Menstrual Problems: Symptoms and Treatment

Now even the most conservative physicians no longer believe that PMS is “all in the head.” Problems that crop up two weeks before you start menstruating and those that occur during your period are very real. Here are the more common problems—and what you can do about them.

Coping with PMS

Surveys have found that as many as 60 percent of all women suffer from symptoms of premenstrual syndrome (or PMS) 10–15 days before the onset of menstruation. In some women, PMS continues for two to three days during menstruation.

The cause of PMS is due to changes in hormone secretion during the latter two weeks of a woman's cycle. It can be made worse by stress, improper rest, or too little or too much exercise (all of which affect hormones greatly). A salty, spicy diet (which makes for water retention and, in turn, uncomfortable bloating, swelling, and pressure on nerves, joints, and organs) also affects PMS.

Symptoms of PMS include:
Anxiety and irritability	Headaches
Mood swings	Fatigue
Weight gain	Breast tenderness
Sugar cravings	Lower back pain
Cramps	Nausea
Depression	Oily skin and skin eruptions
Stomach bloating

Chances are you won't suffer from all these symptoms, but you'll feel enough of them if you have PMS to make those days before your period uncomfortable.

You can avoid severe PMS symptoms by following these some common-sense guidelines:

• Eat a sensible diet that emphasizes fresh vegetables and fruit, fish, whole grain cereals, and bread. Avoid salty, spicy foods, especially in the third and fourth week of your cycle.
• Get a good night's sleep. If necessary, drink some “Sleepy Time” herbal tea or a glass of warm skim milk to help you doze off.
• Try to drink eight glasses of water a day to help flush out the system and relieve bloating.
• Exercise moderately at least three times a week. Walking and swimming are especially good for releasing stress and helping the cardiovascular system without adding the pounding pressure of high-impact aerobics.
• Take Tylenol or Advil to help with cramping, headache, and lower back pain.
• If you need a sugar “hit,” try eating an orange. It's sweet, but prevents the hormone imbalancing effects of refined, processed sugar.
• Pepto-Bismol works for nausea. Also try a cup of herbal tea and plain toast. If your nausea is combined with headache, use Tylenol or buffered aspirin to avoid further stomach upset.
• Try vitamin and mineral supplements for mood swings. Calcium, a B-complex vitamin, and vitamins C and E may help.

Menstrual Cramps (Dysmenorrhea)

Yes, there really is a reason for menstrual cramping, and it has to do with hormones— specifically with the excess production of prostaglandins. These hormones, produced in the endometrium (the mucousy covering of the uterus), help the uterus contract, which is necessary for menstruation flow. Sometimes, however, these contractions hurt and cause cramps. Cramps can also be exacerbated if your body releases too much estrogen into the bloodstream. This increases fluid retention.

If you have dysmenorrhea, you are not alone. Approximately 50 percent of all women experience some degree of cramping during menstruation.

The best prevention for dysmenorrhea is the same for PMS: a salt-restricted diet, plenty of exercise, a good night's rest, and lots of water. A calcium-rich diet has also been found to help. Eat low-fat yogurt and drink skim milk or, if you “hate” dairy products, try a calcium-magnesium supplement. For minor cramps, an over-the-counter medication such as Midol can help. And if you can wear clothing that stretches around your waist and stomach, and can spend an hour resting with a heating pad for company, you might just find the cramps less severe.

If cramps interfere with your daily routine, see your physician. He or she can prescribe stronger medication to alleviate your pain.

Excessive Bleeding (Menorrhagia)

Every woman's definition of a heavy period is different. Some women always have a heavy flow during the first few days of menstruation and it's perfectly acceptable. Still others rarely have heavy bleeding.

Because it is so difficult to pinpoint when bleeding is too much, most physicians suggest this ground rule: if you need to change your tampon or sanitary napkin once or twice every hour, you have menorrhagia.

What causes excessive bleeding? Several things, ranging from the serious to those easily remedied:

• Too much exercise or too strict a diet
• Benign cysts in the uterus called fibroids
• Urinary tract infection
• Dysfunctional blood clotting
• Perimenopause, or the very early stages of menopause

Although fibroids, infections, and clotting disorders need the attention of a physician, you can also help ease the flow by doing the following:

• Cut back on exercise
• Eat a more well-rounded diet
• Ease up on your workload to keep stress at a minimum
• Ask your doctor about iron supplements to keep energy up and prevent the possibility of anemia

Sporadic Bleeding

When spotting occurs is much more important than the fact that you do bleed on occasion. If the spotting occurs during ovulation, it is harmless. If your sporadic bleeding occurs around ovulation, even if it is accompanied by slight pain in the lower abdomen, you don't have to spend any sleepless nights full of worry (although you should check with your gynecologist just to be absolutely certain). However, if your sporadic bleeding occurs at any other time during your monthly cycle, it could signal something more serious, including:

• Urinary tract infection
• Endometriosis (inflammation of the uterine wall lining)
• Benign fibroids in the uterus
• Dysplasia (abnormal cell growth in the cervix)
• Cervical cancer
• Pregnancy problems
• Hormonal imbalance (usually due to the wrong dosage of birth control pills)

If you have irregular spotting, it's important to see your gynecologist to rule out anything serious—and to take care of any problems before they get worse!

Skipping a Cycle

It sounds like a nightmare: PMS for two or three months with no relief in sight! Unfortunately, the stress of waiting for your period compounds the problem—because stress is one of the major culprits in irregularity. (Of course, pregnancy is still reason number one!) When stress strikes, unrelenting and from all directions, your brain sends out a message to the endocrine system: This is not a good time to get pregnant. The result? Your body might stop producing progesterone, a hormone necessary for ovulation, fertilization, and menstruation.

Of course, there are other reasons besides stress that can create hormonal imbalances that make you skip a cycle. They include:

• Too much high-impact, vigorous exercise
• Adolescence (a teen's reproductive cycle has not completely matured)
• Menopause
• Yo-yo dieting (which wreaks havoc with your hormones)
• Fibroids in the uterus
• Endometriosis
• Urinary tract infections (especially if accompanied by fever)
• Cancer (in rare cases)

If you have an irregular cycle for more than three months, see your gynecologist. He or she can rule out any serious conditions or treat them before they get worse.

Emergency Tampons and Sanitary Napkins

There you are, out in the woods, enjoying your vacation to the max. The stress and the dull routines of your everyday life seem far, far away. But wait. There's one thing you didn't count on—your period. And you didn't bring any tampons or napkins. The first solution is an easy one. You can drive to a drug store and buy a box. However, if you're not near civilization or it's the middle of the night, this can be tricky. In emergency situations, practicality rules.

If you only have to wait until morning, use folded up tissue or toilet paper as a makeshift napkin. (After all, our grandmothers and their grandmothers used hand-washed rags that they frequently changed and cleaned. If they could do that, hey, what's a little inconvenience to us?)

If there's no chance of getting to a drugstore, supermarket, or convenience store, you can use thick wads of folded up paper towel or clean washcloths. In a real pinch, you can cut up a clean shirt or T-shirt into squares. Use two to three squares depending on your flow.

If you hate the idea of napkins, you'll just have to adjust. There's no safe way to make an emergency tampon. The probability of infection is just too high.

Excerpted from The Complete Idiot's Guide to First Aid Basics © 1996 by Stephen J. Rosenberg, M.D. and Karla Dougherty. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

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