Since premenstrual syndrome is so complex and so difficult to treat, you can start at the most basic level by doing things that may help you and certainly won’t hurt you.

Many women are helped merely by charting their lives and recognizing patterns in the way they feel. If you have the luxury of organizing your own time and activities, set up your schedule so that on the days you know you are going to feel irritable or bloated, you won’t be doing things to raise your stress level. If you know you are not going to be the most delightful person starting Tuesday the 23rd, don’t plan to have a college interview, an aggravating meeting with an incompetent employee, or a birthday party with your 8-year-old son’s dozen best buddies.

Charting can also be diagnostic. Suppose after a couple of months of monitoring yourself and looking for cyclical patterns, you notice that you feel depressed, irritable, and anxious every day. Because premenstrual syndrome is in the media and therefore on everyone’s mind, you have automatically assumed that your bad moods are cyclical. When you start charting, you may discover that they are not. In fact, you may have depression — which is less acceptable socially than premenstrual syndrome and not usually helped by premenstrual syndrome therapies. We are fortunate that today there are good medications for depression. If you do chart your symptoms and find that you are depressed more than half the month, you and your doctor should try to get the correct diagnosis and treat you for that. An antidepressant will work a lot better than treating your depression as premenstrual syndrome. Therapy may help as well.

Another major step in helping yourself through premenstrual syndrome is to eat so that you get close to your ideal body weight; the closer you get, the better you will feel in terms of general health, whatever time of the month and whatever your age. If you need to lose weight (and it’s a lot easier to talk about ideal body weight than to get there and stay there), try to stick to a relatively low-fat, general-weight-loss diet. Keep your calorie intake high enough to maintain your health, and try to lose weight gradually.

I encourage women who have premenstrual syndrome symptoms to avoid concentrated carbohydrates (like cookies), stay away from chocolate bars if you can manage to suppress the cravings, keep fat intake low, and cut down on salt and caffeine. Decreasing salt intake reduces the bloating associated with fluid retention, and limiting caffeine helps both with breast discomfort and with the caffeine-induced jitters. My standard line is that if your body, like Audrey, the carnivorous plant in the Little Shop of Horrors, shouts “Feed me! Feed me!,” you have to respond negatively. If you eat the candy bar, you will feel worse with the extra sugar on board. If you eat the salty potato chips, you will increase your tendency to bloat.

Regular exercise is another key. It is good for you even if it turns out not to help your premenstrual syndrome. Researchers have discovered substances called endorphins, natural opiates produced by your brain, which make you feel better just as antidepressant drugs do. Endorphins are produced in greater amounts during exercise and account for the phenomenon known as a runner’s high. Since premenstrual depression is an issue for many who have premenstrual syndrome, the endorphins generated through exercise will probably help these women feel better. The goal is a half hour of aerobic exercise (getting your heart rate to about 75 percent of its maximum capacity) three times a week. This is a goal, not a limit; if you feel like exercising more frequently, so much the better.

Lucy feels out of sorts every month before her period. She decides to start running to see if it will help her to control her negative feelings. She begins with short distances but finds that the more she runs, the better she feels. Eventually she becomes a marathoner and completes the New York marathon several times. With her newfound energy, she later takes up karate. She is now extremely fit and generally serene all month long.

Not every woman who takes up exercise to control premenstrual syndrome will end up as a marathoner or earn a black belt, but Lucy’s example shows very clearly that exercise can have a real effect on premenstrual syndrome.

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