PMS and Menopause:
Politics, Medicine, and Health
By Frances D. Alves, M.P.H.
In Western society, two points on the continuum of the female hormonal cycle are somewhat politicized and quite medical-ized. PMS (premenstrual syndrome) and menopause carry society's subtle (and false) message that women are less psychologically and emotionally able to function than men.
PMS and menopause have also come to be regarded as diseases. We speak of them in terms of symptoms and have an armory of drugs and therapies to treat them. In truth, many of the symptoms of both can be well-managed with self-care and alternative treatments.PMS
Virtually all women experience some changes right before and during the first day of menstrual bleeding. Typical changes are mood swings, bloating, breast tenderness, headaches, and cramping. These do not constitute PMS. PMS can be defined as follows:It starts after ovulation (about two weeks before the menstrual period), peaks just before menstruation, and stops abruptly when bleeding begins.
It is severe enough to disrupt a woman's work, social, and/or personal life.
It is not caused by any underlying physical or mental illness.
More than 150 symptoms have been linked to PMS, a syndrome first recognized in the United States in the 1980s. (Women, of course, have recognized it for centuries.) Symptoms can be defined as physical and psychological.
Physical symptoms abdominal bloating, breast swelling or tenderness, acne, appetite changes and cravings, water retention/weight gain and swelling in the extremities, headaches, and gastrointestinal upset
Psychological symptoms, depression, fatigue, mood swings, irritability, anger, crying spells, withdrawal, and difficulty concentrating
What causes PMS?
The exact cause is unknown. Leading theories include an imbalance in progesterone and estrogen, fluctuations in blood sugar levels, and vitamin or mineral deficiencies. Other suspects are too much of a hormone (prolactin) that stimulates breast development for breast-feeding, abnormal action of substances (prostaglandins) that affect the body'S fluid balance and blood flow, and decrease in brain chemicals (endorphins) that reduce the sensation of pain.
PMS is most common in women in their mid-30s. It can develop after a significant break in the hormonal cycle, such as pregnancy or stopping taking birth control pills. Although around 40 percent of women of childbearing age experience significant PMS symptoms sometime during their lives, only about 5 percent have symptoms severe enough to disrupt their lives.
Perhaps because there is no specific diagnostic test or treatment for PMS, Western medicine employs many different pharmaceuticals to treat it. Over-the-counter (OTC) pain relievers, such as ibuprofen, are commonly recommended. Hormonal drugs, including birth control pills, progesterone, and other potent hormones, are employed to ease mild to severe symptoms. Antianxiety drugs and antidepressants are used for mood-related symptoms. In rare cases, surgery to remove the ovaries may be considered for a woman whose severe symptoms do not respond to any other treatment (a good time for a second opinion).
However, many women recognize that many of these treatments do have drawbacks OTC pain relievers, for example, often contain caffeine, which may aggravate PMS. Of greater concern is that pharmaceutical drugs often have vicious side effects and may even lead to other, perhaps more serious, health problems.
Because of this, many women prefer to look to self-care and alternative care as a way to manage PMS. When doing so, trying a range of self-care and alternative care techniques will help determine what works for your symptoms. It will also help counter the feelings of helplessness and loss of control many women with PMS experience. And it may prevent having your problem become unnecessarily medical-ized.
Try one or two techniques at a time for two to three cycles. Stop using anything that doesn' seem effective after two to three months and add something else as part of your own field research. Self-care and alternative care techniques include
a menstrual diary for three consecutive months. This daily record of physical and emotional symptoms and their severity, your weight, and the exact dates of your period can be very helpful in determining whether your symptoms are PMS or something else.
a moderate exercise program, such as walking or biking 30 minutes a day, four to five days a week. Exercise increases endorphins that provide a sense of well-being, helps manage stress, and reduces depression.
a diet of healthy foods in six small meals during the day. Small, frequent meals that are high in complex carbohydrates starchy foods, such as whole grain cereals and whole grain breads help keep blood sugar levels even.
a diet low in sugar, caffeine, alcohol, and salt. High-sugar foods can increase anxiety and tension, and worsen blood sugar fluctuations; caffeine may aggravate PMS symptoms; alcohol is a depressant that can increase negative emotional symptoms; and salt can increase fluid retention.
a PMS support group. Whether you create your own or join an organized group, it is important to have supportive people who understand you and PMS. This includes your family and friends, even your work colleagues if you have severe PMS symptoms.
chaste berry. Chaste berry, fruit from a small Eurasian tree, was recommended centuries ago by Hippocrates and Pliny to ease menstrual symptoms and flow. Today, German physicians prescribe it for menstrual problems, swelling in the breasts, and PMS. A number of German studies document the effectiveness of chaste berry for PMS symptoms.
other measures. Wild yam, stress management, acupuncture, evening primrose oil, sleep deprivation therapy, and supplements of vitamin B6, calcium, and magnesium have also been used for PMS with varying degrees of enthusiasm, effectiveness, and research validation.
Menopause is a two- to five-year process that occurs between ages 48 and 55 for most women (average age: 51). The process is complete when one full year has passed without a menstrual period.
Women are at higher risk for osteoporosis and coronary heart disease after menopause. But the number one reason they seek help is for distressing hot flashes. Because of all these factors, mainstream medicine fully embraces hormonal therapy for menopause.
But the therapy is not risk-free. There is a small but real risk of breast cancer for some women. There is a risk for endometrial cancer for a woman with a uterus who takes estrogen alone. And there is a two to three times greater risk of developing gallbladder disease for all women on hormone therapy.
Against this backdrop, many women try alternative therapies. These include:
phyotestrogens, estrogens from plant sources. A number of studies report that isoflavones (weak estrogens), especially in soy foods, are effective for hot flashes. Isoflavones in clover and alfalfa and other phytoestrogens in grains and such foods as chickpeas (i.e., garbanzo beans) and pinto beans also appear to work for hot flashes. Japanese women, whose diets tend to be low-fat and soy-rich, report fewer hot flashes than North American women. The influence of soy isoflavones on estrogen levels (competing with natural estrogen by binding with estrogen receptors) may be the reason.
black cohosh, an extract consumed by Native American women for a variety of problems. Black cohosh is widely used in German and European medicine for PMS, and menstrual and menopausal symptom chiefly hot flashes. It is approved by the German equivalent of the U.S. Food and Drug Administration for these purposes. A 1998 review of eight human studies found it a safe, effective alternative to estrogen replacement therapy & (Journal of Women's Health 7, no. 5 (June 1998): 525-529).
other treatments. Some women report that dong quai, a widely prescribed herb in traditional Chinese medicine, is effective for their hot flashes. Other treatments for hot flashes include ginseng, biofeedback, stress management, vitamin E, acupuncture, and exercise. As with PMS treatments, the support, efficacy, and scientific underpinnings for these other treatments vary.
Frances D. Alves, M.P.H., is a health writer and editor who has been writing for consumers for more than 20 years.