Comfort Blog

The medical headlines have been full of proclamations recently claiming that PMS is a myth, because of a recent study that was published in the journal “Gender Medicine” and came from a research group based at the University of Toronto.

Well, PMS is not a myth. The researchers say that the emotions women experience around the time of their period may just be tiredness or stress, but these researchers apparently haven’t studied the basics of women’s physiology. Of course women are tired and stressed when they have PMS or PMDD! That doesn’t mean that the fatigue and stress are the cause of the PMS: it could be that the PMS is causing the tiredness and stress.

What’s more important is that, because research is almost always an attempt to nail down a single cause, this study ignores the holistic truth that hormones are affected by fatigue and stress, and vice versa. You can’t really isolate them from each other, and when you try to—as these researchers did—you end up ignoring common sense.

Journalists and the media usually have minimal knowledge of medicine, medical research, and human physiology, so they often tend to trumpet the latest research as the last word on a subject, even when that single headline-grabbing study contradicts hundreds of high quality studies that came before. Unfortunately, most of us have to get our medical news from sources that are simply not qualified to pass judgment on research, and shouldn’t be the ones making the decisions about what stories deserve headlines, and which deserve to be ignored.

Still, this story about “PMS is a myth” shouldn’t be ignored, because it keeps raising its ugly head, year after year. 

PMS and PMDD are not a myth. They are real, physical conditions, caused by a combination of hormones, genetics, diet, stress, and psychological conditions (psychology has a physical-chemical component, of course.) And in case you’re wondering if there is any research to prove that PMS is not a myth, here’s some proof of the existence and seriousness of PMS and PMDD:

• Millions of women experience PMS, PMDD, and premenstrual symptoms. 
• There is a strict medical definition of PMS and PMDD. 
• PMS and PMDD impact women’s lives.
• PMS is not a myth. 

Just because some medical research makes the front page of the news or of your favorite website, that doesn’t mean it’s true. PMS and PMDD are real, and they have very real impacts in women’s lives. 

 

Ju

J

Two of the most common questions we hear, both in the doctor’s office and here on the PMS Comfort website is “Should I get my hormone levels checked?” or “Do I need a saliva test to check for a hormone imbalance?” If your concern is PMS or PMDD or another premenstrual symptom like breast tenderness or cramps, then you don’t need any hormone tests. This is because hormone levels in your blood or saliva don’t determine whether or not you’ll have premenstrual dysphoric disorder or premenstrual syndrome. Hormone levels, including estrogen, estradiol level, and fsh levels are normal in almost all women when these tests are performed.

However, if you do a saliva hormone test, there’s a good chance you’ll be told that saliva tests are more accurate and are more sensitive for detecting hormone imbalance. In fact, these tests rarely tell you more than what your symptoms are already telling you: that your hormones are out of balance.

We understand how confusing this can be. Your medical doctor may very well have done a blood test for hormones, perhaps at your insistence, and told you that you’re fine, everything is normal, and that your premenstrual symptoms aren’t being caused by a hormonal imbalance. Then you get a saliva hormone test, and it says that you do have a hormone imbalance, and that is what is causing your PMS symptoms or PMDD symptoms.  Now we’re telling you that they’re both wrong? How can that be?

The problem is, hormones in your blood stream or your saliva don’t cause PMS or PMDD symptoms. It’s the specific way your individual hormones interact with the cells all over your body (not just your uterus or ovaries or brain) that determine how your hormones affect you—and there is no way to test for this cell-hormone interaction other than your symptoms. You could have very high estrogen levels, but that might not cause cramps or mood swings or fatigue in your case. Your friend may have low estrogen levels and have PMS cramps or premenstrual mood swings or PMDD fatigue. And this isn’t surprising, because it’s how the cells of your brain and your muscles and your whole body react to hormones that determines how you feel. And there is no test for that. Or, to put it another way, your body and feelings themselves are the most sensitive test there could ever be, meaning your symptoms tell you pretty much all you need to know.

This is why we created the PMS Comfort PMS & PMDD Symptom Quiz, the quickest and easiest way to find out if your symptoms may add up to PMS or PMDD.  Unless you’ve already decided that you want to take hormonal drugs (even bioidentical hormones are drugs), we suggest you steer clear of hormone tests. 

I found a post on a popular women’s forum the other day that said, “Studies show exercise helps PMS.” Seems like common sense, right? Every day there is an article published somewhere on the web telling you how to use natural remedies for PMS, and usually somewhere near the top of that list is an admonition to exercise. You’ll find we have similar advice regarding PMS and PMDD symptoms. We’re big believers in the power and health benefits of exercise for natural relief of PMS and PMDD, and for your health overall.

It’s pretty basic: we know that exercise helps stress, and that stress makes PMS worse. There’s only one problem here: there aren’t any good studies that show that exercise relieves PMS. You read that right—most of the self-help and expert medical articles and even academic journal papers that recommend exercise are assuming someone, somewhere has proven that exercise is a cure for PMS, or at least that it helps.

In fact, a 2009 research study published in one of our favorite medical journals, the Journal of Women’s Health, conducted a complete review of the medical literature looking for studies on exercise and PMS symptoms. The author found only four studies, all of them conducted with small numbers of women, and none of them considered high-quality by modern scientific standards. She concluded that there wasn’t enough evidence to reach a definitive conclusion about exercise and PMS.

You could argue that there’s no need to research this subject, since exercise is good for you anyway. Point taken. But in that case, it would be more accurate to say “we think exercise helps PMS, but no one knows for sure” instead of  “studies show…”

We believe it’s worth doing the research. It would be helpful to know, for instance, whether exercise makes PMS 10% better, or 67% better. Does it help emotional PMS symptoms, physical PMS symptoms, or both? Is 20 minutes of moderate walking three times per week enough, or do you need to sweat at the gym six days a week? As far as we’re concerned, the more research dollars invested in women’s health, and specifically PMS and PMDD, the better.

Exercise is only going to help you, and it will probably lower your risk of breast cancer and heart disease. We believe it’s an important aspect of natural relief of PMS and PMDD symptoms. But until studies confirm it, we’d like to see authors refrain from invoking the all-powerful “studies show.”

If you think PMS is stressing you out, you're right—and wrong. That's because stress causes PMS, just as PMS causes stress. A study published in the Journal of Women's Health found that in 259 women, perceived stress early in the month was an accurate predictor of PMS later in the month. The women with the highest self-rated stress levels were much more likely to have a larger number of PMS symptoms compared to those with lower stress levels.

This is enough evidence to tell us that stress and PMS are related, but it isn't enough to say with certainty that stress causes PMS. The stress in this study was measured before the PMS occurred, so we can say that stress before predicts PMS after. That seems like cause and effect, right?

Well, maybe, but not necessarily. There are lots of reasons why a woman with PMS symptoms might be more sensitive to stress at other times of the month. For instance, one theory about the cause of PMS (and PMDD, which is another name for really severe PMS) suggests that both are caused, at least in part, by an imbalance in the brain's neurotransmitter levels, specifically the neurotransmitter serotonin. A woman with a serotonin imbalance might be more sensitive to the effects of stress, or to becoming stressed in the first place. In either case, stress didn't cause the PMS; rather, the stress and PMS are caused by the serotonin imbalance. I will leave a discussion of antidepressant drugs for another blog post—please keep checking back!

Another way that PMS and stress might be related has to do with the direct effects of PMS. A woman with PMS of moderate severity could easily suffer from 4-8 days per month of fairly debilitating symptoms. In other words, a whole week out of the month could be lost to simply feeling awful. It makes sense that that would make the other three weeks of the month more stressful. This is a real situation: a surprising number of women lose anywhere from a few days to over two weeks every month to premenstrual symptoms. So, PMS could be the cause of the stress, not the other way around.

There is yet another way that PMS and stress are related. Many (probably most) women with PMS report feeling short-tempered, short-fused, irritable, easily angered, and/or overwhelmed while they are having PMS. Said differently, tolerance to normal life stressors is lessened by PMS.

Inevitably, some people who know next to nothing about women's hormones and brain chemistry, but who seem to making absurd and completely unsupported pronouncements, claim that women with PMS are wimps and just can't handle life. Let's set the record completely straight: women with PMS have just as much toughness and character and strength and willpower as anyone else. Given the amount of suffering they go through nearly every month, and the face they have to put forward to the world in spite of it, they probably have more gumption than the average person!

PMS, though, is not related to any of these qualities: it is a chemical imbalance of hormones or neurotransmitters but very likely other biochemical factors as well (and very probably, some that science has not even discovered yet), and very probably a combination of them. The point is, during PMS, women's resistance to, and tolerance for, stressful events and emotions is lowered, and through no fault of their own.

Mind you, the lowered tolerance for stress is layered on top of feeling crampy and bloated and tired and not sleeping well and back aches or headaches, which is layered on top of needing to keep life running, whether that is going to school or managing a family or going to work or several of the above.

Here's the take home: there's a definite relationship between stress and PMS. It could be that each influences the other. So, if you have any control over your stress level (and I'm not necessarily saying you do—that's for you to decide) and you have PMS, you are not doing yourself any favors taking on additional stress, or missing any opportunities to learn how to better deal with stress.

Fortunately, there are lots of small steps you can take that can change a stressful moment into a passing moment: start with a deep breath, a walk around the block, or even just counting to ten. Sometimes that moment passes, and a more balanced perspective is fast on its heels—if you can manage to not react in the first place. In many women, PMS makes it extremely difficult to not react, as if a flood of emotion were backing up behind a very flimsy dam.

Exercise discharges stress, and yoga may work especially well. Some other stress busters are music you love, a cup of herbal tea, gardening, or being out in nature (even a city park). Finally, and perhaps most importantly, acknowledge what you are really feeling rather than pushing those feelings away, and give yourself permission to feel what you feel (without reacting or lashing out at others. It can be scary at first, but feelings that are denied or stuffed or pushed away do harm. When you feel your feelings, you usually end up learning something, plus you find out they probably weren't as scary as you might have thought. There may be a completely legitimate reason for the feeling, and even a supposedly holistic method for relieving stress could be just another way to deny or avoid.

When you get a handle on your stress level, you will in help decrease the number and intensity of your PMS symptoms, plus your risk for heart disease, cancer, Alzheimer's, diabetes—which means you'll very likely live a longer, happier life.