What about PMS?

It seems that every condition known to mankind has had an acronym invented to describe it. We have “PMDD”, “ADD”, “AHDD”, etc. One of the original acronyms was “PMS”. That stands for pre menstrual syndrome or perimenstrual syndrome. The symptoms vary from a slight feeling of imbalance to overt hysteria during the two weeks just before the period. Other symptoms such as migraine headache, irritable bowel syndrome (‘IBS’), and depression may be accentuated during the pre menstrual time. Science has been trying to get to the bottom of what is causing these and other symptoms for years. I will address the various theories and possible remedies associated with these theories below:

Theory #1
The changes associated with PMS are due to a build up of small chemicals in the endometrium called prostaglandins. Endometrium is the lining of the uterus that builds up and thickens during the month and is sloughed causing the menstrual bleed. Prostaglandins are small, hormone like chemicals that are responsible for all of the symptoms that aspirin and Motrin like drugs treat. These symptoms include pain, redness, swelling, fever, and inflammation.

This theory was advanced when the observation was made that many women no longer have PMS after a hysterectomy or endometrial ablation even when the ovaries are left in tact. It is also noted that treatment of PMS is sometimes accomplished with the use of non-steroidal anti-inflammatory drugs such as Motrin, Advil, and Naproxen.

While all of these medications have side effects, their importance in treating certain mild symptoms of PMS should not be overlooked.

Theory #2
Progesterone deficiency during the pre menstrual portion of the cycle is related to PMS symptoms.

The first two weeks of the menstrual cycle (from the first day of bleeding to ovulation) is called the proliferative phase. This is a time when there is a proliferation (build up) of the lining of the uterus (endometrium) to make a comfortable setting for a fertilized egg. Estrogen levels are relatively high during this phase and progesterone levels are low to non-existent.

The second half of the cycle, after ovulation and prior to menstruation, is called the “luteal” or “secretory” phase of the cycle. During this time there is a very large build-up of progesterone to “mature” the lining of the uterus and make it a suitable place for the fertilized egg to implant. If no pregnancy occurs, the period starts and the whole process is repeated. Some women have an “inadequate luteal phase” defect, which can manifest itself in several ways. One of these manifestations is worsening of PMS symptoms. When your Doctor says you have a “hormone imbalance” this is what he/she is talking about.

For this imbalance we have noted that the cyclic administration of bioidentical, transdermal progesterone offers significant relief of symptoms.

Both of these theories probably have merit. I personally have noted significant relief from PMS symptoms with my patients that undergo outpatient endometrial ablation as well as being treated with progesterone.