Dr Bollmann, Board Certified Ob/Gyn

As a gynecologist, I often treated PMS, and frequently this was associated with skin problems.. Here is my take on treatment.

Premenstrual syndrome (PMS) is a combination of symptoms that many women get about a week or two before their period. Most women, over 90%, say they get some premenstrual symptoms, such as bloating, headaches, and moodiness.

PMS is frequently associated with menstrual cramps. In this case, the first thing to do is to determine whether this is primary or secondary dysmennorhea (pain with menses).

Primary dysmenorrhea is simply pain with menses with no determined physical cause. Secondary is pain with a medical cause, such as endometriosis - which requires treatment.

The easiest way to determine this is a three month treatment of oral contraceptives. If the dysmenorrhea goes away, then a diagnosis of primary dysmenorrhea can be made. If not, then further investigation is needed.

In my experience, PMS is frequently brought on or exacerbated by stress - merely the thought of impending pain will cause the pain to be worse - the dreaded "curse". Which makes sense - who would look forward to pain every month.

When the diagnosis of primary dysmenorrhea is made, then an office visit reassuring the patient that this is a normal phenomenon, and nothing to worry about, will markedly decrease the pain and anxiety associated with PMS. Then I advise supplementing this with a mild tranquilizer, such as Librium or Centrax. This has the advantage over antidepressants in that tranquilizers can be taken only as necessary, as opposed to the latter which need to be taken daily. Women do not do well on antidepressants in my experience - mostly because they can cause weight gain, which women hate. In my experience these are overused, when reassurance and an occasional tranquilizer will be more effective.

At this point, in cases of primary dysmenorrhea, a decision to continue the oral contraceptives can be made, further decreasing the pain associated with PMS.

It should be mentioned that all contraceptives are not created equal. My preference is a low dose, low progesterone pill. If necessary, different ones can be tried until they are will tolerated. Different people react to different o.c.'s.