Premenstrual Syndrome

Many women experience bothersome symptoms in the days and weeks before their menstrual period begins.  There are more than 90 different symptoms that have been described as part of premenstrual syndrome.  Some of those symptoms include irritability, fatigue, depression, low mood, bloating, weight gain, breast tenderness.  For some women, the symptoms are so severe that they become debilitating.  Normal PMS would be described as mild to moderate and should not last for more than 3 days.

What women often don’t realize is that these bothersome symptoms might indicate an underlying hormonal deficiency, called a luteal phase deficiency.  This deficiency is not only responsible for their bothersome symptoms, but could actually increase their risk of a miscarriage if they became pregnant.


Many women who seek treatment from their gynecologist or family doctor for their PMS symptoms are dissatisfied with the care they received.  They are not told about the possible presence of a luteal phase deficiency and its implications for their future pregnancies.  They express concern that the doctor recommended simply “covering up” the symptom by suppressing the natural menstrual cycle with a hormonal contraceptive.  Women worry about the side effects of hormonal contraceptives and especially about the increasing evidence that long-term use of hormonal contraceptives increase their risk of certain kinds of cancer, such as breast cancer.

The Gianna Approach

Doctors at the Gianna Center recognize severe or prolonged PMS symptoms as a sign of a possible luteal phase deficiency of the hormones estradiol and or progesterone.   They educate the patient about her body and what happens when she has a luteal phase deficiency.  Testing may include hormonal tests, ultrasounds of the uterus and ovaries and sometimes more advanced imaging such as MRI.   Once a diagnosis is made, treatment is directed at correcting the underlying problem to restore health and normal function.  This results in improvement in PMS symptoms and a comprehensive plan is developed for when the patient begins to try to conceive a pregnancy, with the goal of preventing miscarriages due to a luteal phase defect.

Patients interested in finding out whether their PMS symptoms are normal or abnormal, what their symptoms might indicate, or who are looking for an alternative to hormonal contraceptives to manage PMS are encouraged to schedule an initial consultation at their local Gianna Center.  For patients who do not have access to a Gianna Center in their community, several Gianna affiliates offer remote consultations by phone.