Thursday, March 10, 2016

Pelvic Pain; PMS or beyond with the blues?

Guest blogger Elizabeth DeLozier SPT from SDSU
March 2016

Pelvic Pain can be due to many causes, with Physical Therapy at CTS treating myofascial, postural, biomechanical, and post injury (trauma, surgery) related pelvic pain. Often times we notice a cyclical nature of pain flares over the course of treatment, and some of our clients have a strong hormonal influence over the pain, related to PMS, or a more intense cyclical pain cycle PMDD.
We did some research this month to assist our clients who are presenting with cyclical pain flares that can be improved with Physical Therapy, Lifestyle and Nutritional interventions. Discuss the items listed below with your health care provider. Let us know if you suffer with PMS or PMDD and what you have found to be helpful.


What is PMS?
PMS, or pre-menstrual syndrome, is a broad term referring to physical, emotional, and psychological changes which affect women 1-2 weeks before their menstrual cycle and ease when they begin their period. Approximately 30-80% of women of reproductive age experience PMS. Symptoms include abdominal bloating, headaches, increased or decreased appetite, muscle aches or joint pain, fatigue, depression, and irritability.

What is PMDD?
PMDD, or pre-menstrual dysmorphic disorder, is a more severe form of PMS that affects approximately 3-8% of reproductive-age women. PMDD is characterized by significant mood disturbances and irritability which impair occupational and social interactions. The major risk factors of PMDD include a history of mood or anxiety disorders, familial menstrual or pre-menstrual disorder, and age in the 20’s or 30’s.

What causes PMS and PMDD?
Although researchers are unsure of exactly what causes PMS and PMDD, many women suffering from these disorders may have underlying anxiety or depression. Some researchers believe that the hormonal changes that trigger the menstrual cycle may worsen the symptoms of mood disorders. A recent study found that many women who exhibit signs of PMDD have low serotonin levels. Serotonin is a neurotransmitter involved in controlling mood, attention level, pain, and sleep. Women who believe they may have a mood disorder should talk to their doctor about treatment options.

Diagnosing PMDD
The best way to confirm a diagnosis of PMDD is charting daily symptoms. Women suffering from PMDD will experience a symptom-free phase between menses and ovulation. Well-validated studies on using symptom charting for the diagnosis of PMDD can be found below.

Non-pharmacologic treatments for PMS and PMDD can include:
  • Lifestyle changes and nutritional supplements:
  • Decrease nicotine, tobacco, and alcohol use in the 2 weeks prior to menstruation
  • Decrease sugar, caffeine, and sodium intake in the 2 weeks prior to menstruation
  • Ensure adequate rest: at lease 6-8 hours a night
  • Regular aerobic exercise has been shown to be beneficial for women suffering from PMS or PMDD.
A large, multicenter study found that 1200 mg of calcium per day significantly decreased emotional and physical symptoms of PMS and PMDD.

Studies have found that vitamin B6 in doses of 50-100 mg/day are beneficial for women suffering from PMS and PMDD

Herbal supplements:
There is some evidence that 200 mg of magnesium and 400 IU of Vitamin E per day can decrease symptoms.

A recent double-blind, placebo-controlled study found that 1 tablet of chasteberry extract, also known as agnus castus fruit, significantly decreased PMS and PMDD symptoms of irritability, headache, anger, and breast fullness.

Gingko Biloba has been found to decrease fluid retention and breast fullness associated with PMS and PMDD.

More info about PMS and PMDD can be found at: