important hormone that normally helps women react to stress.
Allopregnanolone is a hormone metabolite of the female hormone progesterone. Researchers at the University of North Carolina at Chapel Hill found that women in the second half of their monthly menstrual cycle normally produce more allopregnanolone when they're in mildly stressful situations, but that women with PMDD produce less during stress.
The small study, which involved 24 women with PMDD and 12 without the disorder, is the first to examine the relationship between allopregnanolone and human reaction to stress. The report, appearing in a recent issue of Biological Psychiatry, was written by Susan Girdler, Kathleen Light and A. Leslie Morrow, from the University of North Carolinal's department of psychiatry.
While preliminary, the information could help explain why some women have such extreme symptoms every month, and offer hope for new treatments.
"Women who truly get full-blown PMDD syndrome are somewhat biologically distinct than those who don't get it," Baron says. "We might get to the point in the future where we can run hormonal levels and can prescribe treatments based on symptoms."
Current therapies consist mainly of anti-depressants. The U.S. Food and Drug Administration recently approved use of fluoxetine, the chemical name for Prozac, for treatment of PMDD's mood-related symptoms. It is being marketed under the brand name Sarafem. In Britain, oil of primrose is often prescribed.
Baron says it's "perfectly appropriate" for women to seek medical help for treatment of PMDD; the key is finding a physician who understands how badly the disorder can interfere with a woman's life.
"PMDD is a syndrome that requires some level of intervention -- pharmacologic or something else," he says. "If your marriage is on the rocks or you're ready to get fired, a professional consultation with a physician is in order."
But, he adds, "There are still people in medicine who think the syndrome doesn't exist. It's important for a woman, if she discusses it with her doctor and she doesn't feel [the symptoms are] taken seriously, to find a physician who will take them seriously."
Another important reason to get a medical evaluation is to rule out other possible causes of the symptoms.
"Many more women think they have PMDD than actually do," he says. "We've identified women who had low blood sugar and thought they had PMS. Go to your doctor and get a good physical work-up. A subtle change in thyroid levels can present a significant change in how you feel."
Three lifestyle changes may also help women alleviate symptoms, Baron says.
Exercise is "absolutely helpful. I don't know if it's strictly biological, but every woman I've taken care of in a clinical trial has benefited from a regular exercise program. Whatever it is, I'm sufficiently impressed to recommend it."
Eating smaller, more frequent meals instead of three big meals a day may also relieve symptoms, as can avoidance of the salty foods and chocolate that some women crave when they are pre-menstrual.
Finally, keep an eye on the calendar when scheduling potentially stressful activities.
"The thing that is most helpful is getting a sense of not losing control of your life," he says. "Feeling out of control exacerbates that feeling of anxiety. So, maybe you don't schedule important meetings that week."
What To Do
The most accurate way to diagnose PMDD is by tracking the symptoms. Print out this symptom chart, fill it out for at least two menstrual cycles and take it with you to the doctor. (To access the chart, you'll need the Adobe Acrobat Reader. To download it, click here.)
You can also view the results of a survey about PMDD at the Society for Women's Health Research.
