Premenstrual Syndrome vs. Dysmenorrhea

If you are a woman young or old who has been of the age of menstruation, you have undoubtedly heard the term PMS.  It is a term that gets thrown around a lot, often in ways which show little understanding of what it is.  Many of us have been accused of having PMS if we are irritable, if we feel and speak passionately about something, cry for any reason, or sometimes even if we merely disagree with someone.  Some women have even been told that PMS isn't really a thing, it is just a figment of their imaginations.  This is very untrue.  PMS (Premenstrual Syndrome) is an actual phenomenon linked to our menstrual cycles.  A term that is not thrown around a lot is Dysmenorrhea.  It is so uncommon to hear about, that both the term and abbreviation for Premenstrual Syndrome (PMS) are easily accepted by auto correct, but I am told that Dysmenorrhea is not even a word.  Like Premenstrual Syndrome, Dysmenorrhea is a collection of symptoms linked to our menstrual cycles.  So today in our quest for more knowledge about the menstrual cycle, we are going to talk about those two terms, what they mean, and how to treat them.

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Premenstrual Syndrome
Let's start with the one with which we are most familiar: Premenstrual Syndrome.

What it means:  If we break down the word, we have the prefix "pre" which literally means before, "menstrual" referring to menstruation, and "syndrome" which refers to a group of symptoms that consistently occur together.  So, quite literally, Premenstrual Syndrome means a group of symptoms that consistently occur before menstruation.  That means that if you are experiencing symptoms while on your period, it is likely due to the less widely known Dysmenorrhea discussed below.  That is not to say that you do not get PMS, as it is possible to have both.

Symptoms:  The symptoms of PMS are varied and are experienced differently by everyone.  Some people may experience all of them, while someone else only experiences one or two.  For some women, the symptoms may be somewhat debilitating, while others may barely notice them.  Some of the symptoms associated with PMS include:

• Acne
• Bloating
• Insomnia
• Digestive irritability
• Breast tenderness
• Salt and sugar cravings
• Confusion
• Anxiety
• Irritability
• Depression
• Panic attacks
• Mood swings

If you think that you are experiencing any of these symptoms and believe that they are due to PMS, the best way to tell is to track your cycle and see exactly when your symptoms fall within it.  If you are interested in tracking your cycle but unsure of how to start, there are some great apps out there that can help you.  Check out Kindara, Fertility Friend, Period Tracker, Clue, or Glow to name a few.

Causes:  PMS is fairly common.  About 85% of women report experiencing symptoms of PMS.  Of those women, 20-40% report that the symptoms cause problems for them, and of those women 10-50% report significant problems.  There can be several reasons why someone would experience symptoms of PMS. 

• For many it is a hormonal imbalance which is exacerbated by exposure to environmental estrogens.  Environmental estrogens are foods or plants that mimic the effects of estrogen on our bodies.  These environmental estrogens can be found in pesticides on our produce or in our homes, cosmetic products like nail polish and many hand and face creams, certain plastic containers, and many common foods.  The two most common foods that are environmental estrogens are soy and caffeine.  If you consume a lot of soy based foods like tofu or edamame, or consume copious amounts of caffeine, this may be a cause of your PMS.  If you think you have a hormone imbalance, ask your doctor to check your hormone levels
• For others it may be nutritional deficiencies.  There is some evidence that PMS can be caused by a deficiency of things like calcium, vitamin B6, or some essential fatty acids.  If you think this may be the cause, next time you go in for your annual check up ask your doctor about it.  They can run tests to check for a nutritional deficiency. 
• Some people with PMS may have a neurotransmitter imbalance.  This is similar to a hormone imbalance.  The most common neurotransmitter to impact PMS is serotonin.  If you have a neurotransmitter imbalance, you may also be experiencing low sex drive, depression, lack of appetite, and difficulty concentrating, among other things.  If you think you have a neurotransmitter imbalance, ask your doctor to run a test to check.
• There are some other causes or triggers of PMS that we know a little less about.  There is some discussion about a genetic predisposition, meaning that it runs in families.  If your mom had bad PMS, you may be more likely to have it as well.  There are also some cultural expectations.  It may sound strange, but in some cultures or social groups, it is expected that you feel a certain way before your period.  If everyone you know talks about bloating and irritability, you may begin to feel them as well.  This is getting into an area of study that it a bit more subjective and not as well known.  Stress can also play a role in PMS.  You may have noticed that the symptoms are worse if you are more stressed out.  This is likely due to a change in your stress hormone levels which can impact physical function.

Treatment:  While many of us have been led to believe that PMS is just something that we have to put up with, there are actually several things that you can do to lessen its impact and maybe even get rid of it.  The best thing you can do is see if you can discover the cause of your PMS.  If you find that it is a hormonal or nutritional imbalance, your doctor may prescribe birth control or antidepressants, and may refer you to a nutritionist to discuss how to eliminate the deficiencies in your diet.  If you are having trouble pinpointing the cause, you can try managing the symptoms.  Some treatments for PMS symptoms include:

• Herbs can be helpful in treating a variety or symptoms and can potentially help to eliminate symptoms of PMS.  Red raspberry leaf or peppermint tea are two of the more common herbal treatments for PMS.  Other herbs include dong quai, maca, vitex, lemon balm, wild yam, St. John's wort and more.  If you are interested in learning more about or trying any of these herbs, please consult an herbalist for guidance, as self treating may lead to adverse effects.  
• Diet and exercise can help to eliminate PMS altogether for a lot of people.  Changing to a healthier, more balanced diet can help to eliminate nutritional deficiencies, and regular exercise can help to keep you healthier and in better shape which can actually help with symptoms related to hormone and neurotransmitter imbalances.  If you are unsure of how to get started, try looking for a nutritionist or personal trainer near you.
• Better quality sleep can lead to a reduction in symptoms.  The more rested you are, the more likely you are to feel good.  Getting a lack of quality sleep greatly impact your daily life, and can increase stress hormone levels.  If you have trouble sleeping, check out some of the suggestions in this post with 10 tips for better sleep.
• Massage and acupuncture can help to relieve most of the common symptoms of PMS including bloating, anxiety, depression, and irritability.  They also help to reduce stress and lead to better quality sleep, which as we know can help to lessen the effects of PMS.  Make sure to tell your massage therapist or acupuncturist what symptoms you are experiencing when you go in for your treatment.  I know that many women are still embarrassed to talk about anything surrounding their periods.  If you have trouble talking about it, try writing it in a note and slipping it to them discreetly.

If you are pregnant and feel like you are experiencing signs of PMS, please do not try any of the treatments listed above, but instead call your care provider!

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Dysmenorrhea

What it means:  Let's break this word down too.  We have the prefix "dys" which means bad or ill, "menor" which  refers to menstruation, and the suffix "rhea" which means flow or discharge.  So, the word Dysmenorrhea literally means a bad menstrual flow.

Symptoms:  Symptoms of Dysmenorrhea are much less varied than those of Premenstrual Syndrome.  The main symptom of Dysmenorrhea is pain.  It can occur before, during, or after your period.  You may have noticed that cramping was not listed as a symptom of PMS.  Although many people consider it to be one Premenstrual Syndrome's main symptoms, cramping actually falls under the umbrella of Dysmenorrhea.  Symptoms of Dysmenorrhea usually occur during the first few days of the period, but may persist through the whole phase and include:

• A dull ache or sharp pain in the abdomen, pelvis, or low back
• Headaches or migraines
• Nausea
• Vomiting
• Diarrhea
• Constipation

Causes:  The causes of Dysmenorrhea are a bit more complicated than those of PMS.  There are actually 2 types of Dysmenorrhea; primary and secondary.  Primary Dysmenorrhea generally begins right around the menarch (a girl's first period), and is a condition unto itself.  Primary Dysmenorrhea is often caused by prostaglandins (fatty acid compounds that can intensify uterine contractions) or ligament irritation.  There is also some evidence that there may be a genetic component just as with Premenstrual Syndrome.  Secondary Dysmenorrhea is when you have any of the symptoms above with your period, but they are caused by another condition such as Endometriosis, fibroid tumors, ovarian cysts, Pelvic Inflammatory Disease (PID), an STD, or scar tissue from a previous injury or surgery.  In order to tell if it is primary or secondary, your doctor may run tests such as ultrasound, cultures for infection, or laparoscopic surgery.

Treatments:  Treatments for Dysmenorrhea are similar to those of PMS.  If your doctor can determine an underlying cause, they may prescribe birth control, antibiotics, or surgery to deal with them.  If your doctor is unable to find a cause, you can use some of the following treatments for the symptoms.

• Essential oils are extremely helpful for dealing with symptoms of Dysmenorrhea.  Try clary sage, frankincense, geranium, lavender, peppermint, or cypress.  A couple of drops mixed with a small amount of carrier oil such as coconut, almond, or grapeseed oil can help to treat cramping, headaches, or nausea.
• Herbs can be helpful for eliminating symptoms of Dysmenorrhea as well as PMS.  Try peppermint tea for nausea, vomiting, or headaches, or red raspberry leaf for cramping.  Other herbs like the ones suggested for PMS can be helpful, but again, it is best to seek the guidance of an herbalist before self medicating to avoid any adverse effects.
• Heat can help to eliminate pain from a backache or cramping.  Try using a hot pack where you are experiencing the pain, but make sure to place a cloth barrier between the hot pack and your skin to avoid risk of burning.  You can also try a hot bath with some Epsom salts, and perhaps some of the herbs or essential oils listed above.  If you are experiencing a migraine, try cold therapy instead of hot therapy, or consult my migraine survival kit for more suggestions.
• Massage and acupuncture can be helpful throughout your cycle and can help to eliminate pain from cramping, backache, headaches and migraines, and constipation.  If you are experiencing nausea, vomiting, or diarrhea, it is best to avoid these treatments until those symptoms have subsided.
• Over the counter pain medications like aspirin, acetaminophen, and ibuprofen can be very helpful in eliminating or decreasing the pain associated with Dysmenorrhea.  Please exercise caution when using any drugs, as taking more than the recommended amount can lead to damage of the stomach and/or liver.  If you have any condition for which you are on any other medication, please consult your doctor before use.

If you are pregnant and feel like you are experiencing signs of Dysmenorrhea, please do not try any of the treatments listed above, but instead call your care provider!

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Do you experience Premenstrual Syndrome or Dysmenorrhea?  How do you cope with the symptoms?