Understanding and Treating Premenstrual Syndrome

What is Premenstrual Syndrome?

Premenstrual Syndrome is a chronic medical condition estimated to affect over 9 million women in the UK. Of these, up to 800,000, will experience severe PMS or PMDD (Premenstrual Dysphoric Disorder) that will interfere significantly with their physical, psychological, social and economic well-being.

An accurate diagnosis of PMS, is determined by documenting symptoms and recording menstruation, on a monthly chart over two or preferably three cycles. There is no one pattern in the way symptoms present but they can begin to occur at ovulation and can continue to the day of the heaviest flow in menstruation. Sufferers then can expect to be symptom free for up to two weeks or more, depending on the length of cycle and  when symptoms usually present; however, if the cycle is only 21 days long, any improvement may be barely noticeable.

Around 240 different symptoms have been identified. These will also be experienced by people who do not have premenstrual syndrome but the difference is that the symptoms can be experienced by them at any time and will not be gender related. A PMS sufferer will experience a number of symptoms which will not present during the follicular or pre-ovulatory phase.

Common PMS symptoms are Psychological: depression, anxiety, irritability, acute tension, mood swings, feelings of hopelessness, anger, panic attacks, forgetfulness, tearfulness, poor concentration, fatigue, aggression Physical: asthma, epilepsy backache, breast tenderness, weight gain, headaches, skin problems, bloating, sweet cravings, binge-eating.

The precise cause of PMS remains unknown but ‘cyclical ovarian activity and the effect of estrodial and progesterone on the neurotransmitters, serotonin and gammo-aminobutyric acid (GABA) appear to be key factors ‘( Royal College of Obstetrics and Gynaecology Green Top Guide ). PMS frequently first presents at times of hormonal change; in puberty, following childbirth ( many women who experience Post Natal Illness go on to develop PMS ) miscarriage or termination, starting or stopping the contraceptive pill, following sterilisation.

Treating Premenstrual Syndrome

Mild to moderate PMS may respond to lifestyle changes such as taking exercise and following a diet suitable for PMS sufferers as recommended by NAPS. However, severe, PMS will necessitate consultation with the General Practitioner and may later involve referral to a specialist. Whatever medical treatment is prescribed the suggested dietary guidelines should also be observed to ensure successful management of PMS.

The Royal College of Obstetricians and Gynaecologists has produced a comprehensive guide to the treatment of PMS for health professionals, in one of their Green Top Guides and this can be accessed on www.rcog.org.uk.

For severe PMS the following possible treatment regimen is suggested:

Line 1
           Exercise,Cognitive Behavioural Therapy, Vitamin B6
           Combined.new - generation pill (cyclically or continuously)
           Low dose SSRI’s either continuously or in the luteal phase
Line 2
          Estrodial patches (100 micrograms ) and oral progestogen
          Higher dose SSRI’s either continuously or in the luteal phase
Line 3
          GnRH analogues with addback HRT
Line 4
          Total abdominal hysterectomy with bilateral oophorectomy + HRT
          (including testosterone)

There are a number of complementary treatments which may help alleviate PMS. They include : Reflexology, Vitamin B6, Magnesium, Nutritional supplements, Calcium/Vitamin D, Isoflavones, Agnus Castus, St John’s Wort, Pollen Extract, Evening Primrose Oil and Light Therapy. On the data available on trials relating to these the best exists for Calcium/Vitamin D, Magnesium and Agnus Castus.

It is, however, difficult to assess how helpful complementary therapies are because they are freely available without prescription  and without recommendation by a physician, with little regulation for efficacy or safety. Most are not licensed or registered for the treatment of PMS. 

The National Association for Premenstrual Syndrome ( NAPS ) is a registered charity founded in 1983 which is the only patient advocacy group for PMS sufferers in the world. It provides continuing information and support to PMS sufferers and their families and is also committed to working with health professionals and promoting research, so as to ensure a wider awareness of PMS and appropriate treatment for those who suffer from it. www.pms.org.uk.