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The question

I am a 45-year-old woman who has had a history of severe PMS, but I have noticed over the last year that my PMS symptoms are worsening such that I have symptoms for two out of four weeks of the month. Is that normal? What's your advice for treating the symptoms?

The answer

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Premenstrual symptoms can occur one to two weeks before a woman's period and can include both physical and psychological changes such as breast tenderness, back pain, bloating, insomnia, irritability and acne breakouts. The Society of Obstetricians and Gynecologists of Canada estimates that approximately 80 per cent of women experience some premenstrual symptoms and the intensity of symptoms can vary.



While it is not clear why some women are affected more severely than others, PMS symptoms are thought to be triggered by hormonal changes. As women approach menopause the hormonal changes can be more dramatic and may result in a change in the intensity and duration of symptoms.



For some women, symptoms can be simple PMS, but approximately three to eight per cent of women have Premenstrual Dysphoric Disorder (PMDD), which can cause severe depression, hopelessness and anger, severely affecting functioning at work and in personal lives. While anxiety and depression can be similar to PMDD and PMS, the main difference is that the symptoms occur only in the days preceding a woman's period.



My first suggestion would be to keep track of your symptoms for at least two cycles to identify if there is a pattern. A good example of a diary can be found at the Centre for Menstrual Cycle and Ovulation Research site: . A menstrual diary can be helpful for you and for your doctor to rule out other conditions such as anxiety or depression. Furthermore, awareness of symptom patterns can help you try to alleviate symptoms with a few of the following tips:



Lifestyle modifications: Eating a healthy diet, regular exercise (30 minutes/day) and stress management can be helpful. Excessive caffeine and lack of sleep can worsen symptoms, so limiting these may help. Hydrating well and limiting salt intake can reduce bloating.



Vitamin supplements: Calcium at doses of 1,000-1,200 mg/day can help reduce bloating and breast tenderness with the bonus of helping reduce the risk of osteoporosis. Vitamin B6 (no higher than 50-100mcg/day) and magnesium (200 mg/day) may help too. .



Anti-inflammatory drugs: Ibuprofen or Advil can help to significantly reduce cramps and breast tenderness.

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Oral contraceptive pill: Some women find being on contraceptives to be helpful as they balance hormonal fluctuations and therefore can ameliorate PMS symptoms. Some oral contraceptives have been specifically approved for PMDD and PMS, so check with your doctor.



Antidepressants: Specifically, selective serotonin reuptake inhibitors, including Prozac, Paxil and Zoloft have been found to be effective with more severe cases of PMS/PMDD. For some, it can be taken continuously and for others, their use can be limited to the two weeks before menstruation.



Send family doctor Sheila Wijayasinghe your questions at doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Wijayasinghe.

Click here to see Q&As from all of our health experts.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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