Treatments, lifestyle changes can make the monthly symptoms more bearable, experts say

Many women find the week or two leading up to their monthly period marred by unpleasant physical and emotional symptoms, which may include bloating, breast tenderness, fatigue and irritability.

While these symptoms usually disappear after the period starts, premenstrual syndrome (PMS) can be a monthly nuisance for many women, interfering with daily activities.

PMS symptoms tend to get trivialized, but they're no laughing matter. The American College of Obstetricians and Gynecologists reports that up to 40 percent of menstruating women experience some symptoms of PMS.

An estimated 5 percent to 10 percent of these women have a severe form of PMS called premenstrual dysphoric disorder (PMDD), characterized by depression, anxiety, tension and persistent anger or irritability.

With better treatments to ease or eliminate symptoms of PMS and PMDD, women needn't suffer in silence. Yet many still do.

Women have a grin-and bear-it mentality instilled by their own mothers who told them to just get through it, explained Ellen W. Freeman, a research professor in the Department of Obstetrics and Gynecology at the University of Pennsylvania School of Medicine in Philadelphia.

In some cases, she continued, women simply fail to take the time they need to seek out appropriate remedies: "They don't take care of themselves; they take care of everybody else."

While the causes of PMS are not clear, it appears some women may be more sensitive than others to fluctuating hormone levels.

Freeman led a recent study that may help confirm the hormone connection. In the May issue of Obstetrics & Gynecology, her research team found that PMS sufferers are at greater risk of experiencing common menopausal symptoms, such as hot flashes, depression, poor sleep and decreased libido.

"One of the theories is that PMS women are sensitive to hormonal changes -- their hormones are not abnormal, but they are sensitive to the changes in hormone," she said.

Similarly, studies suggest PMDD sufferers may be more susceptible to swings in estrogen and progesterone, negatively affecting brain function and triggering symptoms of depression.

But unlike a typical case of PMS, PMDD symptoms are so severe they lead to problems with relationships, work and social activities. According to the American Psychiatric Association, a woman must exhibit at least five symptoms nearly every month to be diagnosed with PMDD.

Experts say the newest class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs), works well to treat the mood symptoms of PMDD. This class includes medications such as Prozac and Zoloft, among others.

"They eliminate symptoms, at least during the period of treatment," said Dr. Kimberly A. Yonkers, an associate professor of psychiatry at Yale University School of Medicine.

But if women stop the medication, their symptoms very often return, Freeman cautioned. "It does appear to be a chronic disorder that doesn't go away if you have it," she said.

At this point, there aren't many non-pharmaceutical treatments for PMDD, Yonkers noted. Diet and exercise are not nearly as effective as the SSRIs, and psychotherapy is very understudied, she said.

To relieve the physical symptoms of PMS, the National Women's Health Information Center says regular exercise, a healthy diet and medications such as over-the-counter PMS formulations or ibuprofen may help. It's also recommended that women avoid salt, sugary foods, caffeine and alcohol when they are having PMS.

For severe symptoms, your doctor may prescribe diuretics to ease bloating or birth control pills to stop ovulation.

There haven't been many studies to evaluate the role of vitamins and minerals in easing PMS symptoms, according to the American Academy of Family Physicians.

The one nutritional supplement that doctors don't hesitate to recommend is calcium, which is critical for bone health and often lacking in women's diets. A 1998 study found taking 1,200-milligram calcium supplements each day significantly reduced PMS symptoms.

If you've tried over-the-counter medications, supplements and lifestyle changes and still aren't getting relief, don't be discouraged. Women respond differently to different remedies, and your doctor may help you find the right combination of treatments.