Premenstrual syndrome (PMS) or Premenstrual Tension (PMT) as it was formerly known describes a range of symptoms that occur every month, during the second half (luteal phase) of the menstrual cycle, and disappears when your period stops.

Approximately 90% of women suffer from some form of PMS, 35% of whom say PMS significantly interferes with their lives. The most common age for PMS to develop or worsen is in the mid thirties. Several factors are thought to influence its severity; these include stress, genetics, age, number of children, diet and chronic disease.

There are over 200 symptoms associated with PMS; the most common symptoms include irritability, depression, mood swings, breast tenderness (mastalgia), backache, bloating, and changes in appetite and food cravings.

Some women with severe PMS, have emotional and behavioural symptoms, which can catastrophically interfere with their daily life and relationships, this is called Premenstrual Dysphoric Disorder (PMDD).

There are several different treatment options for this condition. As PMS can have such a major impact on your quality of life, relationship with your partner, children family & friends, it is important that you recognize it. Please attend your GP or Dr Orla Conlon, Consultant Gynaecologist at Marble Arch Health who has a special interest in this condition.

The most important aspect to the diagnosis and treatment of PMS is making the correct diagnosis. The best way to do this is to keep a record of your symptoms for 2-3 cycles to see a pattern emerging.

A symptom questionnaire (an example can be downloaded from the National Association for Premenstrual Syndrome website) is recommended for documenting the symptoms.

Before any medical treatment is started life style changes should be addressed.

• Diet
  There is no definitive evidence that diet alone can cure PMS. Some changes in diet though may help 
  
  
• Carbohydrates
  Some women have massive carbohydrate cravings while suffering PMS, particularly chocolate and sweet food. Eating more complex carbohydrates, particularly those with a low glycaemic index (Low GI) are thought to help reduce symptoms 
  
  
• Caffeine
  Some research as well as women experiences have shown that drinking caffeine was strongly related to PMS. In women with more severe symptoms, the effect was greater. It is thought that caffeine can increase tension and irritability and therefore should be avoided if possible 
  
  
• Salt
  Reducing salt intake is thought to help prevent bloating 
  
  
• Fat
  A low fat diet is also recommended to help maintain a healthy weight 
  
  
• Exercise
  Women who have an active lifestyle who participate regular exercise are less likely to suffer from PMS

Many women get a lot of benefit from spending time with a Counsellor or Psychologist. This is also an important aspect of the management of PMS/ PMDD

• Combined oral contraceptive pill ‘The pill’
  This stops the ovaries being stimulated, making a difference to the second half of the cycle 
  
  
• Oestrogen patch
  With Progesterone tablets during second 2 weeks of your menstrual cycle, again preventing a change in the second half of the cycle 
  
  
• Antidepressants
  During the second half of the menstrual cycle, if depressive symptoms are major 
  
  
• Injections
  (Gonadotrophin releasing hormone analogues) effectively puts your body into the menopause, preventing your ovaries being stimulated, causing a difference in the second half of the cycle. Women taking this injection do get symptoms of the menopause; such as hot flushes and night sweats. A form of hormone replacement therapy (HRT) can be given in tablet form daily to overcome these symptoms. This treatment option works well for many women.
  
  
• Removing both ovaries (Bilateral oophorectomy)
  This is usually left as a last resort but for many women it is the only option particularly women suffering from PMDD.
  Your womb can also be removed at the same time (hysterectomy). This will only be carried out after careful consideration between you and your Gynaecologist. You will be required to have a trial f the ‘GNRH Analogues’ first which will show if removing your ovaries will make a difference to your symptoms. You will also be required to take HRT afterwards to prevent hot flushes and night sweats and to protect your bones. This is replacing what your body would have been producing anyway and will not increase your risk of breast cancer.

Dr Orla Conlon recognises the severe condition of PMDD and has supported many women through surgical treatment to change their lives

Research & Women’s experiences have shown some benefit of taking the following vitamins and minerals to reduce the symptoms of PMS. These will not help all women but may be considered as an additional treatment option.

Vitamin E: 400IU/day, particularly breast tenderness

Magnesium: 250-400mg/day, particularly fluid retention, high doses may cause diarrhoea

Calcium: 1000mg/day

Isoflavones (Phytooestrogens found in Soya & red clover): 68mg/day, particularly headaches, breast tenderness and swelling

Herbal Products
A variety of herbal products have been suggested, BUT NOT PROVEN for the reduction in PMS symptoms. These include, black cohosh, blue cohosh, wild yam root, St John’s wort and dong quai. ( caution: some of these products may interfere with other medication)

Agnus Castus (Chasteberry) is the only herb that has been clinically proven to be of benefit in the treatment of PMS. In Germany 20mg of Agnus Castus is approved for the treatment of PMS. However, it is unclear whether similar preparations available in the UK have little side effects with the same reduction in symptoms of PMS.

National Association for Premenstrual Syndrome: www.pms.org.uk