Not Always P.M.S. -- Other Types of Cyclic Changes

Almost all women (95%) experience some physical or mood changes with their menstrual cycles. But, only one-third of those are actual P.M.S.. Not surprisingly, symptoms or changes are considered to be related to menstruation when there is a cyclic pattern of occurrence. Women vary tremendously in the number, type, severity, and pattern of symptoms before menstruation. The only thing common to all the types of cyclic changes are the decrease or elimination of the symptoms in the two weeks after menstruation up to ovulation.

Pre-Menstrual Changes or Symptoms
This category is the most common and includes the vast majority of women. These women have only one or two symptoms. A syndrome is at least three or more. So, women who have less may be best off treating the symptoms individually, rather than treatments that alter the menstrual cycle or hormones. For example, a woman who only retains water before her period might drink more water (not restrict salt as previously thought). In most cases, the symptom is mild and the woman does not need to see a physician

. When the symptom is severe, the woman will need to have it treated by a doctor. These women may actually be cases of Premenstrual Exacerbation (see below). But, distinguishing between the two is largely irrelevant, as the treatment would likely be the same. Only in rare cases, if all treatments aimed at the symptoms itself fail, should the woman consider hormonal treatment.

Another type of non-PMS pre-menstrual change are simply a syndromes that are not severe. Many women have several of the laundry list of potential PMS symptoms. But, they are mild and do not alter her lifestyle or activities. This common scenario is NOT considered to be P.M.S., and does not warrant medical intervention. The old self-help regimens of "eat-right-get-sleep-exercise" alleviate the symptoms.

Dysmenorrhea or Menstrual Cramps
Cramps are NOT a symptom or a part of P.M.S. at all. This is totally separate problem. Unlike other symptoms, cramps are due directly to the bleeding, not the hormonal cycle that led up to the bleeding. Confusion comes because cramping may seem to precede menstruation. It doesn't. Cramping signals the start of menstruation. It simply takes a while for the blood to pass through the cervix and travel down the vagina to be visible. Some of the treatments for PMS, like birth control pills, also work on dysmennorrhea.

A woman should see a physician for dysmenorrhea if the cramps are severe and not relieved by over the counter remedies or if they start later in life. If pelvic pain is truly pre-menstrual, then it is likely due to a gynecological disorder, such as endometriosis. A gynecological exam and possibly a laproscopy should be done.

Pre-Menstrual Syndrome
Pre-menstrual syndrome affects about one-third of all women. It is when a woman has two or more symptoms and the symptoms are of moderate severity. They are troublesome but do not cause a major life disruption.

Women with PMS usually treat themselves with over-the-counter medications and lifestyle changes. If they do get medical treatment, they usually do not require a specialist. Their primary care doctor can treat them in most cases.

Pre-Menstrual Exacerbation -- Physical Problems
A large number of diseases and medical problems are known to get worse in the pre-menstrual phase. These include migraines, irritable bowel, endometriosis, allergies, seizures, and asthma. These women are already under a doctor's care for these problems. So, the strategy is to be aware and to increase symptom control and prevention measures during the pre-menstrual phase.

Pre-Menstrual Exacerbation -- Mood, Emotional, and Psychiatric Problems
A number of mental and emotional problems may also get worse pre-menstrually. Depression, substance abuse, self-mutilation, anxiety, and eating disorders can get worse. The problem here is distinguishing between standard PMS and Pre-Menstrual Exacerbation. The key is that standard PMS' symptoms disappear in the first two weeks after menstruation. Pre-menstrual Exacerbation's symptoms merely get better. Almost all severe mood problems that are cyclic are pre-menstrual exacerbation, as they don't completely disappear during the post-menstrual phase.

Psychiatry has coined a number of terms and symptoms that essentially make PMS a psychiatric disorder. This is controversial and without clear evidence. In these cases, a woman is best off focusing on treating the underlying psychiatric disorder and not focusing on the pre-menstrual aspect. Standard psychiatric treatments such as anti-depressants or anti-anxiety drugs throughout the month work best. Taking these medications only the week before menstruation or manipulating hormones is not advised.

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