As if all the other HIV-related symptoms aren’t bad enough, then you get the heaviest bleeding and worst premenstrual problems you’ve ever had,“ says Chicago PWA Monica Brown (name changed). ”Cramps from hell, horrible bloating, painful breasts and ’If you look at me sideways, I’ll snap your head off’ irritability and moodiness. What could be more fun?"

Brown’s not alone. Many women with HIV experience a worsening of premenstrual syndrome (PMS) symptoms -- not only those suffered by Brown but leg and back pain, headaches, anxiety and depression. And extensive research has shown that two thirds of HIV positive women have menstrual irregularities (irregular or skipped periods, bleeding between periods, and changes in blood flow), probably due to alterations in the body’s production of estrogen and/or progesterone. The cause remains unknown.

Comprehensive diagnosis can rule out other possible causes and determine whether these irregularities are due to abnormally low hormone levels. If hormones are the problem, birth control pills can be quite effective in normalizing bleeding -- but check on possibly dangerous interactions with other drugs you’re taking. (Many women with HIV also experience either menopause or perimenopause at younger-than-usual ages; for these women, lower-dose hormone replacement therapies, not birth control pills, are used.)

In addition, many women find that acupuncture often brings speedy relief from both menstrual pain and cramps. So do therapies involving rubbing certain energy points -- Therapeutic Touch, Touch for Health and reflexology -- all of which you can do yourself.

For the PMS symptoms, nutritionists commonly recommend several supplements and dietary changes. The lower end of the supplement-dosage ranges suggested below might be appropriate throughout the month for those who regularly experience PMS symptoms, with increases to the higher end appropriate for four to six days prior to the period, if necessary.

Calcium. According to a 1991 study, women whose daily diet contained 1,300 mg of calcium reported an easing of such symptoms as water retention and moodiness. Since the average woman gets only 550 mg daily from food, and the diets of many HIV positive women -- especially those with lactose intolerance -- lack calcium-rich dairy products, it may be useful to take 1,000 -- 1,200 mg of calcium citrate per day. Even in those without lactose intolerance, it may be preferable to reduce dairy and use dark, leafy greens as the major food source of calcium, since some physicians have reported increased menstrual cramps and heavier bleeding in women who consume a high volume of dairy products.

Other supplements. Taking 500 -- 1,000 mg per day of magnesium often eliminates painful cramping, along with the leg and back pain that frequently accompanies it. Magnesium is also particularly useful for the irritability and moodiness that many women experience. For both moodiness and water retention, vitamin B-6 (25 -- 50 mg, three times per day) and potassium (100 -- 200 mg, two to three times per day) are often effective. For painful or swollen breasts, daily doses of 800 -- 1,200 IU of vitamin E seem to be very effective. And research has shown that two borage oil capsules with each meal may provide enough gamma-linolenic acid (GLA) to improve both the emotional and physical symptoms of PMS.

Serotonin-boosting foods. According to research at Massachusetts Institute of Technology, foods that increase serotonin levels in the brain can help reduce PMS-related tension, depression, anger and confusion. Any foods that raise the blood levels of tryptophan, an amino acid key to serotonin production, will work. Included are low-fat, high-carbohydrate foods such as toast with jam or hot cereal, and protein foods such as turkey. An improved mood should follow.

Reduce salt, caffeine and alcohol. Lowering salt intake can decrease water retention. Since many prepared foods are high in salt, try to cook from scratch and shop for salt-free or reduced-salt foods. Cut back on caffeine, known to increase anxiety and irritability in those with PMS. Remember that caffeine is found not only in coffee and tea, but also in chocolate and in many soft drinks and over-the-counter medications. Alcohol has been shown to worsen headaches, fatigue and depression in PMS sufferers; if you drink, don’t do it during the premenstrual week.

A nutrient-rich diet and the supplements discussed here have definitely changed Monica Brown’s life for the better. Her painful cramping, water retention and swollen breasts are a thing of the past. And the moods? “Let’s put it this way: My husband built a shrine to my nutritionist. He no longer has to leave town for a week every month.”