We keep talking about how PMS and PMDD are real, physical, genetic, biochemical, hormonal conditions, and not, as some would have you believe, simply “in your imagination” or a “neurosis.” We’re happy to report that the evidence—scientific evidence—keeps rolling in that the supports our position.
We have to keep revisiting this, and hammering the topic home, because sometimes it seems as if the only people who understand PMS (and this goes for PMDD too) are the women who suffer from it, and occasionally an understanding husband or partner who is truly supportive. All too often doctors, health care practitioners, family and friends seem to think PMS is an imaginary affliction that women dream up because…well, apparently, just because. But let's get real for a second: no woman would actually wish for a bloated, achey feeling several days out of the month; for difficulty concentrating and brain fog; for fatigue and mood swings; and all the other PMS symptoms that are no walk in the park, despite what the PMS doubters think.
Now, the good news: the “PMS is imaginary” school of thought took a major hit last year when research was published showing that among identical twins, there is a strong genetic component to premenstrual syndrome. When a strong genetic component is proven it suggests a biochemical or physical basis for a condition, rather than a purely psychological or emotional one. As always in the world of science, more studies are needed to confirm the findings, but this study of 176 sets of girl twins clearly showed that the tendency to PMS is an inherited trait.
The results of this study made us curious: has any other researcher looked into this question? Twin studies are among the most reliable studies for a wide variety of medical conditions and personality characteristics because they make it clear what is being affected by genetics, and what is a result of environment and psychology.
As it turns out, a 1993 study looked at this same question of PMS in twins and found that, lo and behold, there is a strong genetic influence on PMS. This study came from Australia; the one mentioned above came from Canada. We weren’t surprised by this: it seems the United States has a prejudice against PMS—many people don’t take it seriously, and assume that only PMDD, the most severe type of PMS, is “real.” There are studies showing this genetic component for PMDD as well: a 2007 study showed that a variation in an estrogen receptor gene is associated with PMDD.
Of course, these studies don’t mean that genetics is the one and only cause of PMS and PMDD: the genes involved could cause a woman to have higher than usual requirements for vitamin B6, calcium, or magnesium, or some other nutrient, or to be more susceptible to the effects of caffeine or stress.
If you’re a scientific type, here’s how to look up the two PMS studies themselves (you can go directly to pubmed or try google scholar):
October 2011, The heritability of premenstrual syndrome. Lead author: Jahanfar S, in the Journal Twin Research and Human Genetics
April 1993, The premenstrual syndrome: a twin study. Lead Author: Condon JT, in the British Journal of Psychiatry.
PMS, PMDD, & Your Emotions by Dr. Daniel J. Heller August 24, 2011 Tweet
Your sister calls to ask if she can borrow that sweater that looks so good on her: you know, the one you save for special occasions? The one you had to take to the cleaners after the last time she borrowed it? Well, it’s hard to say “no” to your older sister, and besides, hasn’t she fed your cat when you went away for the weekend, taken you to the doctor for that test, not to mention had your back on numerous occasions?
So, you let her borrow the sweater, but then all those old resentments get stirred up, that have nothing to do with the sweater, and by the time she brings it back, this time in perfectly good condition, you feel bent out of shape, and she doesn’t understand why, and neither do you—it doesn’t seem rational.
Here’s a possible explanation, and it’s not some Dr. Phil recommendation to be more assertive or to communicate your feelings. It’s simpler than that. Maybe all really need to do is actually feel your feelings.
This might seem like a strange recommendation: you might think, don’t I already feel my feelings? And, perhaps you'd rather not feel them, when they are feel confused and overwhelming.
Here’s why: when those resentments for events from last year, or ten years ago, start to pop up, it’s painful. It hurts to feel that you were treated unfairly, or that you didn’t get the recognition you deserve, or simply to remember a time when your feelings were hurt. And so, if you’re like most of us, when those feelings and memories get stirred up, you avoid feeling them (which makes sense—they’re painful!)
Instead, you might end up thinking about who is to blame for causing those feelings; about how you can orchestrate events differently in the future so that those painful feelings don’t recur; or about an explanation for why you feel that way, which is often a story that leads into blame and resentment anyway.
You might be asking, what does this have to do with PMS and PMDD? How is this going to help cramps or bloating or mood swings or irritability? What do emotions have to do with hormones? Those are all very good questions. The connection between hormones and emotions, and between PMS and your feelings, can be summed up in once word: Stress. When you bottle up your feelings, or try to suppress them, they end up coming out in some other way anyway, plus they increase your stress level. And, as the blog post above makes clear, stress makes PMS worse.
Most of the time, the anticipation of painful feelings is much worse than the feelings themselves. But when you directly feel what is really going on in your own heart: sadness, anger, joy, or fear—sometimes referred to as “mad, sad, glad, or scared”—you may then find it easier to assert yourself, or to express your feelings if you need to do so, or to hold them back if you don’t. It can even make it easier to apportion blame if that is necessary, or to avoid unfairly blaming someone who didn’t know any better.
Once you really feel your own feelings—the mad, sad, glad, or scared ones—you may also find yourself feeling more compassion and sympathy for others and their feelings, plus you’ll be a lot more clear about what is happening inside of you. For your overall emotional health, and to release the stress valve that builds up with PMS, feeling your feelings is a good place to start.
You may have heard that the California Milk Processor Board has launched an ad campaign that claims to be targeted at men, suggesting that milk is effective for premenstrual syndrome. There are a lot of reasons why this ad campaign is controversial (it was originally launched in 2005—keep reading and you'll see why). Many women, and, we hope, men, feel that this ad campaign misguidedly minimizes women's legitimate health concerns and suffering by focusing on how PMS affects men—as if men bear the brunt of PMS. Unfortunately, these ads play into those tired, worn-old stereotypes of women as irrational and overly emotional. You can read more about that in my earlier blog post, PMS Is Pushing Forty. Lampooning and satirizing PMS is old hat—but, in our opinion, it is in bad taste, and just plain offensive. (Addendum: this ad, thankfully, was pulled. Apparently, we weren't the only ones who found this objectionable.)
However, the subject of the media portrayal of women cannot be given its just due in a short blog post like this. Many capable authors have tackled it before, and in great depth. Given that, we want to focus on a subject that is more immediately useful: Does drinking milk help PMS? What is the evidence for that, and where does it come from? And, what about women who can't or don't or won't drink milk? Is this a calcium issue, a vitamin D issue, or both?
Here's the lowdown: in 2005, a medical research article showed that women who had the most vitamin D in their diet had 40% less PMS compared to those who had the least, and that women who had the most calcium had 30% less PMS compared to those who ate at the least. And, women who drank low-fat or skim milk were almost 50% less likely to have PMS.
This study followed over 1000 women for more than ten years, making it a reliable study. But don't forget, this is research: it doesn't necessarily mean that eating more yogurt and drinking more milk will relieve your PMS, or that of a friend or daughter! Since the benefit was in the 30-50% range, there's an equal or better than even chance that drinking more milk will do nothing to help someone's PMS. And, given that many people are sensitive to dairy products, and better off avoiding them altogether, we're pretty sure it could make things worse for some women.
There is an interesting story here, about the way food and nutrition research is treated differently from research into supplements by both the media and the medical community: both have an obvious prejudice against nutritional and herbal supplements. The reason the milk study was done is because of some excellent research that showed that calcium supplements—pills, not food—are very effective for treating PMS.
There is so much excellent scientific evidence of the beneficial effects of nutritional supplements and almost always without the risks or side effects of medication. But, chances are, you only ever hear about the negative studies on supplements in media reporting.
Here's our position on the issues raised here:
We don't believe women, and women's health, should be demeaned or parodied. Milk is a good food for those who can tolerate it, particularly if you can find organic milk, but many people have reasons for avoiding it. Since calcium can be hard to get from food, and since calcium supplements work well to reduce PMS symptoms, not everyone needs to drink milk. Based on our experience helping thousands of women with PMS, we feel certain that calcium supplements should be combined with the full array of nutrients and botanicals, not to mention a complete holistic plan that takes the whole person into account, to relieve and resolve PMS.
The title of this blog post is a little bit inaccurate. It says you can overcome PMS, which is true, but what this post is really about is that you can do any number of very difficult things, as long as you're not willing to stop trying.
A study came out a long time ago, and I can't find the reference now, but I want to discuss it anyway. It was a study of smokers who had quit and smokers who had tried to quit, and it asked them all how many times they had tried to quit. The conclusion was, the more times someone tried to quit, the more likely they were to eventually, finally, succeed.
That seems obvious enough, right? Until, that is, you turn it on its head. The people most likely to succeed were the ones who failed the most. One person tries to quit twice, it doesn't work, they learn their lesson and stop trying, and they never "fail" at quitting again. The problem is, they're still smoking. Yes, they've avoided the pain and embarrassment of not succeeding. But they're still doing something destructive to their own body (and the bodies of those around them who breathe the second-hand smoke).
However, the person who doggedly keeps trying to quit smoking probably tries all kinds of outlandish things. They put up with raised eyebrows from friends who have heard about the latest "miracle cure" many times already. They bear the disappointment of family every time they seemingly succeed, quitting for a few weeks, or a few months, or a few years, only to become addicted to tobacco again. And yet... and yet... they keep trying, keep "failing"... and eventually emerge as the biggest winners when they quit for good. Their success has everything to do with their willingness to "fail."
I think this has a lot to tell us about life as a whole. I think so many of us—and I include myself in this, for sure—spend our lives trying not to fail. And, before you think you've seen this movie before, I'm not going to go into a long diatribe about how you should be trying to succeed rather than trying not to fail, or that you should visualize coming out on top or live your best life now (sorry, Oprah!). My point is really much simpler than that, or at any rate I think it ought to be easier to achieve.
By accepting that "failure" is part of life, you no longer just "accept" failure. By that I mean, if you know in your bones that trying new things is likely to be difficult, frustrating, and that you probably won't succeed on the first or second or fifth try, those setbacks and "failures" won't defeat you. Most people think that accepting failure means that you stop trying. I think accepting that failure is part of any difficult undertaking means that you keep trying, because you no longer expect things to be easy and without struggle.
Here's an example different from smoking: learning to ride a bike. Somehow, most children seem to be able to learn to ride a bike pretty readily. How do they learn? It goes something like this: get on, fall off, bump knee, get on, ride a little, fall off, get back on. For some reason, when it comes to learning to ride a bike, most children seem immune to the pain of repeated failure (I have no doubt that in many cases this is because of the support and persistence and foresight of their parents!). But it is interesting because I can almost guarantee you that there other areas of life where that same child refuses to be twice-burned by failure, and will simply refuse to do something difficult.
It's a marvelous example, but no one reading this blog is a seven-year-old child, so there must be another example that is more germane to adults. How about the choice between changing your diet and lifestyle and taking some healthy supplements in order to get your body back in balance and finally free yourself from PMS, naturally? Or, maybe to lose some weight and lower your cholesterol level instead of resorting to a drug. I think one of the attractions of prescription drugs is that very few people fail at taking one pill per day. The drug is really the painless way, not just because eating less, or eating better, might result in hunger pangs, or in having to eat less of the foods we've come to love (and that we know aren't so good for us).
Changing your diet is hard because it inevitably involves repeated failure, sometimes more than once per day! You vow not to dip into the donuts at the break room, but you rushed out the door and got to work starving, and you have to eat something, and then it's not even nine in the morning and you're already off track. You've already "failed."
My opinion is that that is only a failure if you say: "Oh forget it, this is too hard, I can't even succeed at this diet plan for one morning." What if you "failed" at every meal and snack for a week—which adds up to somewhere between 21 and 40 "failures" in a week. That might seem like a lot for one week. On the other hand, at the end of that week you'd know pretty much every speed bump and obstacle in the road, and you might realize that you need to pack your breakfast the night before or that to succeed you'll need to get to bed earlier so that you can get up earlier. In other words, your "failures" can teach you the lessons that lead to your success, if you can bear the pain and disappointment of not succeeding right away. And that pain is dramatically lessened if, as I mentioned above, you don't expect things to be easy.
There are two problems with the scenario I just described. The first is, most of us don't learn from a mere 20 or 40 or 100 failures. Instead, we keep making the same mistakes over and over. I'm not going to bore you with the particulars of my mistakes, but I assure you that my high rate of failure is very promising indeed! The second is, I think a more common scenario is not that someone tries, immediately fails, and sticks with it through repeated failures to get to the success, but rather that you get off to a great start, which leads you to think "this is going to be easy!" So, you do really well on a new healthy or weight loss diet for a few days or a week or a month—and then, when you hit that speed bump, or fall off the wagon altogether (my apologies for the mixed metaphors), you give up, because, lo and behold, it is very difficult.
The essential idea of this study—that failure is a prerequisite for success, and that people who fail more succeed more—is related to many parts of life, but especially the relationship between our lifestyles, our habits, and our health and wellness.