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., Jesse Hanley, M.D. and Virginia Hopkins, Warner Books, 1999
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.
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.
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. 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.