PMS Definition: PMS is a collection of symptoms that typically begin before your period and cease by the end of flow. These symptoms are felt to be the result of complex interactions of hormones, fluids and essential nutrients. The symptoms cause discomfort that has a wide range from mild to severe.
Primary Symptoms: There are over 50, generally grouped in categories:
- Anxiety (irritability, mood swings, nervous tension)
- Fluid retention (sore breasts, abdominal bloating, swollen extremities, weight gain, constipation)
- Mental (poor sleep, crying, forgetfulness, confusion, depressed feelings),
- Skin changes (acne, oily skin, hives)
- Pain (menstrual cramps, backache, leg pain, diarrhea)
- And others
Misconceptions / Controversy: The biggest misconceptions I see are two-fold. First, women feel as though there is something wrong with themselves, and second, that PMS must always be treated with drugs.
My Take: First, it is normal and you are not crazy. Learn that YOU are more than your FEELINGS. That being said, there are simple remedies that can help you care for yourself:
- Regular exercise
- Healthy diet
- Calcium, magnesium and vitamin supplements
- Avoid processed and refined foods
- TLC given to you by you
Some women are challenged with awful cramps or other PMS symptoms that interfere with their ability to function in their usual daily activities. These women should seek professional advice and may need medications.
Use your menstrual cycle as a time to get to know who you are and what you’re feeling. Reach out to your trusted relationships to talk over what is going on and read, read, read!
Experiment and keep a diary of what helps and does not help. These diaries provide insight and are of great value.
Favorite Links: Put “PMS” in the search bar of any of these valuable sites to learn more
www.womenshealth.gov great site with a printable symptom tracker
www.medlineplus.gov great for all health topics from acne to stress
www.mayoclinic.com well-respected national medical clinic with information
PERIMENOPAUSE: Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen. During this transition time, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes they can even be higher than during the reproductive years. Irregular menstrual periods, hot flashes, sleep disturbances, and mood swings are common, normal signs of perimenopause. Some women experience low libido (sex drive) and/or vaginal dryness. During perimenopause, a woman may be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause is reached.
MENOPAUSE: No spontaneous period for 12 months. Menopause is a normal, natural event—defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes). (Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. It marks the permanent end of fertility.) Menopause occurs, on average, at age 51.
Primary Symptoms: see above
Misconceptions / Controversy: The biggest misconception is around the word bio-identical. It can have multiple meanings.
- Bio-identical can refer to hormones in the same chemical form found in our bodies
- Bio-identical can also refer to hormones prepared by a compounding pharmacy or pharmaceutical company
It became popular as an alternative to what the pharmaceutical companies had to offer women during perimenopause/menopause. Most relate it to a popular book written by actress Suzanne Sommers.
Years ago we had not isolated how to make hormones and so we used other available synthetic and animal sources. Since then, we have developed ways to produce the type of estrogen and progesterone that we women naturally make in our bodies. It was only in 1998 that we had available progesterone in this form.
The confusion is do you mean hormones like women make and/or compounded hormones? Presently, bio-identical is seen as any estrogen or progesterone in the form women produce, whether it is made by a compounding pharmacy or a pharmaceutical company.
Each form of preparation has its advantages and disadvantages with respect to potency, steady hormone levels, dosing, FDA approval and coverage by health plans. Your care will be individualized to fit you and keep you as safe as possible.
Every woman is unique. Not all women need hormone therapy and some should avoid its use.
Some women who have hot-flashes and night sweats that affect their quality of life find enormous help from low-dose hormone therapy. In addition, there are other non-hormonal (herbal) options available. My goal is to wisely individualize, using as little for as short a time as is needed.
www.menopause.org – International scientific organization dedicated to women and menopause
www.womenshealth.gov – Great information
www.medlineplus.gov – Much like the above sites but includes children and men
www.acog.org – National organization of Obstetricians and Gynecologists
www.power-surge.com – This is a grassroots site that I like, not all science
OSTEOPOROSIS Definition: Osteoporosis is a thinning of the bones that causes them to break more easily. It is the result of both loss of calcium and loss of the inner structure of the bone.
Misconceptions / Controversy: A common misconception is that we only need to be concerned with osteoporosis after menopause.
My Take: There are steps we can take at every age to maximize bone strength. These include:
- Adequate intake of calcium, magnesium and vitamin D
- Eat a healthy diet in real foods
- Healthy lifestyle choices
www.nof.org – National site not just for women but teens and men too
www.therapilates.com – Located in Santa Cruz, see ‘Do IT Right’ brochure
www.americanbonehealth.com – Based out of Oakland CA
www.nof.org/print/234 – Exercise Examples from Osteoporosis Foundation
Calcium Assessment Tool – see page 6
BREAST CARE Definition: Breast care involves being aware of your breasts (and whole body) and having a trusted health care person to guide you with concerns or symptoms.
Primary Symptoms: Symptoms to seek an exam and advice regarding are
- Breast discharge – clear, green or bloody
- Discomfort or pain NOT relieved by a menstrual cycle
- Any injury should be watched for complete resolution
- Family history of a gene mutation such as BRCA 1 or 2, or breast cancer in a first degree relative before age 40
Misconceptions / Controversy: The present controversies about breast care include
- Value of Breast Self Examination (BSE)
- When to begin mammograms
- Frequency of mammograms
- Use of ultrasound
- Use of MRI
My Take: Breast awareness just makes common sense. I will continue to recommend regular Breast Self Examination and yearly mammograms after age 40, or as specific risks or history dictate.
Breast awareness and self exam:
ANNUAL/PERIODIC EXAM Definition: A visit with a medical professional to review and assess health risks.
This is what we will do:
- A detailed history with a review of present symptoms
- A review of lifestyle and relationship status
- Physical exam of skin, blood pressure, height, weight, thyroid, heart, lungs, breasts, abdomen, pelvis
- Testing of the blood, urine, stool, pap smear and screening for sexually transmitted diseases are considered and individualized according to patient needs and risks
- Mammogram, bone density testing, colon screening and other tests are also individualized according to family history and age factors
This visit provides a yearly opportunity to reflect and assess what preventative testing is appropriate for you. Resources are available for any challenging life issues.
Misconceptions / Controversy:
There is a misconception that a physical exam is more valuable than a thorough history. The opposite is true. But they work best together. There is controversy over how frequently a periodic exam should occur. Yearly is a typical pattern for most women. We now individualize the frequency of pap smears.
My Take: It has been my experience that in recommending yearly visits, they occur at 12-18 months, sometimes 24. Missing a mammogram can make a critical difference in treatments needs. Missing a pap smear for 5 years can make a difference in severity of abnormal cells. The goal of an annual check is to aid patients with insight into wellness, working with their own innate healing ability, and to catch disease processes early whenever possible. I encourage patients to keep a health binder as a quick reference to their pertinent tests and health issues.
Favorite Links: Below are several great websites regarding women’s health.