If ladies think back on the moment they got their first period, we were either overcome with shock ("what is happening to me?!") or elation about becoming a woman (which we now regret because parts of it, frankly, are overrated).
What we all soon found out, however, is that periods are mean. They hurt, they make you wear frumpy clothing and they can turn you into a whole different person. Moody, irritable, depressed, anxious, bloated, headachey.
That's right, we're talking about PMS.
Around 90 percent of women experience PMS of some kind every period. It's something that can both bond us women together, or separate us from each other and everyone else around us. This is often the case when it comes to our male significant others.
Our complete change in mood can catch us, and even the most understanding of men, off guard, which is why it's so important for both women and men to understand the most we can about PMS -- because no two women experience PMS the same.
What is PMS?
"Premenstrual syndrome is an array of symptoms, both physical and psychological, that occur 1-2 weeks before the menstrual period -- by definition six days before the period is the gold standard, which normally ceases when your period starts, or within the first five days after," Dr Clare Ballingall, a GP and chair of RACGP Tasmania, told The Huffington Post Australia.
"It's related to hormone changes because it goes away with menopause and pregnancy, but we don't know which hormones are involved," Ballingall said. "We think it's the sex hormones, but there's no real test for it."
Regardless of the exact cause, PMS affects women to varying degrees in every way imaginable.
"There's something like 200 symptoms of PMS, which seems remarkable, but most women would know the common ones," Ballingall said.
"The emotional symptoms are things like irritability, mood swings, poor sleep and loss of libido. We can all get a bit shouty and experience food cravings, as well."
"There are less physical symptoms, but I think the physical symptoms are very real -- the sore boobs, acne outbreaks, bloating and, for some women, migraines and headaches get worse."
Symptoms of PMS
PMS differs from one woman to the next. The wide range of PMS symptoms can include:
- Abdominal bloating, fluid retention
- Anxiety, confusion
- Depression and lowered mood, which may include suicidal thoughts
- Difficulties in concentration, memory lapses
- Digestive upsets, including constipation and diarrhoea
- Drop in self-esteem and confidence
- Drop in sexual desire, or (occasionally) an increase
- Feelings of loneliness and paranoia
- Food cravings
- Headache and migraine
- Hot flushes or sweats
- Increased appetite
- Increased sensitivity to sounds, light and touch
- Irritability, including angry outbursts
- Mood swings, weepiness
- Sleep changes, including insomnia or excessive sleepiness
- Swollen and tender breasts.
"It's not caused by other medical problems, but other medical problems can be made worse during the premenstrual syndrome time," Ballingall said. "We know that migraines can get worse premenstrually, as well as depression. Pain from endometriosis can get worse, too. It is a diagnosis to be taken seriously."
On top of all the awful symptoms most women experience during PMS, Ballingall explained that there is a small percentage of women who experience psychological changes so severe in the days leading up to their period, they cannot get on with their daily lives.
What is PMDD?
"There's also a smaller number of women who have got premenstrual dysphoric disorder, which affects 3-8 percent of the population," Ballingall said.
"That is the far end of the scale, and is mainly those with more psychiatric syndromes. Premenstrual dysphoric disorder is where it interferes with daily life, to the point where it's interrupting employment, relationships and probably needs more specialised, complex care."
"PMDD symptoms are less of the sore boobs and acneic skin, more of the irritability, depression and mood swings. It's actually recognised in DSM-5, which is classified as a psychiatric disorder."
Basically, don't pass off the way you feel before your period as trivial, inconsequential or automatically 'normal'.
"We do overlook PMS. It is complex, it's not an easy diagnosis to make," Ballingall said. "You look at yourself when you're cranky and think 'is it that time of the month?' and a few of us put it down to that."
But if your PMS is affecting your day-to-day life, it's important to seek medical help. Just because we're menstruating women does not mean we have to suffer.
"People think 'oh it's just women's problems' but I don't think it is. Part of that is women who get PMS do have a higher incidence of things like a past or family history of depression, postnatal depression and anxiety."
When should women seek help?
Feeling depressed, anxious and sick every month doesn't have to be synonymous with having periods.
"Firstly, ask yourself if you feel dreadful. Women are hard on ourselves and when you realise that you're getting down and feeling terrible, that's an important point to see a doctor," Ballingall said.
It's also worth asking the people around you if they notice a drastic change in your mood or character.
"If you work with women, it may be worth asking your colleagues (and your loved ones, your boyfriend or partner) 'do you think I get cranky?' or 'are we always fighting at this time of month?'," Ballingall said.
"It's worth asking people around you, rather than keeping it as an internal monologue. We should be asking each other and talking about it."
We have periods, pap smears, mammograms, babies, gender bias -- let's help ourselves. Really.
Keeping a diary can also help you notice whether (and when) PMS affects your everyday life.
"We diagnose it when these symptoms interfere with normal life," Ballingall said. "To make the diagnosis, what we really need is for women to keep a symptoms diary for at least two cycles. Everybody, women and men, all get cranky at times so it's important to keep a diary.
"In this day and age, there are apps women can use which can be a useful place to keep that diary."
So, who exactly should we see to get help?
"We always say GP first. Your GP does manage most premenstrual disorders. Only the really difficult and complex cases get referred on," Ballingall said. "Family Planning is very good, as well. Each state has a Family Planning organisation.
"For those who see a GP to get treatment which doesn't help, we then refer to psychology and sometimes dietitians to help. Cognitive behavioural therapy can be super helpful with PMS. There's good evidence behind that, as well.
"For the very complex, we refer to gynaecologist. Ideally it's done with a multidisciplinary approach."
What are the treatments for severe PMS or PMDD?
If PMS brings about a significant, negative change every cycle, there are various effective treatments you can try -- both lifestyle and medical.
"There's lot of treatments available, that's important for women to know," Ballingall told HuffPost Australia.
"The first line treatment is lifestyle. Reduce your caffeine and salt in the premenstrual periods, and also increase exercise. Exercise is great for pain relief and stress because it releases all those endorphins. Good, vigorous aerobic exercise couldn't be more helpful.
"We know that, as with everything, eating healthily will be good. There's no hard evidence, but it's all about self-care."
Other self-care exercises like getting early nights, good sleep and meditating can also help.
"Simple non-steroidal pain relief for period and PMS relief helps, such as ibuprofen," Ballingall said.
"If that's not helping, the next step with the best evidence is hormonal treatment. The first line for a lot of women is the combined oral contraceptive pill. There's good evidence that the newer pills containing drospirenone, a new estrogen, can help with PMS -- taken preferably continually, so leaving out the sugar pills, can be effective.
"There's a proviso there that unfortunately some women can't take the pill if they experience things like migraines. For some women, unfortunately the pill can make PMS worse. You have to give it a good trial for up to six months, and also keep using your diary for symptoms."
Another hormone treatment that can be effective for reducing PMS is transdermal contraception, so either a patch or rubbing on oestrogen.
"When you do that, you have to use a bit of progesterone as well. One of the recommended ways to do that is to use something like the Mirena coil, which releases a small amount of progesterone. But, again, that's not great for everybody as it can make things like migraines worse. But it's worth trying."
An alternative line of treatment -- which should only be used under strict medical care -- are cyclic antidepressants.
"There's still a lot of taboo about starting these therapies, obviously. But the good news for people who want to try them is they are very effective, you only need small dose and you can use them in a cyclical basis," Ballingall explained.
Anecdotal evidence suggests that holistic treatments can also be beneficial, Ballingall said.
"There's some soft evidence for (not alternative but) complementary medicines and vitamins. Vitamin B6, magnesium, calcium and vitamin D can be helpful, but there's not a lot of evidence behind them. Evening primrose oil for sore boobs may help.
"For some women, going for the more holistic approach -- massage and acupuncture -- can be helpful."
When these treatments still don't work, you may consider seeing a gynaecologist.
"If none of these things work, it's then the role of the gynaecologist," Ballingall said. "There are some extreme treatments, things like hysterectomy, but really they are for the absolute desperate cases. What they do for those where a hysterectomy is a last resort is using hormones to bring about a false menopause. That can be done under specialist care."
Can certain factors make PMS worse?
There are lifestyle and dietary factors which seem to worsen PMS symptoms.
"There are things we know that make PMS worse. A high salt diet, caffeine and stress will make it worse. Other times, when you're having deadlines or your life is stressful, that can make it worse."
Tips for you and your loved ones
The best thing women and their families, partners and friends can do is understand the most they can about PMS. Share stories like this, head to your GP for a chat, or simply talk to your friends.
"Get informed -- there's lots of good information on the internet in Australia. The Jean Hailes Foundation and the Women's Hospitals have all got great information. All the Family Planning organisations will have information. Always see your GP first and foremost.
"It's part of the conversation people with PMS need to have with their partners. Show them the information and the website, and tell them 'be prepared on this day, I may be a bit cranky, but I'm doing something about it'. There has to be some understanding."
And to the men reading, please, please avoid saying this sentence.
"Avoid saying 'it's just that time of the month' because that's really insulting. It's real, it's happening," Ballingall said.
"The bottom line is be kind to yourself. We have periods, pap smears, mammograms, babies, gender bias -- let's help ourselves. Really."
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