Hello Everyone, I Am New To This Board. I Have Been Reading About Everyone,s Peri Symptoms And Feel Soooo Relieved Because I Have Sooo Many Symptoms And Felt Very Alone....thanks For Sharing....among Other Things I Get Tremor, Shakey, Tingly Feeling All Over, Comes And Goes But Has Been Frequent Over The Past Few Months.....is There Any Way To Relieve This Sensation As It Is Very Weird,,,,this Stresses Me Out The Most...thanks For Listening...p:) :)

Hi Pammcat,sorry you have reached a time in your life that brings you to this board,but welcome!Tell us a bit about yourself.I am 49 yrs. old,been in peri about 5 years,can relate to your troublesome symptoms.I take a multi-vitamin,omega 3,B-complex,2 daily dose aspirin,and several herbal teas.Also take Inderal for high blood pressure and ativan 1 mg.at night.Probably my worst symptom has been and still have problems with is depression/anxiety.Sincerely and God Bless lily

lilypad1 Hi this is pammcat.....thanks for your reply...it sure is a stressful time......i'm 45, an artist , teachers aide, been having symptoms for at least 2 yrs. maybe longer...the tremors are weird and most stressful for me....p

I'm 45 and having so many odd things happening. Unrelenting anxiety. A lot of pelvic pressure. Feelings of having to urinate all the time. My legs feel like they are going to sleep..just after a short time sitting still. Tons of depression..hair thinning out. You name it. Suddenly, I'm feeling old and I hate it!!!

I am so glad to hear from you all:wave: ..though I am sad that we all are here with these problems. I am 45 and having so many symptoms of this thing I can't count them all. I have been having symptoms for about 3 or 4 years now, it started with really really heavy periods and anxiety and just progressively gotten worse. I have terrible digestive issues, anxiety and unpredictabe periods. Anyway, the good news is that we have each other to help us through this stage of life!!
Take Care Everyone...Here's to feeling normal again!!!
Crazy

I have all the same symptons and mine too started with very heavy periods. Also major anxiety. I am on B complex, 3000mg. Vitamin C, fish oil, flax seed oil and a multi-vitamin. I also have ativan as a back up. I hate the feeling of being cloudy and just not feeling right. People don't understand unless they are going through this. When I think back I had very mild symptons about 5 years ago and then the last year started with these periods that are unreal. So heavy I feel like I can't leave the house. (I am a teacher so I do leave the house) My husband had to stop and by me so pants during my very first heavy period when I was bleeding through everything. I was never so scared in my life. Then it stopped the next day and was light and "normal". I now keep everything in my classroom. I have had 11 months of very heavy periods for one day, then 2 or three lights days and then it's over. I have no idea how long this will last. It's an adventure every month. I am so gald I am not alone through this. Marla 20

It's great to have a support forum like this. Seriously! This is just beginning for me and I can't imagine having to go through this for years to come. I just feel awful most of the time. I have no energy to do anything. Does anyone just feel like the lower half of their body is different? It feels dry and it feels very heavy. Almost like it did after you've given birth. If any of you have given birth. It's that feeling like your pelvic area is trying to hold everything in. It's just uncomfortable. Along with the backaches.

I hate this!

Hi, you're not alone. Seems we all have some of the same symptoms. I too have unrelenting intestinal problems, but my biggest is the heavy legs like the other gal. They feel like lead, especially after sitting just a little while, they feel like they won't bend and get cold easily, makes it hard to walk, they feel tight, like my skin won't stretch to flex and move them. Its tough, I always walked for miles and ran up & down stairs all day. This can't be over soon enough!!!!!!!

I am also new to this board. It is a relief to find you all. For the past three months, I have had random/skipped/heavy periods. I have also experienced my first adrenaline surges, often with a rise in heart rate. I was diagnosed with a mitral valve prolapse, which has really remained asymptomatic for 36.9 years, but is now sensitive to the adrenaline rushes -- so at least that's what my doc tells me. I am on a low dose of Toprol, and today I began using a natural progesterone cream.

The scariest part of this is the accompanying anxiety. Thank you all for sharing your stories. I have thought once or twice that I might be going crazy, and I've become panicky when at work, or in the car for a long time. I used to travel more frequently, but the thought of getting on a plane or enduring a long car ride makes me a lunatic. These weird questions like "what if an adrenaline rush comes on in the middle of the trip?" "What if it's a heart attack"?, etc. . . even though tests/EKG, etc have come back normal (except the mitral valve thing, which I've been told "don't worry about it").

Thanks again....

Hi all, i'm also a newbe here,i myself have been having weird symptoms for the past 3 years,first my Dr's thought i had a bleed on the brain,then it was MS,and now because i have missed 3-4 periods out of 6-7 i am going through the "menopause".Apparently it is the early menopause for me as i am 38,my main and most anoying symptom is the "tingling" almost like dull pins and needles,but because it is on,in,arround (not quite sure wich one)my head it really drags me down and i feel like hell most of the time this will normaly last from a few weeks to a few months and i hate it:mad:
My periods when they come are much the same as all yours really heavy for a day or two then they stop and go away,if any one has any great ideas on how to help get rid of this "tingling" i would be most greatfull thanks in advance,hope you are all well,or as well as can be.
kazy68 :)

I have all the same symptons and mine too started with very heavy periods. Also major anxiety. I am on B complex, 3000mg. Vitamin C, fish oil, flax seed oil and a multi-vitamin. I also have ativan as a back up. I hate the feeling of being cloudy and just not feeling right. People don't understand unless they are going through this. When I think back I had very mild symptons about 5 years ago and then the last year started with these periods that are unreal. So heavy I feel like I can't leave the house. (I am a teacher so I do leave the house) My husband had to stop and by me so pants during my very first heavy period when I was bleeding through everything. I was never so scared in my life. Then it stopped the next day and was light and "normal". I now keep everything in my classroom. I have had 11 months of very heavy periods for one day, then 2 or three lights days and then it's over. I have no idea how long this will last. It's an adventure every month. I am so gald I am not alone through this. Marla 20

:)So tell me taking all of the vitamins you have listed, does it help you? I am not bleeding anymore, for at least 10 months this time, but I do suffer from major panic and anxiety. I am also suffering with stomach problems. Is this ALL related to perimenopause/menopause? This is crazy...........I asked the doc and he said yep, but somehow I feel like there are other things going on. I am will to try anything to make these feelings go away. :)

Hi,
Just wondering if anyone has replied to you about your post. I am really very new to the whole peri/menopause thing too. Night sweat, feeling strange down there etc. I have been battling a major yeast infection that is driving me crazy. Starting AZO tablets every day per doc's orders to see if that takes care of reoccurence of these things. Also really dry down there, itchy, no sex drive. Just awful!! So glad for this board and that we can be support for each other.
LS

Hi all, i'm also a newbe here,i myself have been having weird symptoms for the past 3 years,first my Dr's thought i had a bleed on the brain,then it was MS,and now because i have missed 3-4 periods out of 6-7 i am going through the "menopause".Apparently it is the early menopause for me as i am 38,my main and most anoying symptom is the "tingling" almost like dull pins and needles,but because it is on,in,arround (not quite sure wich one)my head it really drags me down and i feel like hell most of the time this will normaly last from a few weeks to a few months and i hate it:mad:
My periods when they come are much the same as all yours really heavy for a day or two then they stop and go away,if any one has any great ideas on how to help get rid of this "tingling" i would be most greatfull thanks in advance,hope you are all well,or as well as can be.
kazy68 :)
i also have the tingle like systoms in my feet and lower part of both legs. i have been through all the tests and nothing is wrong. last month this started 18 days after the wierd double period i had and lasted 2 weeks then just went away. now this month 19 days after a period it started again. this must be hormones or the systoms would not disapear for over a month and occure almost the same amount of time after a period as last month. watch your systoms and see if they are along the same time frame each month.

Hi Ladies,

I too believe I am in perimenapause!!!! I am 47 and am having "over the top" anxiety, depression, dizziness, heavyier than usual cycles, tingling all over, etc. Is there a list of Peri symptoms that you all are referring to? How do I find this list? lets keep this thread going, because I know I could certainly use the support through this time!!!!

Pam

Hi there, I havr read many posts on this site now,well i think i have read them all :D,and a lot of ppl are taking vitamins,do you need a script from your GP to take these vitamins or is it ok to buy them over the counter,i would love to take something that worked or at least helped with what we are all going through,i am only 38,well 39 on the 10th but i dont like to think about that my age just means i am getting old:(,i just cant understand why i am going through this and i have not yet reached 40 i have two sisters older than me who are loving being in their 40's and here is me hating being in my 30's.I know my mom was 39 when she started the meno and went through it for around 12-13 years,she was also quite ill,i remember her passing out on me when we were out shopping one day,any reply on the vitamins would be most helpfull thanks for all your help.
kazy68;)

Dear Kazy, I Feel For You, I Have Experienced All Of Your Symptoms. I Still Get The Tingling Thing But Mildly Now...since I Found This Board I Have Felt So Relieved. So Many Other Women Are Going Through This But Now We Have A Network And Because I Have Others Who Understand My Fears And Symptoms I Am No Longer Fearful And My Symptoms Have Almost Vanished. A Couple Of Weeks After I Started A Complete Multi Vit. My And Extra C On The Side My Symptoms Including The Weird Tingling Had Subsided....i Still Tinglr All Over Except The Head By It Is Very Mild And I Dont Preoccupy My Thoughts With It. Even Though Our Symptoms Are Real They Will Be Magnified When You Sit And Think...thats All I Was Doing Until I Took Control.stay Calm Eat And Drink Soy Giving Up Dairy By 80 % Really Helped Me. I Found The Tingling The Most Frightening....hand In There Pammcat

Dear Pammcat,Thankyou for your reply to my post,i am now definatley going out tommorow to get a multivitamin,like you i feel so much better since reading and joining in on this board,i no longer get worried that there is something seriously wrong with me and when i do get an anxiety atacks they arent so bad,quite mild compared to what i was getting,i have took to waking up every morning and telling myself to LIVE MY LIFE cause for the last 3 years i feel as tho i have just been existing,i feel and know i have missed out on so much my youngest boy was only 6 when all this started and used to ask me every day more than once if i was ok,i used to sit and cry for hours on end and i could see the worry and pain in his face,but surfice to say for the last 2-3 weeks he thinks i have gone totaly mad:D we have had so much fun laughing,watching films togther(mind you there should be a limit on how many times you have to watch the simpsons movie lol :D) and putting the Christmas tree up was fab we all did it together this year,you can imagin what it looked like for the last 3 years as the other half put it up for me lol,so now i can see my life turning round,i know i will get bad days but i intend to get on with what i can on the good days,and like you i think it is great that we have other ppl to talk to that are going through the same thing,and i am so glad that i know now that it is not all in my mind. I will catch up with you soon thanks again Kazy x :angel:

Dear Kazy.....soooo Glad You Feel Better...remember You Are Not Alone And Can Network Anytime Happy Holidays ........pammcat

Hi Ladies,

I too believe I am in perimenapause!!!! I am 47 and am having "over the top" anxiety, depression, dizziness, heavyier than usual cycles, tingling all over, etc. Is there a list of Peri symptoms that you all are referring to? How do I find this list? lets keep this thread going, because I know I could certainly use the support through this time!!!!

Pam

HI PAM
I AM ALSO 47 AND HAVE THE SAME SYMTOMS AS YOU. THIS TINGLING IN MY LEGS IS WIERD AND THE CRYING AT TIMES FOR NO REASON THIS IS REALLY HORRIBLE. I REALLY THINK MENOPAUSE IS JUST A BAD JOKE. WE HAVE PERIODS FOR 40 PLUS YEARS AND HAVE THE PAIN OF GIVING BIRTH ALL FOR THIS LOL. I WOULD ALSO LIKE TO KNOW WHAT CAN RELIEVE THESE HORRIBLE SYMTOMS

Hi all,i wish there was a quick fix for all this,the past few days or nights i can not sleep every half hour to an hour im awake then it takes me another hour to drop of again,i can not even begin to tell you all how this had made me feel during the day i am totaly exhausted,i could sleep all day and im sure i would not wake up but when it comes to bed time i start to get anxious and keep saying to my self i hope i get a good nights sleep,then of cause this makes me worse :mad: my eyes are constantly sore and running all through the day because i am tired,i sure do wish i was ME again,but in the end i have to go on the house will not clean its self :( i wiish it would tho till next time keep well and hopefully sweet dreams kazy x

hi kazy
i know how you feel. i wake up a number of times all night and also have night sweats if not sleeping is not bad enough. i wish this would be over with and i could go back to the way i used to be. the only good thing we will all get out of this is no more periods. but when that will happen we can only hope soon. well happy holidays to all and thaks for posting on this website. it's nice to know that i am not the only one with these problems.
michelle

there really is no list that decribes all of our systoms. when i found this website i had been searching every where for my systoms but some i just could not fine. then i found this website and many women have the same systoms as me and you. i told my doctor and he said he had never heard of some of the systoms like the tingling but other women have the same tingling i have and that makes me feel alot better. i don't think enyone really understands perimenopause. keep in touch
michelle

HI MICHELLE...UNFORTUNATLY MANY DR'S ARE NOT FAMILIAR WITH MANY SYMPTOMS but we as women know what we are feeling. i have had the tingling..i hate it ...for apx.1 yr on and off..my periods have changed and everything else..i know it is all hormonal....as for a list that some of us reffer to...that was an old posting on this board and tingling is on it..i have had 32 of the 35 symptoms on that list dont care what a doc...especially male...says i know it is hormonal...it is not so uncommon and we can network here....mine subsided drastically i know it is from the vitamins, takes a couple of weeks though.....hang in there...pammcat

Hi Pammcat
Thanks For Your Responce. I Agree That Most Doctors Just Dismiss Our Systoms And Think It Is In Our Head. Have You Had Any Dizziness ? Also What Kind Of Vitamins Do You Take? In The Past Many Years Ago They Made Me Sick So I Just Don't Take Them But I Am Willing To Try Anything Right About Now.

Michelle.....hi....i Started Taking A Multi For Women.... I Got It From The Vitamin Shop..if You Ask They Will Help You With Finding A Complete Formula For Menopause...they Are Very Complete And Will Kick In At Apx 2 Weeks I Also Take An Additional 500mg Of Vit C....i Was Very Anxiety Ridden And Felt Doom For A Long Time Had Heavy Tremors Throughout My Body...yuck....i Got Slightly Dizzy At Times Not To Much But That Is A Common Symptom In Peri. I Just Felt Weird Alot And Had Many Other Symptoms.....they Have Really Subsided...i Try To Drink Soy Milk Daily And Backed Off Of Dairy, Had Lots Of Digestive Problems....all Are Soooo Much Better....read Some Of The Old Entries On This Board...you Will Learn Alot And Feel Less Frightened....you Are Not Alone....take Care....pammcat

pammcat
thanks for your reply. i will try the vitamins and see if it helps me. my B12 was a little below normal and i am not sure if a multivitamin will be enough. i will ask and see what kind of suggestions the vitamin store can give me. are you still perimenopause or have you stopped having periods and are now in menopause? my periods are all over the place and i can't wait for them to stop.

Hi all, I dont know if it is me but since the peri started when my monthly period is due i am in more pain than ever my abdomen is agony and my back well most the time i think it has broken,dont know if anyone has this one tho,just underneath my shoulder blades the muscles are that tight that it feels as if they are coming out of my chest and i have to keep taking deep breaths,i get out of breath so easily it feels as if my muscles are pushing against my lungs i know it sounds weird but that is just how it feels,anyone else with this one could you please drop me a line and give me some idea on how to relieve this one it is agony i hate feeling out of breath all the time,i wouldent mind but it will only last a few days sometimes weeks then it will go away again for a few months but when it rears its ugly head i hate it thanks kazy ;)

Dear Kazy....i Know The Torment Of Feeling Weird.....i Didnt Have Your Pain But For Months The Back Of My Neck And Across Both Shoulders Were So Achy And Stiff....strange Like Arthritis Kind Of...i Read Some Info On That Symptom...neck Stuff Along With Many Other Things Is A Symptom Of Peri At This Time In Life....its Like A Shoulder Lock....not Sure If This Is What You Feel But It Was At Times Agonizing....much Better Now...all Symptoms Are...my Allergies Have Been Horrible As Is My Post Nasal Drip...over The Past Year...common For Allergies To Become Severe....just Feel Strange Alot....not So Bad Anymore...im 45 And Have Had Symptoms That Im Aware Of For Apx.3 Yrs...my Eyes Always Feel Odd...eye Stuff Is Also Common As I Have Read...for Me, A Mega Menopausal Multi Vit And Extra C Daily Made A Big Difference For Me After A Couple Of Weeks......hope This Is A Bit Helpful....take Care...pammcat

Thanks Pammcat,i can always tely on you for an answer :D ,dont know now what i would do without you,you always put my mind at ease,it is so great to have someone there and you know they will answer your questions if they can,of cause that is you,:D, thanks again for all your help with what ever i put down here it is so much appreciated by me and of cause all the other women who post here,Pammcat you are a lifesaver :angel:

Does anyone cry at anything and everything that is the least bit emotional?

Hi jlbrow,the answer to your question is most definatley yes,i will cry at anything just thisevening i was watching a program on T.V called Strictly Come Dancing,its where profesional ballroom dancers are dancing with celebrity's well this week its the semi final,and there are only 3 celebs left and they had to do 2 dances each,and yes you've guessed i cried after each dance,my hubby bless him,said they were good enough to cry at,i think he said it just to make me feel better,so the answer to your question is most definatley yes from where i am ;) kazy

Hi All,hope you are all doing ok,me well i'm not to bad at the min,the breathing is still rough im hoping it will subside for Christmas,i would realy love to enjoy this this one for the past 3 years it has been wuite rough.
I went to visit my GP todayroutine visit more pills required as usuall,he asked if all was well to witch i replied not bad just broke out in spots every where chest,legs,face,arms,bottomand stomach,after he checked them out he gave me the great news that i have got chicken pox,great 39 going through peri and got chicken pox lol,i got to laugh or i will cry. I would just like to wish you all a fab Christmas and an even better new year,hopefully symptom free,or at least mostly free Merry Christmas all.:angel: kazy xxxxx

Dear Kazy....am Happy To Help You Feel At Ease...have Been Soooo Busy With The End Of School...in College To Teach Elementary School...tonight Is My Last Class And My Last Test....hooray....glad I Could Help.... Giving Someone Info. Doesn't Cost Anything And I Went Through My Stuff Alone For A Loooong Time Just Do For Someone What You Feel I Have Done For You...pay-it-forward...........feel Free To Ask Away Anytime...pammcat

Hello All,

Regarding the perimenopause/menopause symptom list, I have just about all of them--irregular periods, irritability, irregular heartbeat, no sex drive, shrunken breasts, clear vaginal discharge now and again, dizziness/poor equilibrium/feeling off balance, tired late in the day, sleep disrupted, etc.
I have been to cardiologists, internists, etc. They all say everything is normal. My ob/gyn tested my hormones and said that they're normal. How can they be normal if I have all of these symptoms?
Help anyone? I'd appreciate it!

Merry Christmas All!
I just joined because I wanted to find out more about perimenopause.
I feel like I am so old and I am only 46. In March I found out my job was being cut due to a buy-out. That's when the changes really started to get my attention. I was clock work every 27 days. Of course my first thought was stress. I changed jobs and hated it. So stress again. Then in late august I found a new job. I started the day after Labor Day. Love the new job. Period still not right.
I am married and not on birth control. I took it years ago and had nothing but problems. I mentioned in March I noticed the changes. I missed my period for 2 months. I have been pregnant 3 times. One was a miscarriage and the 2nd & 3rd were tubules. The last one I lost a tube but the doc said I could still get pregnant and to watch out. You can imagine my thoughts! I took 5 pregnancy tests at home! All negative. I am averaging a short period every 2-3 months since. I finally decided to go to the Doc. I have an appointment on Jan 3.
I have been having problems in the past years with what I called hot flashes. They are nothing like I have heard so I brushed them off. I would all of a sudden get all hot and flushed with dizziness. I went to the doc and she said I was having accumulated anxiety attacks. I had one while I was there. She put me on anti depressants and I am still on them. That was maybe 5 years ago?
Since March I have noticed that I tear up and cry at the drop of a hat. It is getting worse each week. Also I have been having what my mom says is rheumatoid arthritis. So far she, my sister & brother have it. Siblings are younger than I. Doc did the tests and they come back negative on me. First my hips hurt terribly. Seems it was around that time of month when it was the worse. I told the doc and she could not explain it. Then it was my elbows, wrists and now my feet. It seems to move around. Mind you, when it moves around to another place it stops in the last until lately. Now I get tingly, asleep feeling in my feet and they are swollen very badly and I get a sharp pain in the heels. My arms and wrists get the same tingle. Sometimes in my wrists & thumbs it is like a catch and I feel it pinch and then it is ok. In the morning ny feet hurt the worse. I look like a woman of 80 all bent over. After I rest and am off them it happens all over again. If I am on them for long periods of time they start to really hurt. I went to an RH doc and he said it is not RH.
My last symptom is my bladder. It seems to be not working as well as it used to when I sneeze or cough. I found when I get the urge to go I better or I am in trouble.
Thanks for reading and my apologizes if I went on and on.
Again, Merry Christmas!!
Jb

Hi All, :)
Hope you all had a great Christmas,mine was quiet,very quiet,mainly down to me,my period came on the 23rd three days late(not to bad this month),but i have been unbareable for the whole time it has been here, Xmas eve i was the most evil person snapping at anyone that got in my way,i did apologise to all of them but it did'nt make me feel any better,Xmas day i was'nt to bad we were at my mums for lunch so i put on a brave face and had a laugh and joke with all,but when i got home i was back to being evil again and i have been this way ever since,today was the worst myself and my hubby went a walk round the shops for an hour and came back screaming and shouting at each other all because my cousin asked us to go to her house for a few drinks(she only lives 7 doors away)but i couldent be bothered to go,i really do feel absolutley aufull,shouting and screaming at ppl especially my family,and of cause letting them down,i hate feeling like this i have noticed over the last couple of months my temper is getting more and more frayed when i get my period,i feel i have ruined Xmas for everyone around me and i have no idea how to put it right i want to be nice nast is'nt me but as the words come out my mouth it is not what i want to say and i dont know where it comes from any help or advice on this one would be great,thanks.
Kazy :(

I think the bladder problem is my biggest issue now. I've had a lot of UTI's in the past 6 months. And I never got them before. It's like my whole pelvic region is very sensitive. They say I don't have an infection anymore but I'm still having problems. It feels like I'm always trying to hold it in. It's just uncomfortable. And I'm bloated all the time. Even when I hardly eat anything. My weight is slowly creeping up..I've heard that topical estrogen cream can work to stregthen things up down there as it everything thins out with the fall of estrogen. This is truly a nasty thing to go through. Why didn't my mother tell me about this?

I turned 52 in November 2007 and to date, it is 84 days and counting since my last period! I am keeping my fingers crossed that is does not come back again and I can go the whole year, so I can finally say, I've reached menopause!
I have low back pain, disturbed sleep at times, occasional hot flashes, though not severe, some pelvic pain at times, yeast infections that come and go, unable to lose weight, foggy memory at times, etc....the whole gamut!

Adrianna

Thanks for sharing on the "one heavy day, then light days" scenario. This happened to me in late 2006 and again this week and it scared me. Other than really, really light spotting in December (which I don't count), I went 115 days until a period this week, and the way it was different really scared me. I also felt so weak when it happened. Anyone else get that?

Hi Everyone, I just joined the forum today.

I think I am going through the perimenopause, as for the last year my periods have been heavy, and for about the last 6 months I've been getting blood clots with my flow. When I have been ovulating I've had some awful pains with it, and since January I've had 3 periods, on 4th Jan, 21st Jan and the 2nd Feb, but the last two were lighter. I've had the shakes, night sweats (that started about 3 weeks ago) which wake me up every night now. Sometimes I get tingling in my hands like pins and needles and I hate that! I'm also so forgetful, and just yesterday I had my first case of feeling really dizzy. I can't say I'm urinating more, as I've had that problem since I've had my children.

My breasts are fuller and very tender (wish they'd stay fuller! LOL) and I also feel bloated and fat. I know I have water retention. I'm only 37 though! :confused:

However, it is so good to come here and be able to talk to people about it, who are also going through it.

Thanks for listening.

I can relate to your symptoms Jebelote, my bones and joints hurt so much sometimes in my feet I can hardly walk as well as everywhere else, I have put this down to hormones. Everything is hormone related. Unfortunately I also have an under active thyroid which doesn't help either.
The Bladder department is also failing when coughing/sneezing, it's just one of those things. I suppose eventually they will go, just when I don't know! I wish they would hurry up.
I also feel so bloated most of the time, which is so uncomfortable. The bowels don't seem to work too well either recently. I too have tingling all over sometimes.
Have you ever had your thyroid checked? Might be worth it.
Pam