Well-woman care

Our well woman exams offer a complete range of gynecology screening and testing. Our focus is on prevention and early detection of diseases to help women maintain good health.

Premenstrual Syndrome (PMS) is the term used to describe a group of physical or behavioral changes that some women experience before their menstrual periods every month. PMS can be considered an abnormal response to normal hormonal changes. Women with PMS have a specific susceptibility for mood problems triggered by normal monthly cycles.

Physical symptoms: Abdominal bloating, breast tenderness, acne, appetite changes and food cravings, swelling of hands and feet, headache, upset stomach, constipation, clumsiness, and fatigue. Emotional symptoms: Irritability, mood swings from sadness to anger, depression, being overly sensitive, crying spells, social withdrawal, forgetfulness, lack of concentration, a change in sex drive, and trouble coping with everyday stress.

Most women with PMS have only some of these symptoms. Some women have more of the physical changes, and others have more of the emotional symptoms.

*Premenstrual emotional and physical changes occur in up to 80% of women.

*20-40% of these women experience some difficulty as a result of these changes.

3 to 7% of women report mood swings and physical symptoms that can interfere with work, lifestyle, or relationships.

PMS tends to follow a pattern of symptoms that occur at the same time in a woman's cycle. This general pattern occurs month after month. It may vary somewhat from month to month.
For a woman to be diagnosed with PMS, there must be a pattern of symptoms:

• Physical or emotional discomfort starting near the middle of the cycle with the most intense symptoms felt in the last 7 days before a woman's period starts.
• Rapid relief of symptoms once the period starts.
• A symptom-free time between days 4 and 12 of the cycle.

At least 25% of women with premenstrual symptoms will have no such symptom-free interval, suggesting the need for further evaluation, and consideration of such possible causes as menopause, a thyroid disorder, depression, or other psychiatric disorders.

There are no tests that can help detect PMS. The only way to identify it is by keeping a daily record of your symptoms. This way, you can see if a pattern exists. Keeping a daily record helps you to be aware of your body and your moods. Once a woman knows when to expect these changes and how long they last, she may be better able to manage them.

While the cause of PMS is unknown, it can be treated to some degree in most women. Understanding the symptoms of PMS can help reduce the anxiety that many women feel about whether their behavior or feelings are normal. A woman's best defense against PMS is knowledge. Know what PMS is, know when it occurs, and know what you can do to lessen its effects.

Some of the things that promote a healthy lifestyle may help improve symptoms and are worth a try. Along with its other known benefits, exercise enhances well-being and improves ability to handle stress. Women who exercise regularly report milder PMS symptoms.

Dietary changes have been widely recommended but are of no proven benefit.

Some studies indicate that taking vitamins and minerals (such as 50 mg of vitamin B6 daily) can be helpful, but other studies do not confirm the benefit.

When you can, adjust your schedule to avoid stress that may be harder to cope with when symptoms of PMS are at their worst. PMS can affect your relationships with others. Talk about what is happening to you. If you share your feelings with your family, they may be more supportive when you are having symptoms. Being aware of symptoms also may help you avoid conflicts with your family and coworkers.

If your symptoms are not relieved through exercise or stress reduction, your doctor may suggest drug treatment. The medicine your doctor suggests will depend on your symptoms and how much they affect you. Diuretics (or "water pills") are sometimes prescribed to help reduce bloating. They help the body get rid of excess fluids through the kidneys. You may take pain relieverssuch as ibuprofen (Advil, Nuprin, Motrin) or naproxen (Aleve) to relieve the pain of headaches or cramps. In some women, the use of birth control pills has been helpful in reducing symptoms.

Alprazolam, a mild tranquilizer similar to Valium has been reported to have beneficial effects in some studies, whereas other studies have not been able to demonstrate any effectiveness. However, this drug can be addictive.

For some women with severe PMS, certain drugs that alter mood and are used to treat depression or anxiety have been shown to relieve symptoms. Examples of these mild antidepressants are Prozac, Zoloft, Paxil, or Luvox. These medications may be taken on a daily basis, or they may be prescribed to be taken for only for 7-14 days of the cycle.

Source: American College of Obstetricians and Gynecologists.