Some 50 years ago, my late mother wrote in a psychosomatic journal that there is a strong clinical relationship between the triad of: postnatal depression, premenstrual syndrome and severe menopause symptoms. These 3 recognised gynaecological sets of symptoms can cause extreme misery, and result in depression. Sadly 50 years later, many women remained unsupported with no clinical support. This was made worse during the lockdown and the recent pandemic.
PMS is common and affects between 3-30% of women, and is likely to be under reported in ethnic minorities. The incidence of severe PMS or PMDD, the more severe form (premenstrual Dysmorphic Disorder) is lower at 5%.
The NAPS website(www.pms.org.uk) has a very useful symptom chart diary which will need to be filled in over 2 cycles, to confirm the diagnosis.
My colleagues have now identified over 150 symptoms: but the most common are:
Psychological:
Mood swings, depression, tiredness lethargy and irritability. Anxiety a sense of loosing control. A loss of cognitive ability, extreme anger. Insomnia and food disorders.
Physical:
Breast pain, occasional skin rashes, headaches, back ache and some women complain of bloating and constipation.
PMDD (premenstrual Dysmorphic Disorder) is an extreme form of PMS, and both resolve after a period.
PMS does not occur before puberty and after the menopause.
PMS is a gynaecological condition which develops with distressing physical behavioural and psychological symptoms which are not due to any organic or psychological disease, and regularly recurs during the luteal phase of the menstrual cycle, and disappears by the end of menstruation.
The cause of PMS is still uncertain, but occurs as a result of the effect of cyclical ovarian activity and the effect of both oestradiol (an oestrogen) and progesterone on certain neurotransmitters. We know this because women do not experience PMS before puberty and after the menopause. It is the crescendo increases and reductions in oestradiol will lead to an increase in hormone dependent depression in an at-risk woman.
Researchers have definitely shown that the risk for the extreme variant of PMS, premenstrual dysmorphic disorder is associated with a genetic variation in the ESRI gene.
What treatments can help PMS?
Once the diagnosis has been confirmed, women who experience symptomatic PMS should seek advice. I advise my patients to read the PMS Naps website, it offers so much useful information.
Vitamin Supplementations
I routinely offer women Pyridoxine (Vitamin B compound), at dose of 50mcg daily. This has shown to offer some women symptom benefit.
Some women may also benefit from magnesium supplements.
The pandemic taught us the importance of vitamin D deficiency, and in my practice I routinely measure Vitamin D levels, which have been shown to be lower in women with PMS. Weekly vitamin D supplementation can reduce the risk of PMS.
Alternative Treatments
Can also be taken, including St John’s Wort, and Agnus Castus. Evening Primrose Oil which contains linoleic acid has been shown to be ineffective for severe PMS, but helps cyclical mastalgia.
Medical Treatments
can be used to suppress ovulation and to improve serotonin metabolism.
The newer combined oral contraceptive pill.
Transdermal oestrogen with a cyclical progesterone.
Mirena coil.
GNRH analogues.
We now know that serotonin is an important molecule in the aetiology of PMS, and should be considered as a treatment option for severe PMS.
Premenstrual Syndrome (PMS) FAQ's
Can PMS be treated with cognitive behavioural therapy (CBT)?
CBT should be considered as a treatment option.
Does vitamin D supplementation reduce PMS symptoms?
PMS symptoms are improved with vitamin D supplementation.
Is evening primrose oil effective for severe PMS?
No this treatment does not work.
Can I have a hysterectomy performed on women who has severe PMS?
A hysterectomy with bilateral salpingo-oophorectomy and HRT support remains an option.
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