PMS Survival Guide

"It's that time of the month again, isn't it?"

Statements like this one from even the most sensitive of significant others only make dealing with PMS (premenstrual syndrome) more difficult than it already is. The bloating, the headaches, the moodiness you just can't control -- each of these changes can disrupt your daily routine and drive you -- and those around you -- crazy. PMS affect the minds and bodies of 40 percent of the menstruating population every month -- yet despite its prevalence, there's no known scientific cause.

"We're conditioned to think PMS is in our mind or that we're neurotic," says Donnica L. Moore, M.D., an obstetrician-gynecologist in Neshanic Station, N.J., and medical correspondent for NBC's Later Today. "But the fact is, women's hormones (estrogen and progesterone) fluctuate in a cyclical fashion -- and we do react to those changes." Even so, many women either don't believe that they have PMS or aren't sure if what they're going through once a month is actually PMS. What follows is Moore's three-step plan to help you figure out if what's bothering you is PMS -- and to help you get some relief.

Is It PMS? Step 1: Keep a symptom diary. Making note of your mood swings, aches, and pains over a period of three months will help you judge whether or not you really have PMS. For example, if you notice that you're especially quick to snap at your parents or your boyfriend, write it down. If your breasts are sore one week, but not the next, or your face is breaking out in an abnormal manner, write that down, too. There are as many as 150 symptoms attributed to PMS, both emotional and physical, but you're likely to experience only a few. Among the most common are the following:

Physical

  • Bloating, breast tenderness, acne, increase in appetite, food cravings, headache, upset stomach, constipation, swelling of hands and feet, clumsiness, and fatigue.

Emotional

  • Irritability, mood swings, depression, being overly sensitive, crying spells, social withdrawal, forgetfulness, lack of concentration, and decrease in sex drive.

What Your Doctor Can Do Step 2: Talk to your doctor. After keeping track of your symptoms, take your notes to your doctor for an official diagnosis. "PMS is real and it's worth discussing with a physician because there are treatments that can help you feel better," says Moore. He or she can help you figure out whether or not you have PMS or something more severe, such as PMDD (premenstrual dysphoric disorder). Affecting less than five percent of menstruating women, PMDD causes severe mood changes and can impair normal activity by making you feel out of control. This condition usually requires prescription drugs for treatment.

Here's how your doctor will likely define PMS:

  • It occurs for at least three months in a row.
  • Related symptoms go away with the start of bleeding, with the most intense symptoms appearing the last seven days before your period starts.
  • Symptoms last at least 7-10 days.

Keep in mind that severe headaches and cramps that last beyond the start of your period are not part of PMS. These may be "menstrual-associated migraines" -- which may or may not include cramping, nausea or vomiting -- and require specific treatment for migraines.

What You Can Do Step 3: Treat and control your PMS. Your doctor is the best person to help you figure out your individual needs and treatment, but in the meantime, here are a few guidelines:

  • Get moving. "The number one self-treatment for PMS is staying active," says Moore. Spending 20 minutes a day doing some sort of aerobic activity to get your heart rate up will help you reduce stress and relax. "The good news is that aerobic exercise includes sex, if you can find a partner to do it for that long, that is," adds Moore.
  • Eat right. Maintain a well-balanced diet and take a multivitamin with iron every day. Also, try eating smaller, more frequent meals when you have PMS.

  • Drink plenty of water. "Most women tend to cut back on liquids because they feel bloated, but increasing your water intake will actually help flush out your system more quickly," says Moore.

  • Avoid caffeine and cigarettes, both of which promote stress. Eliminating these cravings helps control jittery or anxious feelings. "On the other hand," says Moore, "caffeine can be beneficial in reducing breast tenderness, headaches or fatigue, so choose the regular or unleaded stuff at Starbuck's depending upon your most annoying symptoms."

  • Go on the Pill. Studies have shown that the birth control pill works very effectively in reducing PMS symptoms.

  • Give over-the-counter drugs a try. OTC drugs for pain contain ingredients that may offer some physical relief, but they only work for some people, so you may have to try several brands or dosages before you find one that works for you.

  • Have Sex. "Women often find that their sex drive lessens during PMS," says Moore. "But if you can get over that hurdle, [having sex] may actually help by reducing stress and relaxing your body and mind."

  • Relax. Of course, this is easier said than done, but any activity that helps reduce stress will help with PMS symptoms. Try taking a hot bath or getting a friend to give you a massage.

The Guy's Guide to PMS "If guys got PMS, there would be a national holiday once a month so they could take off and rest," says Moore. "They should feel fortunate that they don't have to go through it, but they should also acknowledge that (a) women don't choose to have PMS, and (b) they need to be supportive of their friends or partners who do have it," she adds.

What's a sensitive guy to do? Start by trying to understand what's going on. "Most guys don't know what parts of a woman's body exist, much less how they might work together to cause PMS," says Bruce Bekkar, M.D., an obstetrician-gynecologist and clinical instructor of reproductive medicine at the University of California in San Diego and co-author of Your Guy's Guide to Gynecology (North Star Publications, 2000). If that's the case with you, here's a cheat sheet:

  • Be supportive. Listen to what the woman in your life has to say, and face the fact that PMS is real. It's a physical and emotional condition, not a made-up excuse she uses just to bully you around. But take caution: the best time to discuss PMS isn't while she has it.

  • Don't add extra stress to her life. If the two of you are due to have a highly sensitive conversation ("I am so going to that bachelor party!"), be smart and save it for later.

  • Avoid temptation. Don't tempt her with foods or activities that will only make her symptoms worse, such as chocolate or sitting down for a Star Trek marathon. Instead, offer to share a salad, or take a walk with her.

  • Most importantly, don't take her reactions or responses personally.

And ladies, talk to your guy, as well. Let him know that you realize you can get bitchy, and that you don't mean it. If he still insists on throwing out comments like "Oh, here it is again," you might want to run Moore's favorite piece of advice by him: "Men need to know that jokes about PMS can be hazardous to their health."