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PMS doesn't mean something's wrong with hormones

What is the best thing to do for those of us who suffer from PMS? I get so irritable every month that it's driving the people around me crazy.

- Kathy C., Medford

Premenstrual syndrome - the physical and mental changes that occur prior to a woman's menstrual period - is a very real concern for millions of women and those around them.

Dr. Joan Rote, a Medford gynecologist, says many women attribute their PMS symptoms to "something wrong with their hormones," but the reality is that women respond differently to the normal changes in the levels of hormones the body produces during the reproductive cycle.

Some women can carry on with daily life. Others may feel overwhelmed mentally or physically, but "there's nothing wrong with their hormones," Rote says.

Symptoms vary tremendously from woman to woman. Some feel very fatigued. Others feel bloated or swollen, or irritable or depressed.

No single treatment may address all the symptoms associated with PMS, but Rote says lifestyle changes help many women tone down their symptoms. Regular exercise seems to improve mood, and a diet low in simple sugars can help too. Women who feel bloated may want to reduce their salt intake. Reducing stress can also be helpful, and eliminating caffeine and other stimulants can help lower general stress levels.

Unfortunately, lifestyle changes alone don't always resolve PMS. Rote says there are plenty of women who still have symptoms even though they exercise regularly, watch their diet and eliminate stress. They may need to keep track of their symptoms in relation to their monthly cycle to determine whether what they're experiencing is actually PMS.

"PMS is truly on-again-off-again," Rote says. "If you're always irritable or distressed, you've got depression or a mood disorder. You don't have PMS."

If the calendar confirms the symptoms are really PMS, then a physician can help the patient work out a treatment plan. Supplements are often prescribed to make sure women have enough calcium (1,200 mg/day), magnesium (400 mg/day); vitamin E (400 IU/day) and vitamin B-6 (50-100 mg/day). L-tryptophan also is helpful for some women, along with chaste berry, an herbal supplement.

Primrose oil is helpful for some women who experience breast tenderness. Progesterone creams are sometimes used, but Rote says double-blind scientific tests have indicated they have no positive effect.

Rote says many physicians now treat PMS with some of the same medicines used to treat depression. Selective serotonin reuptake inhibitors (known as SSRIs) can be taken when symptoms occur, usually 10 to 14 days a month. Birth-control pills, which regulate hormone levels, also may be helpful for some women, especially those with heavy periods and PMS symptoms.

Rote says surgical removal of the uterus and ovaries should be considered only as a last resort. Drugs can be taken to mimic the effect of removing the ovaries to determine whether a hysterectomy would really eliminate the symptoms associated with PMS.

Call Bill Kettler with your medical questions at 776-4492, or e-mail them to: bkettler@mailtribune.com or send them to: Mail Tribune, Ask Your Doctors, P.O. Box 1108, Medford OR 97501.