Excerpted from What Your Doctor May Not Tell You About PREmenopause:
Balance Your Hormones and Your Life from Thirty to Fifty, by John R. Lee,
M.D. and Virginia Hopkins, Warner Books, 1999.

A FEW FACTS ABOUT PREMENSTRUAL SYNDROME (PMS)

Premenstrual syndrome (PMS) is by far the single most common complaint of
premenopausal women. Current estimates are that severe PMS occurs in 2.5 to
5 percent of women, and mild PMS occurs in 33 percent of women. PMS was
first described in 1931 as a “state of unbearable tension,” a description
most women can understand to a certain degree. Some women have PMS from the
time they begin having menstrual cycles but for most, PMS begins in the
premenopausal years, around the mid-thirties, and becomes increasingly
severe as the years go on. Although it's possible to create a list of
dozens and dozens of PMS symptoms, the most common are bloating/water
retention and the resulting weight gain, breast tenderness and lumpiness,
headaches, cramps, fatigue, irritability, mood swings, and anxiety. In
women with severe PMS, irritability and mood swings can become outbursts of
anger and rage. By definition PMS symptoms occur in the two weeks before
menstruation and sometimes for a few days into menstruation.

No Magic Bullets but Plenty of Solutions

You should know right up front that there is no magic bullet for PMS. A
little bit of progesterone will help a lot, and in some women it solves the
problem, because it offsets the effects of environmental estrogens and
anovulatory cycles, but PMS is a multi-factorial problem that needs to be
handled on many physical levels as well as on the emotional level.

Stress is almost always involved in PMS. Stress increases cortisol levels,
which blocks progesterone from its receptors. Therefore, normal
progesterone levels do not mean that supplemental progesterone is not
needed. Extra progesterone is necessary to overcome the blockade of its
receptors by cortisol. When a woman discovers she has a handle on
controlling her PMS, it will help her manage stress better. Then lower
levels of progesterone will work normally again.

Misconceptions about PMS and Hormones

For years it was assumed that since PMS symptoms occur when progesterone
levels are normally relatively high, that it was progesterone that was
causing the symptoms. Theoretically, symptoms could relate either to
elevated progesterone levels or progesterone deficiency (estrogen
dominance). Elevated levels of progesterone are unlikely since, during
pregnancy, progesterone levels are 10 to 20 times higher than normal
mid-cycle levels and similar symptoms do not occur.

ESTROGEN DOMINANCE AND PMS

Progesterone deficiency
(estrogen dominance) is much more likely since many of the symptoms
correlate with estrogen dominance symptoms, most notably water retention,
breast swelling, headaches, mood swings, loss of libido, and poor sleep
patterns.

A woman's response to her own cyclical hormones is extremely individual,
and this is part of the reason that it has been so difficult to pin down
the causes of PMS. Estrogen levels that cause anxiety and bloating in one
woman will have virtually no effect on another. A woman who sails through
an anovulatory cycle with hardly a ripple is in complete contrast to the
woman who is plagued by migraines or anger premenstrually when she doesn't
ovulate. Birth control pills and premenopausal hormone replacement therapy
(HRT) will cause a long list of side effects (including PMS) in many women,
while others will say they feel fine. This is why it's so important that
you become familiar with your own body and your own symptoms, and don't let
anybody tell you that what you're experiencing is “just an emotional
problem,” or that an antidepressant or tranquilizer is all you need.

Copyright, Warner Books 1999. This material may not be reproduced in any
form without written permission of the authors.

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