premenstrual syndrome

If you think you might have premenstrual syndrome or PMS, you are not alone. In fact, about three-quarters of all girls and women experience PMS during their reproductive lives. A syndrome is a group of symptoms that occur together and that are characteristic of a disease or condition. Premenstrual syndrome is present when certain physical and / or emotional signs or symptoms occur.

PMS Diagnostic Criteria

The University of California, San Diego has developed the most widely used and accepted diagnostic criteria for diagnosing PMS. Although over 150 symptoms have been associated with PMS, women must self-report at least one of the following physical symptoms of PMS and at least one of the following mental symptoms of PMS. Additionally, these symptoms must occur during the five days before menstruation begins to meet the diagnostic criteria for premenstrual syndrome.

The Physical Symptoms of PMS

• Sore, tender breasts
• Headache
• Abdominal bloating (the most common physical symptom)
• Swelling of the extremities

Mental Symptoms of PMS

• Fatigue (the most common mental symptom)
• Angry outbursts or mood swings
• Irritability
• Confusion
• Social withdrawal

All symptoms must disappear by Day 4 of the menstrual cycle and must not occur before Day 14 (of the average 28-day menstrual cycle) to meet the criteria for a diagnosis of PMS. The final requirement for a diagnosis of PMS is that symptoms must be present in the absence of any pharmacological treatments, hormone ingestion, or drug or alcohol use.

A true diagnosis of PMS causes identifiable dysfunction in social or economic performance and includes at least one of the following:

• Marriage or relationship problems which are confirmed by the partner of the woman seeking diagnosis of PMS
• Parenting difficulties
• Decreased performance and / or attendance problems, including being late, at school or work
• Less than normal amount of social activity during the premenstrual period of the menstrual cycle
• Legal issues
• Suicidal thoughts, words, or actions
• Seeking medical attention for physical symptoms of PMS

Some girls and women experience a more severe form of PMS called premenstrual dysphoric disorder, or PMDD. The diagnostic criteria for PMDD includes the above criteria as well as the presence of additional symptoms.

If you think, you have the symptoms of premenstrual syndrome see your physician for diagnosis and treatment. Getting a diagnosis of PMS requires keeping a menstrual cycle calendar for two or three menstrual cycles to reflect a pattern of symptoms.

_Sources:

_{The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, DC, American Psychiatric Association 1994.}

_{Robert F Casper, MD. Patient information: Premenstrual syndrome and premenstrual dysphoric disorder (PMDD), Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder, UpToDate [online]; accessed 10/24/2006.}

Getting Your Period

Probably the most talked about event of puberty for a girl is her period. Getting your period is another way of talking about menstruation.

Within about a year after beginning her growth spurt, most girls will have their first period. This marks the beginning of a girl's life as a young woman. In some cultures, this is celebrated publicly. Others choose to be more private about it. Some girls can't wait for their first period to come, while others may dread it or feel neutral about it. No matter how you feel, it's an important event in your life and part of the normal process of becoming an adult.

Most American girls start their periods between the ages of 9 and 15. There really isn't any way you can tell the day or week you'll get your first period. There also isn't really any way you can make it come sooner or delay it from happening. But you can understand what is happening inside your body to know what is normal for you.

During each period, the inner lining of your uterus is shed through the vagina, the passage that connects your inner reproductive organs to your outer sex organs or genitals. This lining is mostly blood and other tissues that have been building up since your last period. The purpose of this blood is to provide nutrients for a fertilized egg if you were to become pregnant. Girls start having their periods early in heir lives, but most don't decide to start a family till they've already been having their periods for many years. Most women stop having periods when they are between 45 and 55 years old. This is called menopause.

You may have heard some women talking about their monthly cycle. This cycle begins on the first day of one period and ends on first day of the next period. While women's periods do tend to come about once per month, there is a wide range in the length of menstrual cycle from woman to woman. Some women's periods come as often as every 21 days, some as far apart as every 35 days. The most common range is 25-30 days. Some women have regular cycles and their periods start exactly the same number of days apart each time. For other women, the length of their cycle varies from month to month.

There is also a great range in how much blood flow each woman loses during her period. You may have a heavy flow and need to change your pad or tampon frequently. Or you may have a light flow with barely any blood loss. Usually your flow will be heaviest at the beginning of your period. It may start out light, get heavier, and then get lighter again until it's over. It's also common to see some small clots or pieces of tissue in your menstrual blood. Most women's periods last from 3 to 7 days.

Another thing that can vary is the color of the blood on your tampon or pad. Sometimes the blood from your period can be a dark, rust-like color. Other times it can be a bright red color. The color may vary according to where you are in your period or the heaviness of your flow. Pay attention to the rhythm of your body, so you'll know what is normal for you in terms of flow, cycle and period length, and color of your blood.

~Adapted from the Women's Health Information Center

menstruation 101

Menstruation is the cyclic occurrence of uterine bleeding that occurs near the end of puberty in girls. Typically, first periods occur around age 12 or 13. However, some girls begin having periods as young as 8 or 9 years old, while others may be as old as 15 or 16. If menarche does not occur by the time a girl reaches the age of 16, she should see her doctor for evaluation. Menstruation usually begins about 2 1/2 years after girls begin developing breasts, and growing pubic and underarm hair.

Once menstruation begins, it continues until menopause occurs around the age of 50 when monthly menstrual cycles end. Surgical menopause occurs following removal of the ovaries during hysterectomy. Menstruation also temporarily stops during pregnancy. Hormonal contraceptives also stop normal menstruation and can safely be used to stop periods indefinitely or until pregnancy is desired. If menstruation fails to occur for any other reason, amenorrhea occurs. Amenorrhea is a menstrual cycle disorder.

For the most part, the menstrual cycle occurs predictably and without problems. However, when things don’t go right -– when you experience heavy or excessive bleeding, when your period doesn’t occur when expected, when you have physical or emotional symptoms during the weeks before you menstruation, or when you experience painful periods or other symptoms –- you may have a menstrual cycle disorder.

Abnormal uterine bleeding is a common menstrual cycle disorder that includes several types of abnormal bleeding patterns, including amenorrhea. Other menstrual cycle disorders include dysmenorrhea, premenstrual syndrome or PMS, premenstrual dysphoric disorder or PMDD, and uterine fibroid tumors. Other factors that may affect normal menstruation include stress, illness, exercise, diet and nutrition, and work, family, and relationship issues.

What Causes the Menstrual Cycle and Menstruation?

Your endocrine system produces hormones that work together with your reproductive organs to cause the menstrual cycle and menstruation when conception does not occur. The glands of the endocrine system produce hormones that regulate various bodily functions such as blood sugar levels, metabolism, and reproduction. The menstrual cycle occurs in distinct phases during which hormones cause the changes that prepare the uterus to sustain a pregnancy, and to cause menstruation when pregnancy does not occur.

How Often Does Normal Menstruation Occur?

The average menstrual cycle is 28 days and women menstruate, on average, about five to seven days during each cycle. The first day, or Day 1, of the menstrual cycle is the first day any bleeding occurs, even if it’s just spotting. It’s a good idea to use a calendar to keep track of your menstrual cycle. Tracking your periods and any symptoms that occur during the menstrual cycle can help your physician diagnose any problems that may occur.

How Much Blood Loss is Normal during Menstruation?

You might be surprised to learn that, while it might often seem like much more, the total amount of blood lost during menstruation is only a few tablespoons. You may be experiencing excessive bleeding if you have to change pads or tampons every hour or so for several hours in a row. Contact your health-care provider if you experience excessive bleeding during your period.

What to Tell Your Doctor about Your Period

When your first period occurs, make sure to inform your doctor. From that point on throughout your reproductive years, your doctor appointments should include notation of the first day of your last period. Having a menstrual cycle calendar helps you to remember this information when asked. Other things you should tell your doctor about your period include:

• Having irregular, excessive, or other types abnormal bleeding
• Experiencing severe cramps during menstruation that is not relieved by OTC pain-killers, or experiencing pelvic pain that is unrelated to menstruation
• Not having periods
• Having menstrual cycles that are less than 21 days, or more than 35 days apart
• Anything about your period, or menstrual cycle, that seems abnormal for you

Tip: Girls often have irregular periods during the first few years after menstruation begins. It’s completely normal to have irregular periods while your body adjusts to all the physical and emotional changes that occur during adolescence.

_Sources:

_{Getting Your Period; GirlsHealth.gov; http://www.girlshealth.gov/body/period.htm; accessed 07/10/07.}

All About Menstruation; Teens Health, KidsHealth.org; accessed 07/10/07.

PELVIC EXAM

During a pelvic exam, your doctor visually and manually assesses your reproductive organs. A pelvic exam usually is done as part of a woman's regular checkup, or your doctor may recommend a pelvic exam if you're having symptoms such as unusual vaginal discharge or pelvic pain.

A pelvic exam is a relatively short procedure. In the course of a pelvic exam, your doctor checks your vulva, vagina, uterus, rectum and pelvis, including your ovaries, for masses, growths or other abnormalities. A Pap test, which screens for cervical cancer, may be performed during a pelvic exam.

Why it's done

To assess your gynecologic health. A pelvic exam often is part of a routine physical exam for women to find possible signs of a variety of disorders, such as ovarian cysts, sexually transmitted infections, uterine fibroids or early-stage cancer. Your doctor can recommend how frequently you need to be examined, but many women have a pelvic exam once a year.

To diagnose a medical condition. Your doctor may suggest a pelvic exam if you're experiencing gynecologic symptoms, such as pelvic pain, unusual vaginal bleeding, skin changes, abnormal vaginal discharge or urinary problems. A pelvic exam can help your doctor diagnose possible causes of these symptoms and determine if other diagnostic testing or treatment is needed.

No special preparation is required for a pelvic exam, although your doctor may recommend that you schedule your pelvic exam on a day when you don't have your period.

If you have questions about the exam or its possible results, write them down and bring them with you to the appointment, so you don't forget to ask about them during the visit with your doctor.

What you can expect

A pelvic exam is performed in your doctor's office and takes only a few minutes.

You'll be asked to change out of your clothes and into a gown. You also may be given a sheet to wrap around your waist for added comfort and privacy. Before performing the pelvic exam, your doctor may listen to your heart and lungs and perform a breast exam.

During the pelvic exam
During the pelvic exam, you lie on your back on an examining table, with your knees bent and your feet placed on the corners of the table or in supports called stirrups. You'll be asked to slide your body toward the end of the table and let your knees fall to the sides.

• External visual exam. First, your doctor visually inspects your vulva, looking for irritation, redness, sores, swelling or any other abnormalities.
• Internal visual exam. Next, your doctor uses a speculum — a plastic or metal-hinged instrument shaped like a duck's bill — to spread open your vaginal walls and view your vagina and cervix. Often, the speculum is warmed before it's inserted. Inserting and opening the speculum can cause pressure or discomfort for some women. Relax as much as possible to ease discomfort, but tell your doctor if you're in pain.
• Pap test. If your pelvic exam includes a Pap test (Pap smear), your doctor collects a sample of your cervical cells before removing the speculum. After the speculum is removed, your doctor examines your other pelvic organs for signs of abnormalities. Most experts agree that you should have your first Pap test within three years of becoming sexually active or by age 21, whichever comes first. How often you need a Pap test depends on your age and medical history. Talk to your doctor about when you should have a Pap test.
• Manual exam. Because your pelvic organs, including your uterus and ovaries, can't be seen from outside your body, your doctor needs to feel (palpate) your abdomen for this part of the exam. To do this, your doctor inserts two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. This is to check the size and shape of your uterus and ovaries and identify tenderness and unusual growths. After the vaginal examination your doctor also inserts a gloved finger into your rectum to check for tenderness, growths or other irregularities.

Usually, at each step along the way, your doctor tells you exactly what he or she is doing, so nothing comes as a surprise to you.

After the pelvic exam
After the pelvic exam is over, you can get dressed and then discuss with your doctor the results of your exam.