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PMS

Premenstrual Tension is experienced by as many as 90 percent of women, while 20 to 30 percent experience more severe symptoms called premenstrual syndrome (PMS). This is not the same problem as menstrual cramps, which are associated with the monthly shedding ofthe uterus. Rather, premenstrual discomforts specifically occur between ovulation and menstruation. They may occur for a day or two prior totend over the entire two-week period following ovulation.

A specific cause for PMS has not been identified, but the effects are all too familiar for many women, including adolescents. Physical symptoms can include bloating and fullness in the abdomen, fluid retention (with tightness of rings and shoes), headaches, breast tenderness, backache, fatigue, and dizziness. More dramatic are the emotional symptoms: irritability, anxiety, depression. poor concentration, insomnia, difficulty making decisions, and unusualThese can occur in various combinations and levels of severity. The most striking feature is usually the instability and intensity of negative emotions, which can send other family members running for cover. Some teenagers and oic_:t Dr. Jekyll and Ms. Hyde—calm and rational for the first two weeks of theout of control for the second two weeks, with dramatic improvementmenstrual flow is under way.

A few decades ago PMS was considered primarily a psychological event, an reaction" to reproductive issues or life in general. This is no longer PMS should he taken as seriously as any other physical issue. While no quick-fix remedies or lifetime cures exist for PMS, a number of measures can help your adolescent (and others at home) reduce its impact:

•Make sure the emotional and physical symptoms are, in fact, PMS.Adolescent emotions are often intense and variable, and other life issuesinvolving school, friends, etc.) may be at the heart of the problem. If:here is any question, symptoms can be charted on a calendar, along withmenstrual periods, for two or three months. You should see an improve-ment for at least a week following menses. Symptoms that continue well after a period is over or throughout the cycle involve something otherthan (or in addition to) PMS.

•Keep the lines of communication open and plan ahead. A teenager whosecycle is well established will be able to predict when the more trouble-some days are coming. This may give others at home a little advance"storm warning," and they will be able to respond with an extra measureof TLC or at least a little slack. This is particularly important if morethan one person at home has difficulty with PMS, since the collisionof two unstable moods can be quite unpleasant. If your daughter iscurrently irritable because of the time of the month and a change for the better is likely in the immediate future, you would be wise to postponeany conversations about emotionally charged issues for a few days ifpossible. It is important to acknowledge the reality of PMS symptoms without allowing them to become a blanket excuse for blatant disrespect,acting out, or abandonment of all responsibilities.

•Encourage sensible eating and exercise. Frequent, smaller meals and avoid-ance of overtly sugary foods may help keep blood glucose levels (andmood) a little more stable. Avoiding salt can reduce fluid retention.Caffeine may increase irritability, so decaffeinated drinks (and medica-tions) are more appropriate. All-around physical conditioning throughthe entire month can improve general well-being and help her navigatemore smoothly to the end of a cycle

In addition, a variety of remedies, nutritional supplements, have been recommended at one time or another for this problem. Some have more consistent track record (and better scientific support) that your adolescent should consider getting advice from her physician any of these. Ultimately the bottom line for any PMS treatment. est assessment of the effectiveness, safety, and side effects for the individual taking it.

• Nonprescription medications such as acetaminophen orreduce aches and pains may be of some help.

• Dietary supplements, especially vitamin B6, magnesium, and calcium have been suggested, although results in patients have been mixed. Megadoses of any vitamin or mineral that exceed RDAs (recommended daily allowances) are not recommended for this condition.

• Prescription medications that are most widely used for PMSbasic categories. Obviously, the use of any of these will require evaluation and follow-up by a physician.

(a) Diuretics. For many women, much of the discomfort :-arises from bloating and fluid retention, so the use of a mild diuretic (or "water pill") to maintain normal fluid levels during the second half of each cycle can be effective.

(h) Antidepressants. Many PMS symptoms essentially duplicate those seen in depression, and some women with severe PMS figh:forms of the same emotional symptoms through the entire month. It is possible that the fundamental physiological problem involves changes in the levels of biological messengers in the brain kr.neurotransmitters. New research has shown significant reduction in PMS symptoms with this type of medication, although in order to be effective, daily dosing for an indefinite period of time is necessary. These drugs are safe and not habit-forming, but individual respon.effects vary considerably.

(c) Hormonal manipulations have been utilized with varia.s.although they are not commonly prescribed for adolescents -Women who take supplemental progesterone during the se: --the menstrual cycle may report marked improvement, asymptoms (especially depression), or no effect at all. Hormo:-._tions should be utilized in adolescents only after thoughtful coLion of the pros and cons by patient, parent, and physician