For affected women and their families, premenstrual syndrome is no laughing matter. It can destroy relationships and wreck lives.
Premenstrual Syndrome is the name given to a group of physical and behavioural symptoms that occur in the second half of the menstrual cycle (after ovulation). The most severe form of this is called Premenstrual Dysphoric Disorder ('dysphoric' means sad).
Up to 75% of women with regular cycles may suffer to some degree or other from Premenstrual Syndrome, with around 5% of these women having the more severe Premenstrual Dysphoric Disorder. Exact figures are unclear, as inclusion criteria vary from study to study. However, some countries seem to have higher prevalence rates than others and New Zealand is in the group of higher rates.
The two main hormones involved in the menstrual cycle are oestrogen and progesterone. Their levels change continuously throughout the cycle. Various tissues in the body are sensitive to these changes including chemicals in the brain which affect mood, in particular the chemical serotonin. Women who are affected by Premenstraul Syndrome or Premenstrual Dysphoric Disorder seem to show an abnormal response to the normal hormonal changes of the menstrual cycle.
If you think you may have Premenstrual Syndrome or Premenstrual Dysphoric Disorder, your GP will ask you to keep a diary of symptoms. Symptoms typically start a week prior to the period and last until a few days into the period. There is a noticeable absence of symptoms from days 4-12 (day one being the first day of bleeding). Premenstrual Syndrome or
Premenstrual Dysphoric Disorder is unlikely to be the cause if symptoms persist between days 4-12.
Some of both behavioural and physical symptoms (listed below) are required for diagnosis of Premenstrual Syndrome/Premenstrual Dysphoric Disorder.
- Bloating
- Breast tenderness
- Acne
- Headache
- Gastrointestinal upset
- Hot flushes
- Palpitations
- Dizziness
- Behavioural
- Extreme fatigue
- Irritability
- Tension
- Depressed mood
- Unstable mood
- Increased appetite
- Forgetfulness and difficulty concentrating oversensitivity; angers or cries easily
Before diagnosing Premenstrual Syndrome or Premenstrual Dysphoric Disorder, it is important to exclude other medical conditions. These include irritable bowel syndrome, migraine, anaemia and an under or overactive thyroid gland.
Studies have also shown that considerable numbers of women (up to 40%) presenting for treatment of presumed Premenstrual Dysphoric Disorder, actually have a mood or anxiety disorder, which includes clinical depression. It is important to make the distinction, as treatments differ.
treatment for premenstrual conditions
Just keeping a diary is a positive move. This allows both you and your family to see the cyclical nature of the symptoms - that there is a pattern, a medical problem, and that it’s not just mum being an unreasonable ogre! Get your family on side and involve them in making some lifestyle changes.
Start a diary on a daily basis over several menstrual cycles and if you find it difficult to be objective about your mood and behavioural symptoms, ask your family members to help by keeping their own record about you. You may not like what you read, but it’s all a step in a positive direction.
- Whether you are taking contraceptives.
- What and when you eat.
- When and how much you smoke or drink.
- Your stress levels.
- At what stage of your menstrual cycle you first notice symptoms of PMS.
- The amount and type of exercise you do.
diet and exercise
- Make sure you eat regularly and sensibly, including plenty of fresh fruit and vegetables.
- Exercise regularly. Exercise helps in a number of ways. A daily walk at least five times a week for 30 minutes is relaxing and releases natural anti-depressants (endorphins) into the system which in turn reduce your stress levels.
- Get a good night's sleep.
The abovementioned simple conservative measures have no side effects, do not cost anything and may go a long way to improving harmony in the home.
Vitamin and mineral supplements (magnesium, calcium, Vitamin E and Vitamin B6) are possibly helpful, but trials are still inconclusive at this stage.
for more severe cases
SSRIs
This group of drugs is known as the Selective Serotonin Reuptake Inhibitors. They work by increasing serotonin levels in the brain. The most commonly used is Fluoxetine (Prozac). It has proven beneficial effects and in some cases needs only to be taken in the second half of the menstrual cycle although it may take a few cycles before it starts to work.
alprazolam
This is used much less frequently and is generally reserved for the more severe cases of Premenstrual Dysphoric Disorder. It is good in controlling the depressive symptoms but has less effect on the other symptoms listed above. It can be addictive and, for this reason, should only be taken during the second half of the cycle.
oral contraceptive pill (OCP)
This stops the ovary from producing eggs and in effect, mimics the hormonal environment of pregnancy. Anecdotal reports suggest that Prementrual Syndrome symptoms resolve during pregnancy so in theory, taking the OCP should be beneficial. Controlled trials to date have been inconclusive. It may be worth trying, especially if contraception is also required.
diuretics
The drug Spironolactone is the most widely investigated but, again, study results have not shown consistent results. There are other drug options, but their use is limited because of side effects. Your doctor will be able to tell you more.
for further information
Talk to your GP, Practice Nurse or Family Planning Centres as they can assist with information. Some have group sessions on PMS. Telephone numbers of your nearest branch are in the telephone directory. Some hospitals offer specialist PMS clinics - ask your doctor for a referral.
Dr Kirstie Peake, Obstetrics and Gynaecology Specialist
