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is PMS? 

(PMS) refers to uncomfortable physical and mental symptoms that occur before the

onset of the woman�s menstrual period. Estimates of affected women range from

40 to 80%. About 5% of women experience symptoms that cause them severe

impairment. PMS may start at any time during the years that a woman menstruates.

The peak occurrence is in the 20s and 30s. Once PMS begins, the symptoms often

continue until menopause. 

of PMS 

Many women find that healthy lifestyle changes decrease symptoms of PMS.

Exercise, three to five days per week, improves mood, and increases physical

tone. Women who exercise regularly have fewer PMS symptoms. Eating less salt may

minimize bloating and swelling. Also helpful is a healthy diet, rich in complex

carbohydrates and low in simple sugar. Decreasing caffeine and alcohol intake

may help irritability and mood swings. Relaxation techniques, such as meditation

or yoga, decrease physical discomfort and stress. 

woman with mild PMS, are able to accept and adjust to her monthly changes in

energy and mood. Although parts of the experience are unpleasant, she discovers

that it helps her to view things from a different perspective. If she is

impulsive or irritable before her menses, she may decide to defer important

decisions for a few days. If she feels angry at a friend, she may write down the

anger. If, after a few days, it still bothers her, she then responds to the

anger. Some women learn this on their own. Others may seek counseling to help

reduce stress and to learn ways to actively cope with the PMS. 

supportive spouse or roommate can be a great help during low energy days or

periods of irritability. Some women can take turns helping each other during

vulnerable times. However, women who live or work closely together often go into

synch: they have their menses at the same time. Depending on the situation, this

can either be a support or a difficult time for the entire group. 

Minerals: There is some evidence that Calcium may decrease many PMS symptoms. 

Moderate doses of Magnesium and Vitamin E may also be helpful. Controlled

trials have failed to show nay benefit from high dose Vitamin B6. Additionally,

high doses of B6 can cause peripheral nerve damage. 

Symptoms: If lifestyle and dietary changes are not effective, there are other

treatments. Diuretics help reduce fluid buildup and decrease bloating. Some

women find that oral contraceptives decrease symptoms of PMS. This varies,

depending on the dosage and mix of hormones in the particular pill.

Non-steroidal Anti-inflammatory Drugs  such as Ibuprofen, are helpful for

PMS-associated pain. 

mood changes are called Premenstrual Dysphoric Disorder. (PMDD) The symptoms of

PMDD resemble major depression. A woman with PMDD has her mood swings only in

the one to two weeks before her menses. When we suspect PMDD, we often ask the

woman to chart her moods for three months. This helps determine whether the mood

shifts are confined to the premenstrual days. If depression or other mood shifts

also occur in other phases of the cycle, we treat it as any depression, anxiety

or bipolar disorder, using psychotherapy or medication. 

If charting reveals that depression occurs only before menses, we can

choose to treat with medication all month or we may decide to use medication

only during the days before menses. The woman should be an active participant in

making this decision. Full-cycle treatment is easier to remember. It does not

require the same degree of charting and calendar watching. However, if the woman

experiences medication side effects, or simply wants to minimize her medication

use, she can take an antidepressant during the 10-14 days before her menses. The

SSRIs (Prozac, Paxil, Zoloft and others) are the first-line antidepressants for

premenstrual depression or irritability. They seem to work more rapidly for PMS

mood symptoms than for regular major depression. If a woman has significant

manic symptoms before her menses, she may need to take a mood stabilizer such as

Lithium or Depakote during her entire cycle. 

when the most severe symptoms, mood, or physical symptoms, are addressed; the

other symptoms are less intense. Thus, a woman who is successfully treated for

premenstrual depression may experience fewer physical symptoms. Other women need

active treatment for both kinds of symptoms. 

symptoms may temporarily become worse in the perimenopausal period (the years

just before menstruation ceases.) However, true menopause often brings the end

Menopause 

�menopause� comes from two Greek words that mean �month� and �to

end.� It translates as �the end of the monthlies.� 

The medical definition of menopause is the absence of menstruation for 12

months. In American women, the average age for menopause is 51. However, it can

occur between a woman�s late thirties and her late 50s. Menopause also occurs

when a woman�s uterus and ovaries are surgically removed.  

two to fifteen year span before menopause during which a woman experiences

changes due to declining levels of estrogen and progesterone. For some women,

cycle is governed by the endocrine system. The central glands, located deep in

the brain are the hypothalamus and the pituitary. These structures regulate the

sex hormones produced by the ovaries. Other glands and structures are also

involved, but these are the main players. When a woman is having regular

menstrual cycles, the hypothalamus signals the pituitary to secrete gonadotropin-releasing

hormone (GnRH) during the first two weeks of the menstrual cycle. The GnRH

stimulates growth in some of the eggs in the ovary. The ripening egg (follicle)

produces estrogen, which causes the lining of the uterus to thicken. At about

day 14 in the cycle, the hypothalamus causes the pituitary to produce

luteinizing hormone (LH.) This causes the release of the follicle from the

ovary. The area around the released follicle becomes the corpus luteum. The

corpus luteum secretes a lower amount of estrogen and an increasing amount of

progesterone.  If the egg is not

fertilized in the critical period after ovulation, the corpus luteum produces

declining amounts of estrogen and progesterone. When the estrogen and

progesterone reach a low point, the hypothalamus begins to start the next cycle,

and menstruation begins.  

changes in her menstrual cycle several years before true menopause. The ovary

has a finite number of eggs, and these begin to run out. The hypothalamus

stimulates the pituitary to make more FSH in an attempt to cause the remaining

eggs to mature. FSH and LH levels rise. Estrogen levels may vary. Because of

this we can use FSH levels to determine whether a woman is entering menopause.

ovulation occurs intermittently. If there is no ovulation, the progesterone does

not increase and the estrogen production may continue. This may cause the uterus

to build up a thicker lining. The menstrual period may occur irregularly and may

be quite heavy. Other cycles may produce a light menstrual period. As

perimenopause moves into menopause, the ovaries produce much less estrogen and

menopause, estrogen and progesterone levels are low and fairly constant.

However, during perimenopause, their levels may fluctuate in an irregular

pattern. Some perimenopausal women have an exacerbation of their premenstrual

symptoms. Fortunately, when menopause occurs, the PMS symptoms cease. 

are experienced by up to two-thirds of perimenopausal women. They usually occur

one to five years before the end of menstruation. These symptoms are more severe

in women who have had their ovaries surgically removed. It is thought that low

levels of estrogen cause the brain to release a surge of Gonadotropin-releasing

hormone. This may be the cause of the hot flash. . 

A woman suddenly feels hot and may perspire profusely. She may then have

a cold chill. They are more common at night but can occur at any time of day.

They last from a few seconds up to an hour.  

heavier, or lighter. There may be increased or decreased cramping. Eventually,

menses lighten, become less frequent and then stop. 

common in women who have had difficulty with PMS. There is some suggestion that

estrogen levels influence the production of serotonin.  

women report difficulty with concentrating or remembering specific words. A

woman with attention deficit disorder may first come for treatment at this age

because declining estrogen level has exacerbated her ability to concentrate. 

is a common complaint of women in perimenopause or menopause itself. Night

sweats may disrupt sleep. Irritability and depression can impair sleep. Reduced

sleep can lead to tiredness and irritability during the day. 

Before and after menopause, lowered estrogen levels cause the lining of the

vagina to become drier and thinner. This may lead to painful intercourse and

decreased interest in sexual relations.  

Some urinary symptoms may be related to pelvic floor changes that occurred years

ago during labor and delivery.  As

the estrogen level drops, further changes can occur. Low estrogen levels may

weaken the urethral sphincter that helps hold in urine. If the woman has gained

choices in dealing with symptoms associated with approaching menopause. These

include healthy lifestyle changes, hormone replacement therapy, other

medications, social support and therapy. 

decrease depression and irritability. Good muscle tone can also improve energy

level and decrease aches and pains. Some forms of exercise may help decrease

bone loss. Yoga or Tai Chi decrease stress and may reverse the decreased

flexibility often associated with aging. Regular Tai Chi has been shown to

decrease the incidence of hip fractures in older individuals. A diet high in

complex carbohydrates, including multiple small meals may reduce irritability

and improve one�s feeling of well-being.  

women experience menopause as a time of increased freedom and new possibilities.

As their own children grow up, they may have more time and flexibility. However,

some women experience the empty nest as the loss of their central role in life.

Loss of a spouse through death or divorce can increase isolation. The physical

changes associated with hormonal fluctuations can be confusing. Menopause may

cause some women to start to think about the finite nature of life. Supportive

friends and family can help a woman understand and cope with life changes.

Reading about menopause or talking to one�s doctor can help make the changes

less mystifying. A return to spirituality can spur growth at this phase of life.

estrogen and progesterone can help some of the symptoms associated with

approaching menopause. The decision to take hormones is an individual one. A

woman considering HRT needs to consider the severity of her symptoms, her health

history and her family history. She may also have personal preferences about

taking medications. Estrogen is the hormone that seems to relieve many of the

symptoms of approaching menopause. If a woman has already had her uterus

removed, she may take estrogen by itself.  However,

if a woman with an intact uterus takes estrogen without progesterone, the lining

of the uterus may build up, and the woman may be at increased risk of uterine

cancer. Thus HRT often requires a combination of estrogen and progesterone. The

doses of estrogen and progesterone used for HRT are generally lower than the

doses used for birth control pills. Often, women only need HRT for a limited

number of years after menopause. There can be benefits and drawbacks to the use

of HRT. Estrogen can relieve hot flashes, vaginal dryness, urinary problems, and

sometimes insomnia. It can also promote a feeling of well-being. Some women feel

that it improves memory and concentration. HRT can reduce the chance of

osteoporosis. Estrogen may help prevent heart disease, but recent data has

suggested that this effect may not be as dramatic as previously thought. For

some women there may be drawbacks to HRT. Some studies have suggested a link

between HRT and an increased incidence of breast cancer. Estrogen may elevate

blood sugar, cause headaches, weight gain, or other side effects.

support, healthy lifestyle changes and hormone replacement therapy are not

enough. The death of loss of a spouse, heath changes and other stresses may

cause stress. Depression and mood swings are more common during perimenopause

than after menopause is well established. However, a woman with a history of

anxiety or major depression may have a reoccurrence during either of these

periods.  Counseling may help some

women deal with losses. Counseling may also help a woman review her life and

make decisions about new directions and interests. If a woman has a persistent

depression or experiences sleep, appetite and energy changes, or has suicidal

thoughts, she may want to consider antidepressant medication.  

Feelings: Depression or Just the Blues? 

different ways. In Understanding Girls with AD/HD, Nadeau, Littman and

Quinn identify types of ADHD girls. Active girls may act like tomboys. They may

socialize with boys. They are active, and may engage in impulsive escapades.

Another group of girls shows their ADHD by talkativeness and excessive

socializing. They too may become involved in risky behavior. Some girls with

ADHD seem to fade into the background. They are shy and inattentive. They may

have few friends and are more likely to be depressed. The last group is often

escapes diagnosis until adolescence or adulthood. These are the very smart girls

who have the ability to put in an extraordinary effort to hyperfocus. Adults see

them as achievers but are often unaware of the anxiety and extreme effort the

such girls use in order to compensate for their inattentiveness. Such girls are