FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

A GROUCHY WOMAN MORE LIKELY TO HAVE DEPRESSION THAN PMS

Question: I am currently starting a relationship with a girl who has told me she suffers from PMS quite severely. I have known her for nine weeks, and twice she has been very emotional, erratic, and acted like she was in a panic. Can you help me understand her condition and suggest things I can do to help her during these times? It is very important.

Answer: Premenstrual syndrome, often abbreviated as PMS, is so ubiquitous that the term has become a part of the common vocabulary. It describes an occurrence of anxiety, depression or other changes in mood before the onset of the menstrual period. Other symptoms such as breast tenderness, fatigue, bloating and abdominal cramping may also be present. Most women have some or all of these symptoms associated with their menstrual cycle, but in a mild and brief form. For an unfortunate few women, estimated at between 3 to 8 percent, the mood changes and other physical symptoms are both longer in duration and more severe in nature. It can truly become a disabling condition.

In PMS the symptoms clear up within a day after the start of the menstrual period. All seems well for another two to three weeks. Then one to two weeks before the next period is due, another episode begins. The label "PMS" is often used by both men and women to describe a woman who is irritable, anxious and moody, particularly if she "growls" at those around her. In more than 80 percent of cases, the cause of the mood disorder is not PMS. Depression, anxiety or even too much coffee or other drugs can be the cause. In fact, women don't have exclusive rights to moody behavior. Men act this way about as often, there just isn't a catchy acronym to describe their behavior.

For the majority of women with PMS-like symptoms and for all those men who act the same way, the treatment is directed at the underlying depression, anxiety disorder or psychiatric condition. Fortunately, we have treatments today that are very effective for these problems. Unfortunately, we are not as successful with true PMS.

The cause of PMS has not been identified. Most researchers currently believe that it is a subtle disorder involving the relationship between the levels of sex hormones, principally estrogen and progestin, and the chemicals in the brain called neurotransmitters, particularly serotonin. Because of this the current "cure du jour" includes the use of an antidepressant medicine that raises the level of serotonin. It is beneficial for most. There are other medicines that are also helpful for some sufferers, but there are also a number of prescription and non-prescription products that have been touted as the cure du jour for PMS and are now proven to be ineffective. High doses of progesterone, vitamin B6, vitamin E and Primrose oil are among these. The use of calcium and magnesium supplements are currently in vogue, and they may or may not ultimately prove to be beneficial.

There are two important things you can do for your friend: Be emotionally supportive, and encourage her to talk to a family doctor or gynecologist about what may be causing her symptoms. It may be true PMS or it may be another condition. In either case, suitable treatment can be recommended once the correct cause of her symptoms has been established.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.