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What is premenstrual syndrome?
Around 90 per cent of menstruating women get advance warning of an approaching period because of physical and/or psychological changes in the days before their period begins.
For most women the symptoms are mild, but a small proportion finds their symptoms so severe they dread this time of the month.
The terms ‘mild’ and ‘severe’ in respect of PMS are arbitrary, but relate to the extent of disruption to your home and work life that's attributable to the monthly cycle.
About a third of women say PMS significantly affects their life, with 5 to 10 per cent classifying their PMS as severe.
Symptoms of PMS
There are more than 100 recognised symptoms that may be due to PMS. Fortunately, most women experience only a handful of problems. The most common symptoms are listed below.
- Psychological
- Irritability.
- Mood swings.
- Losing your temper easily.
- Loss of confidence.
- Crying for no particular reason.
- Aggression.
- Poor concentration.
- Tiredness.
- Physical
- Breast tenderness.
- Abdominal swelling or bloating.
- Weight gain.
- Swollen ankles.
- Headaches and possibly migraine.
None of these symptoms is exclusive to PMS. They can be caused by other conditions such as depression, stress, thyroid gland problems (under- or over-activity) and anaemia.
How do I know if I have PMS?
While blood tests and urine tests are helpful in making sure there isn't another cause for PMS symptoms, there is no test that can diagnose PMS.
Instead, diagnosis is based upon the type of symptoms and when they occur. The symptoms of PMS have a fairly consistent relationship with the start and finish of a period, which is an essential clue to the diagnosis.
However, it is possible to have more than one problem at the same time, so care needs to be taken by doctors not to ‘blame the hormones’ too quickly.
Most women with PMS notice a gradual worsening of their symptoms during the week running up to their period, with a rapid or gradual disappearance of symptoms when their period starts.
But sometimes symptoms can persist during your period or even for a couple of days after it has finished.
To help doctors diagnose PMS, it helps to keep a diary of your symptoms and their severity over a few consecutive months.
A cyclical pattern should be apparent, and a diagnosis of PMS is usually only made if there are 10 consecutive symptom-free days
When should I seek treatment?
It is not exactly known what causes PMS. Common sense indicates it must somehow be linked to the fluctuating levels of female hormones experienced after ovulation. But the subtleties of why some women are more affected than others are not understood.
Normal fluctuations in  hormone levels are responsible for some of the symptoms most commonly associated with the monthly cycle, such as bloating, breast tenderness or headaches.
Women who suffer from PMS may possibly have a lower than normal level of a certain chemical in their brain (serotonin), which may explain some of the non-physical symptoms such as irritability, depression and mood swings.
PMS is not caused by any underlying abnormality with the pelvic organs.
When should I seek treatment?
Recognising your symptoms are due to PMS is an important first step.
For the majority of women, the symptoms are a minor inconvenience you can recognise, anticipate and deal with yourself.
You may seek reassurance from your doctor, but do not necessarily need or want treatment. The value of such a discussion can be high and result in significant improvement in your symptoms.
For a minority of women, PMS is serious enough to affect work, daily life and relationships. If this sounds like you, you should see your GP to discuss your problems, possibly with a view to some treatment.
Women with severe symptoms who have not responded to simple treatments might wish to see a specialist. This usually means a gynaecologist, but a psychiatrist with a particular interest in treating severe PMS can sometimes be more appropriate.
What treatments are available?
There are many treatments for PMS, most of which have some short-term benefit. However, few provide relief for longer than a few months.
Treatment will depend upon the nature of the symptoms and their severity.
For many women, simple changes to diet and lifestyle, reducing alcohol and caffeine intake and cutting down on cigarettes will make the monthly symptoms more bearable. Your GP can give you guidance in this.
A suitable diet sheet is available via the National Association for Premenstrual Syndrome (NAPS) at www.pms.org.uk.
Non-hormonal treatments
Vitamin B6
This is also known as pyridoxine. It is commonly recommended for mood swings and irritability.
There is some scientific support for its use for mild symptoms, but you need to be careful not to take too high a dose. It is advisable to consult your doctor before starting treatment.
Evening primrose oil (EPO)
Capsules of EPO can be helpful in alleviating premenstrual breast pain in some women. However, the evidence in favour of its effect is slight and it has been withdrawn from NHS prescription for this reason.
There are some more non-hormonal treatments as well as hormonal treatments, please ask your GP for further information. There is also some treatment for severe PMS
Surgery
For a small minority of women, surgical removal of the ovaries is the only measure that will allow them to continue a normal existence, free of PMS.
This is a major and still controversial step to be considered carefully by you, your GP and gynaecologist.
Once the ovaries are removed, you must be prepared to take hormone replacement therapy (HRT) until at least the age of 50.
Because it is such a drastic step, the use of LHRH analogues are usually used first - effectively non-surgical ways of putting the ovaries out of action. If this treatment works well, there is more chance surgery will be effective.
Many gynaecologists will not operate for PMS alone, but will do so if there are additional problems, such as uncontrolled heavy menstrual bleeding, for which surgery is going to help.
Written by Dr Philip Owen, consultant obstetrician and gynaecologist for netdoctor.com
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