For Buckhead resident Daniela Staiculescu, the trouble began a few years ago, right after she stopped taking the birth control pill.

Between three and seven days before her period started, she would experience jolts of sharp pain in her abdomen. Depression and moodiness would set in. "I couldn't be a normal friend or wife or anything else because I was not myself," she says.

Far from being abnormal, the symptoms that Staiculescu experienced—-commonly referred to as premenstrual syndrome or PMS —- may affect as many as 85 percent of women of childbearing age, according to some estimates. And yet women often suffer in silence with pain and emotional difficulties that are severely hampering their quality of life.

However, those who are willing to track their symptoms, and work cooperatively with a sympathetic medical provider, can usually find relief —- in many cases through simple adjustments in diet or lifestyle.

Make mental and physical notes

While it is not entirely clear what causes PMS, most experts believe it is related to hormonal changes that occur in the second half of the menstrual cycle. Such fluctuations tend to affect women in different ways, so the condition can be difficult for medical providers to pin down. A large constellation of non-specific symptoms is associated with PMS, ranging from physical signs such as breast tenderness, bloating, abdominal pain and extreme fatigue to mood changes including irritability, depression or tearfulness.

The key to associating them with PMS is timing, according to Dr. Genevieve Fairbrother, department chief for obstetrics/gynecology at Northside Hospital.

"To be considered PMS, those symptoms have to occur in the luteal phase, which begins after ovulation (midcycle). This is essentially the week before your period," explains Fairbrother, noting that she will usually talk with the patient about what she is experiencing, when it's happening and whether it gets better within two days of their period starting. She cautions that some medical and psychiatric problems can get worse or magnified right around the period. "The key is if you have any symptoms at any other time other than right before the period, then it is not considered PMS."

The timing of symptoms is so central to diagnosing PMS that Dr. Carla Roberts, an assistant professor of gynecology and obstetrics at Emory University School of Medicine, recommends that women track their symptoms in writing so that they can spot whether there is any regularity to the times of the month when they occur.

"We have a menstrual diary that has 17 or so symptoms, and we actually have people rate their symptoms [using 1, 2, 3, or 4] according to severity," says Roberts, noting that this type of information can help a woman more effectively communicate to her provider that she really is suffering.

"When the physician sees it written down, in many cases [the pattern] can be very clear," says Roberts. "Then it hits home for them, and that is how we have come up with a lot of our treatments."

Find what works for you

There is, in fact, a wide array of treatment options for PMS, but Roberts acknowledges that every woman needs to find what works for her. "Some things work for some patients and don't do anything for other patients. And then there are other patients ... who will respond to a very odd treatment that no one else would even think of using."

Not wanting to take any type of prescription medication, Staiculescu eventually found relief from her PMS though a regimen of acupuncture and Chinese herbs. Her Atlanta-based acupuncturist, Dr. Li Liu, says she gets clients complaining of PMS almost every week, and she typically includes a healthy dose of lifestyle guidance in her treatment plan.

For example, she recommends regular exercise, and she asks women to stay away from coffee, sweets, spicy food, processed food and alcohol. "The diet plays a very important role because whenever people eat a bad diet, you just worsen the problem," the acupuncturist says.

It makes sense to try simple behavioral modifications first, but when such efforts fail to provide adequate relief, there are other options. For women who experience mainly physical symptoms, for example, Fairbrother notes that contraceptives that inhibit ovulation will often help to reduce breast tenderness, bloating and swelling. Patients with severe mood symptoms often respond to an antidepressant medication, she says.

In fact, Fairbrother observes that troubling mood changes are what typically prompt women to seek medical help —- more so, in her experience, than the physical symptoms.

"Sure, women want to stop the bloating, the breast tenderness and the swelling, but it's the not liking who they've become that forces the issue," she says.

TRACK YOUR SYMPTOMS

Because timing of symptoms is key to diagnosing PMS, some medical professionals recommend keeping a diary, noting when symptoms occur and rating their severity on a scale of 1 to 4. This information can help your doctor spot if there is any regularity to the times of the month when they occur. If there is a pattern, he or she can help you find a treatment.

DATE

SYMPTOM

SEVERITY

acne

breast tenderness and swelling

feeling tired

having trouble sleeping

upset stomach

cramps

bloating

constipation

diarrhea

headache

backache

appetite changes or food cravings

joint or muscle pain

trouble concentrating or remembering

tension, irritability, mood swings or crying spells

anxiety

depression

Clip 'n' keep!

TRY CHANGES IN DIET, ADD SUPPLEMENTS

While dietary modifications are unlikely to offer a total cure for PMS, some nutritional strategies help to relieve certain symptoms, according to Lona Sandon, M.Ed., R.D., an assistant professor at the University of Texas at Brownsville, and a spokeswoman for the American Dietetic Association.

> Hold the salt. If bloating is a problem, the first thing to do is "take your salt shaker off the table and look at what kinds of foods you are choosing," Sandon says. "Extra salt helps to hold water in the body."

> Eat smaller, more frequent meals. For mood problems such as irritability, consider adjusting your meal timing. "Try to eat every four hours, so that may mean even having a snack or two at midday so that you are keeping those energy levels consistent throughout the day," says Sandon.

> Don't skip the carbohydrates. Sandon notes that they have been linked to the release of serotonin, which is a calming type of neurotransmitter in the brain. Opt for carbohydrates that have a slow release of energy such as whole-wheat bread or whole-grain cereals rather than refined sugars that may give you a quick short-lived boost.

> Limit alcohol and caffeine. Both can negatively affect mood problems associated with PMS, according to Sandon, so it makes sense to limit or avoid them, especially during the week or two before you get your period.

> Eat foods rich in omega-3s. These fatty acids —- which are plentiful in fish, walnuts and flaxseed oil or can be taken via supplements —- can have a positive impact on mood.

> Consider taking a calcium supplement. For severe cramping, some people find that calcium supplements offer relief. Sandon explains that this is because calcium and potassium help muscles contract and relax. Calcium might also help to reduce food cravings as well as lower back pain, she adds.

> Discuss other options with your doctor. There are, in fact, many types of supplements on the market, and some of them are healthy and effective, but they are not subject to regulations the way medications are in this country. Sandon stresses that it is always a good idea to discuss them with your doctor.