PMS: ‘Not all in the mind’

Though Pre- Menstrual Syndrome (PMS) affects many women the world over, it is not well understood. For decades, doctors have dismissed symptoms of the disease as the result of depression, unhappiness or even mental instability. Increasingly, however, it is being recognized as a genuine complaint. This month, MediScene speaks with Dr. Nalinda Rodrigo, Consultant Obstetrician and Gynaecologist, about how you can recognise and cope with PMS.

PMS is the name given to the physical and psychological symptoms that appear regularly in the days just before a period, but recede with the onset of the menstrual flow. Though many women consistently experience PMS the world over, it is still difficult to categorise or quantify - each woman experiences it differently and to a different degree. In fact, some women may find that they experience different symptoms with every cycle, and even the intensity of the symptoms may vary.

While a few women suffer intensely, complaining of debilitating symptoms that interfere with their ability to lead a normal life or be productive, other women remain blissfully unaware, and have no symptoms whatsoever. Between these two extremes lie the majority whose symptoms are relatively mild, and consequently easier to live with.

No one knows the exact cause of PMS. However, it is believed to be closely connected to the fluctuations in sex hormone levels and arrangements that occur throughout the menstrual cycle. Such fluctuations occur in men as well even in the absence of a menstrual cycle, however, in women they tend to be more acutely felt.

PMS is clearly not "all in your mind". However, it must be understood for what it is - a mixed set of individual responses to the natural process that is the menstrual cycle. Lists of PMS symptoms are lengthy indeed, with more than 150 entries. Fortunately, most women will experience only a few at a time. The most common symptoms are:

In addition, existing conditions such as asthma and allergies can become worse during this period.

Diagnosing PMS is often a process of elimination. Very few of its symptoms are exclusive to the condition and doctors must first eliminate all other possible causes including depression, stress, thyroid gland problems (under-activity or over-activity) and anaemia before they can settle on a diagnosis. Patients themselves must be very careful not to blame PMS for every mood swing or physical discomfort.

Key to arriving at a reliable diagnosis is close observation of the menstrual pattern. The patient must make note of her physical and emotional condition not only in the build-up to her period but also, for the purposes of comparison, on a day-to-day basis. This 'diary' will help a physician quantify the degree and nature of the condition.

A doctor may also use extraneous, harmless substances like contraceptive pills to knock out or completely stop the hormonal changes in the body. If the symptoms improve, a diagnosis of PMS can be confirmed, and the symptoms can then be attributed to that rather than to the emotional make up or mental state of the woman.

Simple measures, like reducing caffeine and nicotine intake, while keeping to a diet that's low in salt and fat but high in fibre, may help some women. Regular exercise and plenty of uninterrupted sleep is also considered beneficial as PMS is sometimes aggravated by stress.

However, if your symptoms are so serious that they encroach on your ability to lead a normal, happy, productive life, you must seek medical advice. In such cases, your gynaecologist may recommend hormone treatments - the contraceptive pill, for instance, may be helpful. Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant drug often used to treat depression and anxiety, may also be prescribed.

In serious cases, some doctors may advise a patient to remove her ovaries during hysterectomy as this can be effective in some cases as a method of controlling the range of PMS symptoms. This method, however, has its detractors and is widely considered controversial.

Removing your ovaries is a big step. It precipitates menopause in women who haven't yet reached it naturally and is widely believed to increase the risk of osteoporosis unless women employ hormone replacement therapy (HRT) for some time. HRT carries with it its own risks.

Even though their periods may stop, women who keep their ovaries during a hysterectomy are unlikely to escape PMS as the ovaries continue the hormonal cycle until menopause.