A woman’s cycle consists of natural and necessary fluctuations in estrogen and progesterone, two hormones released by the ovaries. To some extent the length of the cycle varies month to month and is dependent on environmental factors such as diet, exercise, stress, pregnancy, medications, and hormone therapies. The intent of the cycle is to prepare the uterus for pregnancy, release an egg (ovulation), and to start over if no fertilization occurs.
Explanations of Period Discomfort
Alterations in the concentration of hormones can result in water retention. This causes bloating and can increase blood pressure, one potential cause of headaches. Cramping is caused by contraction of the uterine muscles at the beginning of the cycle to cleanse the uterus of accumulated blood cells. Cramping may also be felt during ovulation, when the ovaries release an egg into the fallopian tubes. Alterations in the level of estrogen also results in sleeping difficulties and mood swings. In some women, or some months in the same woman, the drop in estrogen may occur more rapidly and have more severe or noticeable effects.
Premenstrual Syndrome
Many of the common experiences of discomfort have been assembled into a syndrome of symptoms called premenstrual syndrome (PMS). The phrase PMS was coined in the 1960s to shed light on the authentic discomfort women complained about to their doctors, but were told there was nothing wrong. Diuretics to alleviate bloating and pain killers to reduce the intensity of cramping are common solutions to what a woman has to deal with on a monthly basis. However, for some women there are more severe mental consequences to their hormone swings.
Premenstrual Dysphoric Disorder
In 1985, a group of psychiatrists tried to create an accepted definition of what is now called premenstrual dysphoric disorder (PMDD). The attempt was based on an observation that some women suffered intense emotional and personality swings at the end of their cycle around the time of PMS. Though it was given a place in literature in 1991, there is still much debate about the existence of this disorder. PMDD is currently only a footnote in psychiatric guidelines in the United States and was ruled nonexistent by the European drug regulating group.
If PMDD does exist as a new disorder, it is estimated to affect up to only 7% of women. It is a mental illness consisting mainly of depression symptoms. In 1998, the FDA approved the use of Lilly’s Prozac, called fluoxetine, to treat PMDD. Lilly renamed the pill Serafem and made it lavender in color, probably so women would not feel they were being given Prozac, a drug with societal connotations. Currently Pfizer’s Zoloft and GlaxoSmithKlines’s Paxil are also approved to treat PMDD.
The Problem With Marketing PMS Medications
Calling the discomfort a syndrome, and recognizing the mental anguish a small number of women suffer, has allowed women access to drugs that help ease the pain accompanying their cycle. The problem lies in the extent of the marketing done to encourage prescriptions for PMDD medication. The first ad campaign by Lilly in 1998 resulted in a warning letter from the FDA, addressing the broad nature of the ads. Normal and healthy occurrences of discomfort may be over-diagnosed as a severe mental disorder.
There are also potential side effects with the antidepressants that are given for PMDD. Paxil has severe withdrawal concerns and all three approved for treatment have negative sexual side effects. These drugs should be reserved for women with the mental disorder, not dispensed as a cure all for mood swings. It is believed by experts in the field of psychiatry that many of the women suffering from extensive mental anguish are suffering from stress or relationship and environmental issues as opposed to a health issue that can be solved with a pill.
How To Deal With Severe PMS
For women suffering from the natural side effects of their cycle, there are options. Over-the-counter medications are sold specifically for women, consisting of diuretics and pain reliever in one pill. A caution though is that some contain caffeine, which has been shown to help pain relievers work, so caffeine intake should be decreased when using the medication. Basic pain relief medications such as acetaminophen and ibuprofen are also options, but do not take both a women’s over-the-counter and another pain reliever.
Eating healthy, including foods containing iron, may help reduce headaches and fatigue. Exercise during all times of the cycle is beneficial. Reducing salt and caffeine intake will reduce water retention. Acne can be stunted by washing with mild soap and warm water or using topical over-the-counter medications. As with anything else be sure to read the label for directions and warnings.
If mood swings, depression, or pain interfere with daily life it is important to seek a doctor’s advice. A physician can determine if there is a health problem. A psychiatrist can determine if there is a mental problem. Both doctors would be beneficial to determining if a woman suffers from a more severe disorder than the normal PMS.
Reference
Ray Moynihan and Alan Cassels Selling Sickness: How the world's biggest pharmaceutical companies are turning us all into patients Nation Books 2005.
