Reply separately to two of your classmates posts (See attached classmates posts, post#1 and post#2). Instructions: - Reply # 1: Consider discussing cervical cancer and discharge on your reply. - Reply

POST # 2 DANIKA

NOTE: For your reply, consider elaborating on the statement - "Many women report food cravings and increased appetite during the luteal phase (Kwan & Onwude, 2015)."

Topic: Premenstrual Syndrome (PMS)
In order to understand and treat premenstrual syndrome (PMS), it is important to acknowledge what is happening with the female hormones during this phase of the cycle. PMS symptoms are most commonly reported during the week before menstruation which is known as the luteal phase (Kwan & Onwude, 2015). Progesterone starts to rise in the beginning of this phase along with a slight increase in estrogen and testosterone. Toward the end of the luteal phase if the egg has not been fertilized, all three hormones reach their lowest point which usually correlates with PMS symptoms (Vitti, 2020). Estrogen has shown antidepressant effects in women and changes in estrogen are related to pain transmission, headaches, temperature regulation, and mood (Cunningham et al., 2009; Rybaczyk et al., 2005). The onset of depression in women is often correlated when estrogen is low like early in pregnancy and menopause or low in comparison to progesterone as in the luteal phase of the female cycle (Rybaczyk et al., 2005). 
A woman is diagnosed with PMS if she reports recurrent psychological and/or physical symptoms during her luteal phase. These symptoms can include irritability, depression, anxiety, abdominal bloating, breast tenderness, sleep disturbances and headaches (Kwan & Onwude, 2015). According to Kwan and Onwude (2015), there has not been a consistent way to diagnose severity of PMS because there are a variety of scores and scales and a lack of randomized controlled trials (para. 1). The American College of Obstetricians and Gynecologists (2015) recommends keeping a log of symptoms to confirm a PMS diagnosis. 
Both the American College of Obstetricians and Gynecologists (2015) and Institute of Functional Medicine (2020) suggest addressing lifestyle and diet changes to manage mild to moderate PMS symptoms. Regular exercise, adequate sleep, and stress management are all factors in maintaining healthy hormone regulation (American College of Obstetricians and Gynecologists, 2015). Diets should be focused on nutrient dense foods with an avoidance of sugar, caffeine, and alcohol. Many PMS symptoms are due to nutrient deficiencies that can be prevented with a nutrient focused diet. Studies have shown diets higher in calcium and vitamin D reduced PMS symptoms in women (American College of Obstetricians and Gynecologists, 2015; Institute of Functional Medicine, 2020; Vitti, 2020). Magnesium is essential for cortisol regulation, blood sugar balance, sleep, thyroid function, and eases constipation which is one reason for PMS bloating. When vitamin B6 is low, hormonal acne and fatigue are more common in the luteal phase (Vitti, 2020). Supplements many be needed if women have difficulties incorporating all nutrients into their diet. 
Many women report food cravings and increased appetite during the luteal phase (Kwan & Onwude, 2015). This is a completely natural occurrence because metabolic rate increases during the phase which increases energy expenditure (Solomon et al., 1982). This requirement for more calories is because the female body is preparing for the potential demands of pregnancy if the egg is fertilized (Vitti, 2020). During this phase, the APRN should advise women to eat nutrient dense complex carbohydrates, like roasted root vegetables, to decrease binging on less nutritious food and keep blood sugar stabilize to prevent energy dips that contribute to mood swings (Vitti, 2020). 

Severe PMS symptoms can be classified as premenstrual dysphoric disorder (PMDD) (Cummingham et al., 2009). If diet and lifestyle modification do not improve PMS, underlying hormonal dysfunction should be explored for issues like thyroid disorders, insulin resistance, and PCOS. Antidepressants like serotonin reuptake inhibitors may be taken intermittently or throughout the cycle for PMDD (Cummingham et al., 2009). It is a common thought that having a menstrual cycle means suffering through PMS symptoms. The cyclical nature of women’s bodies requires flexibility throughout the month in areas like diet, exercise, and rest. As an APRN, it is my goal to empower women to learn about their cycle and understand their bodies in order to harness the innate capabilities of female hormones and reduce negative symptoms like PMS. 
The Institute for Function Medicine has provided “A Functional Medicine Approach to PMS” found at 
https://www.ifm.org/news-insights/womhorm-functional-medicine-approach-pms/. 
Another resource for managing PMS is found at https://www.acog.org/patient-resources/faqs/gynecologic-problems/premenstrual-syndrome. 
References
American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS). Retrieved June 29, 2020, from https://www.acog.org/patient-resources/faqs/gynecologic-problems/premenstrual-syndrome
Cunningham, J., Yonkers, K. A., O'Brien, S., & Eriksson, E. (2009). Update on research and treatment of premenstrual dysphoric disorder. Harvard review of psychiatry, 17(2), 120–137. https://doi.org/10.1080/10673220902891836
Institute of Functional Medicine. (2020). A Functional Medicine Approach to PMS: IFM. Retrieved June 29, 2020, from https://www.ifm.org/news-insights/womhorm-functional-medicine-approach-pms/
Kwan, I., & Onwude, J. L. (2015). Premenstrual syndrome. BMJ clinical evidence, 2015, 0806.
Rybaczyk, L. A., Bashaw, M. J., Pathak, D. R., Moody, S. M., Gilders, R. M., & Holzschu, D. L. (2005). An overlooked connection: serotonergic mediation of estrogen-related physiology and pathology. BMC women's health, 5, 12. https://doi.org/10.1186/1472-6874-5-12
Solomon SJ, Kurzer MS, Calloway DH (1982). Menstrual cycle and basal metabolic rate in women. Am J Clin Nutr. 36(4):611-616. doi:10.1093/ajcn/36.4.611
Vitti, A. (2020). In the FLO: Unlock Your Hormonal Advantage and Revolutionize Your Life. New York, NY: HarperCollins.