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combined oral contraceptive pill, which evens out the normal fluctuations in the female hormones estrogen and progesterone, can ease PMS symptoms by blocking ovulation. Some women obtain relief by taking diuretics (drugs that remove excess water from the body); eating a diet that minimizes consumption of caffeine (including from chocolate), sugar, alcohol, red meat, and salt (which can increase water retention and bloating); and taking calcium, magnesium, vitamin B complex, and vitamin E supplements. Regular exercise and adequate rest also can help diminish PMS symptoms. Antidepressant drugs called selective serotonin reuptake inhibitors (see page 712), which modify levels of the brain chemical serotonin, reduce PMS symptoms in many women and can be taken at lower doses and for shorter periods than those prescribed for depression.

If your symptoms are not relieved with these measures, your doctor may prescribe mild pain relievers or tranquilizers to take on the days when your symptoms are most severe. If you have persistent depression that occurs at other times (not only before your periods), your doctor may refer you to a psychologist or psychiatrist.

Abnormalities in Sex Hormone Production

Several hormones regulate the menstrual cycle. Each month, the hypothalamus, deep in the brain, produces chemicals called releasing hormones. Releasing hormones pass into the pituitary gland at the base of the brain and stimulate the production of pituitary hormones, which in turn cause the ovaries to release an egg. These hormones also stimulate the production of the female sex hormones estrogen and progesterone in the ovaries.

A number of factors can throw this hormonal cycle out of balance. For example, stress, extreme weight changes, excessive exercise, drug abuse, or a severe illness can affect the hypothalamus, altering the production of releasing hormones. In rare cases, some brain disorders such as a brain tumor can affect the hypothalamus. Rare disorders of the pituitary gland and ovaries also can affect hormone production.

Symptoms

The main symptom of abnormal sex hormone production is infrequent or absent menstrual periods (see page 846). If the problem resides in the pituitary gland, other symptoms—such as the abnormal production of breast milk, irregularities in growth, thyroid problems, or underactivity of the adrenal gland—also may occur.

Some disorders of the ovaries or adrenal glands cause an overproduction of the male sex hormone testosterone, which is also naturally produced in women. Excess testosterone can cause hair growth on the face and body, deepening of the voice, acne, and weight gain.

Diagnosis

If your periods have become irregular or have stopped completely, your doctor will perform a pregnancy test. If the test shows that you are not pregnant and you have missed fewer than three periods, the doctor may recommend returning after you have missed three periods, especially if you want to become pregnant. He or she will then perform a thorough physical examination to determine if an underlying disorder is causing the problem. If your doctor suspects an underlying disorder, you may need to have blood and urine tests to evaluate your hormone levels, and a CT scan (see page 112) or MRI (see page 113) of your pituitary gland.

Treatment

The treatment for abnormal sex hormone production depends on the underlying cause. Treatment may include some type of hormone therapy, such as oral contraceptives or progesterone medication.

Menopause

Menopause is the period in a woman’s life when menstrual cycles and ovulation stop permanently. The term perimenopause is often used to describe the transition phase that occurs during the 3 to 5 years before menopause. After menopause, your body makes much less of the female sex hormones, especially estrogen. In the years leading up to menopause, your menstrual cycle changes and your periods may become irregular as your hormone levels rise and fall. Eventually your periods stop altogether. Doctors consider menopause to be complete when a woman has not had a period