by Marcelle Pick, OB/GYN NP
Advanced Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) Treatment
There are certain times in life that we experience strong emotions that move us, and alter our mood for a period of time. For example, watching a movie where a mother reunites with her long lost child can bring up strong maternal instincts and we often find ourselves hiding our sniffles, bawling our eyes out or hugging our own children or younger siblings tightly. Some women go through similar types of emotional and physical stress hindering their ability to lead a normal life before their menstrual cycle each month. Their PMS (premenstrual syndrome) is so terrible that they are in need of medical help. Health clinics offer specialized treatments for women who suffer from severe PMS and PMDD (premenstrual dysphoric disorder) to help accommodate their specific lifestyle and nutritional habits.
If you have the misfortune of being diagnosed with severe premenstrual syndrome or premenstrual dyphoric disorder, you might benefit from some of the advanced treatments listed below. These treatments are meant to be temporary, a person may go through a treatment anywhere from five months to a few years. The idea is to ease the transition of the body to its natural state to begin a more normal function. When the body starts to adapt to the natural state of menstruation, it balances a woman’s physical and emotional stresses, these encourage the patient to ease out of treatment. It is important to consult with a qualified healthcare practitioner before you indulge yourself in any of these advanced treatments.
Prescription-dose bioidentical progesterone for PMS and PMDD. Being a woman who suffers from abnormal premenstrual syndrome, it is a good idea for you to have your baseline progesterone levels tested. This can help determine whether the prescription progesterone intake is a good alternative to birth control and antidepressant pills.
Testing your progesterone levels may even reveal whether one suffers from overt luteal phase progesterone deficiency. If you do have a progesterone deficiency, supplemental progesterone can perform miracles for you. It can help rid woman suffering from PMS associated issues such as irregular periods or heavy bleeding. It is important to consult with a well educated and trusted practitioner as determining what can be considered low level of progesterone in a woman is often difficult. The range of what is considered “normal” is so wide that a woman might be mis-diagnosed by an inexperienced practitioner. Some women may experience chronic progesterone deficiency and instead of a temporary treatment, they might need it until they reach their menopause.
The treatment of choice for some women has been the use of birth control pills. However, a reasonable alternative would be a prescription progesterone or compounded progesterone formula. Branded formulas such as Prometrium or compounded USP (bioidentical) progesterone can be found at speciality pharmacies. Prometrium treatment for PMS is considered “off-label”, therefore it may be helpful to let your health care provider know. Bioidentical progesterone can be taken orally or in a cream form, but this technique requires a woman to get her progesterone levels checked every three to six months. This is done to ensure that progesterone is not being converted into estrogen, which can happen for some women.
Women at our clinic are often put on a regime of progesterone supplementation days 10-14 of their cycle until menses. Many times we will use 100mg of progesterone and have it taken up to three times per day. After seeing the response from women, the dosage is adjusted accordingly. For many women the response is so amazing that they finally feel relief from symptoms they have had for years and were not able to get them under control.
Natural neurotransmitter testing and support. Women who fail to make any obvious progress despite boosting their nutritional support, improving their exercise habits, altering their diet and implementing bioindentical progesterone are considered for a more focused treatment. Taking part in a more natural neurotransmitter support plan may be the next best step for you.
Some of the ways in which neurotransmitter functions are targeted are as follows:
- Additional omega–3 fatty acids in the form of EPA/DHA, boosting to 2–3 grams per day total.
- 5–HTP, 50–100 mg, generally taken in the evening. More may be needed during the PMS time-frame (up to 800mg), but dosage and timing depends on your body’s individual make-up.
- Vitamin D (25-OH vitamin D) blood testing and supplemental treatment to achieve optimal blood levels (50–60 ng/mL).
- A trial of St. John’s wort, dosage and formulation varying with the individual, and not to be taken in conjunction with prescription antidepressants.
- Neurotransmitter testing. Evaluating levels of serotonin, dopamine, norepinephrine and GABA levels, as well as others, to gain an overall sense of what levels are.
- Neurologic support with Neuroscience and Metagenics amino acid and herbal combination formulas.
Antidepressants for PMS and PMDD — serotonin stop-gaps. If a woman is unable to get out of her bed due to extreme discomfort and becomes unsafe for others or oneself when suffering from premenstrual symptoms, antidepressants are utilized for treatment as the last resort.
This is often times necessary and can be very effective. Medications such as Sarafem, Zoloft, Lexapro, Effexor, and Wellbutrin are prescribed to patients once a thorough investigation of the individual’s health is determined. You need time and a safe place to tell your story and discuss the issues. It will help your healthcare provider to gain an accurate picture of your mental and physical health. This process can also help you heal and is essential to develop the best plan moving forward. Many conventional practitioners find it hard to determine whether a person suffers from dysthymia (a milder form of chronic depression) or another depressive disorder. In a situation where a woman requires emergency assistance, and needs the antidepressant medications, I generally acquiesce, as long as she promises to be closely monitored and guided by a practitioner skilled in advanced implementation of these medications. The antidepressants do not always have to carry a negative connotation. Often times, these serve as a bridge over troubled waters for women who make use of them, encouraging her to make healthier and conscious nutritional and lifestyle choices. Natural restoration of the neurotransmitters should always be on top of our goal list, and at Women to Women we can help get you to that stage.
Antidepressant and birth control pills seem to be the most used or also synthetic designer drugs to subdue the PMS or PMDD symptoms. What women do not realize is that these drugs temporarily block the pain and discomfort and does not heal the body physiologically, it just blocks the symptoms. Long-term use of such medication often makes the situation worse. Another important key point to remember is that all women are different, and they have different stressors that induce PMS. To treat everyone with the same remedy is not the solution as we are all different and may all need different interventions.
So instead of using drugs to avoid discomfort temporarily, it is better to start with understanding the causes of PMS and PMDD. At Women to Women we strongly emphasize and encourage the implementation of first line therapies that help the body naturally restore hormonal and neurotransmitter balance. Remember neurotransmitters are a byproduct of amino acids, which can be found readily in our food. Altering your diet to include sources that would help balance the body and regain its control by natural means is a better alternative to medication when possible.
NOTE OF CAUTION: If you are on prescription antidepressants or mood stabilizing medications, consult your prescribing doctor before making any changes in your medications. These medications cause a change in your body chemistry, and some individuals experience severe symptoms, including anxiety, chest pain, and headaches, if these medications are abruptly stopped. Nevertheless, you can always consider adding fundamental nutritional and lifestyle support measures to enhance your progress.
How birth control pills obviate your PMS
As women we should always try to make better lifestyle choices and focus on treatments that encourage natural alterations. But in time of need, many women opt for the birth control pill. It helps them to avoid pregnancy but most of all it helps some of them get rid of the PMS. The synthetic hormones in the pill can stop a woman’s body from ovulating. It can lead to a women feeling worse in some cases. But for some it does tone down the symptoms of hormonal crisis prior to their menses.. Current popular choices of contraception includes the third-generation lower-estrogen pills such as Ortho Tri-Cyclen, Ortho Try-Cyclen Lo, Mircette and their various generic forms, as well as the NuvaRing vaginal delivery method. The new Yasmin pill and lower dose Yaz have been shown in studies to have a significant impact on mood and physical symptoms, leading to their heavy marketing toward PMS and PMDD sufferers.
Changing the pattern of birth control pill usage is coming into increased favor now too, either by shortening the pill-free (placebo) interval at the end of each pack cycle, or by extending the length of cycles so that the women on them bleed every 6–12 weeks rather than every four. Pill choices for manipulating cycles in this way are monophasic, meaning that each pill in the pack contains the same dose of synthetic hormones, rather than being varied over the cycle. So using Ortho Cyclen, for example, would be better than trying it with Ortho Tri-Cyclen. One formulation that has been packaged and formally approved for such use is called Seasonale (or the newer Seasonique). There are many others that can be used in this fashion under the guidance of a healthcare practitioner, as long as they are monophasic and you are given enough extra packs to get you through the extended cycles.
Again, while birth control pills are popular as a form of contraception, we see there use for treating a range of women’s health issues, such as irregular cycles, acne, and symptoms of PMS, as palliative only — this means they relieve the symptoms temporarily but do not cure the core imbalances. The benefit of many of these medications is temporary and may require more interventions to have resolution of the symptoms.
What does “PMS” mean for you?
I hope that by understanding what PMS is for you, it will allow you to take the steps you need to transform “the curse” into an opportunity for you to see things differently and transform that time in your life to an experience you enjoy and do not dread. We hope that this article helped you have a better understanding of what severe PMS means for you and whether this information can help you or someone you know. It is important to get an evaluation of your health, so it will be easier for you to transform this discomfort “curse” into a blessing being healthy. And we’re here to help each step of the way.