Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Premenstrual syndrome (PMS) refers to physical and emotional symptoms which occur in the one to two weeks before a woman’s period. Symptoms vary between individuals women and resolve when the period begins. Common symptoms include acne, tender breasts, bloating, feeling tired, irritability, sleep issues and mood changes.
Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depressive symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS) – PMDD is much more severe compared to PMS and very much more life-disrupting.
To make a long story extremely short hormonal fluctuations are involved in PMS and PMDD. However every single woman in her reproductive years has hormonal fluctuations: so why does one person suffer severe symptoms whereas her friend might say “gosh I never know when my period is about to come and often it takes me by surprise – I really have to keep track of it on my phone to have some sort of warning to be prepared”. One woman has little or no warning that her period is approaching whereas another may suffer severe PMS or even PMDD and is very much aware that her period is on its way and is wishing that it would arrive as soon as possible so that she can return to some kind of normality.
There are several different pattern types of PMS. Some women are extremely aggressive with their minds speeded up in the days or weeks before their period whereas, as a complete contrast, other women find themselves incredibly slowed intellectually and find it difficult to engage their brain even in quite simple tasks like mental arithmetic – for these women their brain temporarily stops working.
Some women will report that really they only have one good week per month: this group will tend not to feel particularly well during the period, will pick up mood wise on day six or seven as the period is over, may feel quite well at ovulation time but then the next issue is for the two weeks in the run-up to the period they know they will feel awful.
For some women the resolution of symptoms as the period arrives is complete, for others the improvement is partial and for some improvement may only be negligible.
A significant number of women find that they are extremely low during their period – since it is during rather than before the period this is not, strictly speaking, PMS or PMDD but it still is hormonally mediated issue and this issue turns up with relative frequency in PMS/PMDD sufferers and needs a different treatment slant.
Most of the women who feel very ‘flat’ during their period will usually begin to feel better by day five or six post onset of bleeding. Frequently the week just after the period may, for many sufferers, be the best time of their monthly cycle -a time when they feel comparatively normal.
Some women feel wonderful for 2 to 3 days around ovulation time but their joy in feeling well is tempered by the knowledge that their PMS/PMDD whirlwind is now on its way.
Finding out what is going on with a particular patients PMS or PMDD
Every woman in her reproductive years experiences hormonal fluctuations throughout her monthly cycle. That is a given. So why does one woman have a PMS/PMDD problem while another woman has no PMS -type issues?
Diagnosis and Treatment
A detailed history is critical, then I measure hormone levels and I also look at certain biochemical tests which may help me to identify those individuals who may have a tendency towards raised noradrenaline levels at the expense of lower dopamine levels.
Obviously, vitamins, minerals, immune system all also are in the mix. It is important also to consider methylation chemistry which affects serotonin and melatonin availability because hormones interact dynamically with brain chemistry. Some patients with elevated free copper (causing dopamine/noradrenaline imbalance) may remark when asked: “I really could not tolerate the birth control pill – it seriously affected my mood”.
Functional medicine, standard ‘evidence-based medicine’ and patient outcome:
Functional medicine is not ‘standard medicine’ nor is it considered a form of ‘evidence-based’ medicine despite having been introduced in many U.S centers of conventional medicine e.g. the Cleveland Clinic. What I offer to patients 38 years of clinical experience, extensive personal study and also what I have learned personally from medical colleagues from around the globe who have devoted their lives to treating patients with unexplained symptoms. In my experience, functional medicine proves very useful much of the time in helping patients for whom pharmaceutical medicine has not worked but I emphasize that I cannot guarantee a favorable outcome.