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Pre-Menstrual Syndrome (PMS), Pre-Menstrual Dysphoric Disorder (PMDD) and Integrative Mental Health by Les Cole, MD & Delene Cole, LMFT

Do you have PMS?

Pre-Menstrual Syndrome (PMS) affects up to 75% of women. 20 – 40% of women have seen a medical doctor (often Ob-Gyn) for PMS symptoms. But if you have seen an alternative practitioner, these numbers are probably low


The symptoms of PMS are many and varied, generally begin/occur between 2 weeks before your period to a few days after and include:


  • Abdominal bloating
  • Acne
  • Angry outbursts
  • Anxiety
  • Appetite changes
  • Asthma attacks
  • Avoidance of social activities
  • Backache
  • Bladder irritation
  • Bleeding gums
  • Breast swelling & tenderness
  • Bruising
  • Clumsiness
  • Confusion
  • Conjunctivitis
  • Constipation
  • Cramps
  • Cravings – salt/sweet
  • Crying spells
  • Decreased hearing
  • Decreased productivity
  • Decreased sex drive
  • Depression
  • Distractibility
  • Dizziness
  • Drowsiness
  • Eye pain
  • Facial swelling
  • Fatigue
  • Fear of going out alone
  • Fear of losing control
  • Finger swelling
  • Food sensitivity
  • Forgetfulness
  • Aches & pains
  • Headache
  • Herpetic outbreak
  • Hives or rash
  • Hot flashes
  • Alcohol sensitivity
  • Sensitivity to light & noise
  • Inefficiency
  • Indecision
  • Insomnia
  • Irritability
  • Joint pains
  • Leg cramps
  • Leg swelling
  • Mood swings
  • Nausea
  • Palpitations
  • Panic Attacks
  • Poor coordination
  • Poor judgment
  • Poor memory
  • Poor vision
  • Restlessness
  • Ringing in ears
  • Runny nose
  • Seizures
  • Sinusitis
  • Sore throat
  • Spots in vision
  • Suspiciousness
  • Tearfulness
  • Tension
  • Tingling in hands & feet
  • Tremors
  • Visual changes
  • Vomiting
  • Weight gain


If you have any of these symptoms during this time period, you likely have PMS.


Many times the following PMS symptoms are diagnosed as Psychological or Psychiatric problems and are treated with Psychiatric medication like anti-depressants or anti-anxiety medications.


  • Anxiety disorder
  • Depression
  • Seizure disorder
  • Panic attacks
  • Agoraphobia
  • Eating disorders
  • Various personality disorders



If you have PMS, the most likely cause is Estrogen Dominance. This is an imbalance between Estrogen and Progesterone in your cycle. This can be easily measured with a salivary hormone test. Once these 2 hormones are rebalanced, the majority of symptoms improve. This corrects the underlying problem and helps to prevent you from having increased risk for endometriosis, fibroids, ovarian cysts, infertility, miscarriages, birth control pill side effects and breast cancer in the future.


How do you know if you have PMDD? Is it the same as PMS, just worse?

Premenstrual Dysphoric Disorder (PMDD) affects approximately 5% to 8% of cycling women. There are still many medical practitioners that don’t believe PMDD exists. If you have PMDD and sought help, you may have been told this, or worse, that you are depressed or have a mental health problem. Most practitioners, who acknowledge the existence of PMDD, believe this to be the same process as PMS, just worse – like PMS2 or PMS on steroids. It is not the same condition. It is a different condition altogether.


If you have severe “Psychological” (Emotional) symptoms such as


  • Depression
  • Anxiety
  • Irritability
  • Feeling overwhelmed or out of control
  • Mood Swings
  • Sensitivity to rejection
  • Social withdrawal
  • Sudden sadness or tearfulness
  • Seizure disorder
  • Panic attacks
  • Agoraphobia
  • Eating disorders
  • Various personality disorders
  • Bipolar disorder
  • Obsessive Compulsive disorder

that are only present or worse during the 2nd half of your cycle, whether you have any or no physical symptoms, then you likely have PMDD. Because of the cyclic nature of PMDD – it may especially be mistaken for Bipolar disease. If you have PMDD you may have wound up in the Psychiatrist’s, Psychologist’s or Therapist’s office as either your first stop or through referral. Whether diagnosed as PMDD or a “Psychiatric disorder”, it is likely you have been treated with anti-depressants, anti-anxiety or other psychiatric medications and found inadequate benefit.


PMDD is not a Psychiatric disorder so anti-depressants, anti-anxiety or other psychiatric medications often do little to help. It is a hormone imbalance different from the Estrogen Dominance that causes PMS. This imbalance is more pronounced in the second half of the cycle and can cause profound symptoms. Estrogen dominance is not the cause so rebalancing Estrogen and Progesterone won’t help here. If you have PMDD and someone puts you on Progesterone your symptoms won’t improve and may actually worsen. Most Ob-Gyns will prescribe birth control pills, however, there is only one indicated for treatment of PMDD but often is of little use and some birth control pills, shots, creams and patches may actually make things worse. For some women, symptoms are so severe they choose total hysterectomy or even suicide.


There is good news, however. Now PMDD can be treated easily and successfully by regulating the hormonal imbalance that contributes to it.


At times the same cause of the hormone imbalance in PMDD can cause imbalances in other hormones leading to acne, sometimes severe.


And, if you have PMDD, as well, as other typical symptoms of PMS, such as bloating, heavy and/or painful periods, painful or swollen breasts, etc. you could also have estrogen dominance (PMS) that needs correcting along with the proper treatment for your PMDD.


At St. Petersburg Health & Wellness, we get to the underlying problems. Call us at 727-202-6807 to get better answers.


Les Cole, MD practices Functional, Anti-Aging, Integrative & Preventive Medicine and is certified by the American Academy of Anti-Aging Medicine in Functional, Anti-aging and Regenerative Medicine and by the American Board of Integrative and Holistic Medicine. Delene Cole, LMFT is a Marriage and Family & Integrative Mental Health Therapist with additional certifications in Hypnosis, Internal Family systems Therapy and Soul Collage. To learn more about PMS & PMDD and other topics to improve your Health and Wellness, visit, Like us on Facebook, or call St. Petersburg Health & Wellness for an appointment 727-202-6807.

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