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The Premenstrual Syndrome

What is it?

In the past this common, distressing and exclusively female ailment was usually known as pre-menstrual tension (PMT for short). This name obviously put the emphasis on the mental and emotional aspects, which are certainly important, but because there are also so many physical symptoms, it is now more correctly termed pre-menstrual syndrome (PMS for short).

So the pre-menstrual syndrome covers a mixed bag of the mental and physical symptoms, which occur during the second half of the monthly cycle after ovulation. In each individual woman suffering from PMS, the symptoms start each month at precisely the same time. In some this may be only a few days before a period. In others it can start as much as ten or fourteen days before the onset of menstruation. In all cases the symptoms disappear soon after your period starts.  

What are the symptoms?

The physical symptoms of PMS vary from woman to woman and sometimes from cycle to cycle in the same woman. But the ones most often experienced include backache, headaches, and sometimes nausea and vomiting. There is usually some breast tenderness, and what many women describe as a ‘bloated’ feeling, due to water retention. This leads to quite considerable weight gain, varying from a few pounds to over a stone in some severe cases. Some women have to keep special clothes to wear during this period. One woman has described them as her fat clothes.

The psychological or mental symptoms are much more consistent, and most sufferers of PMS seem to experience mounting tension, with depression, irritability and extreme lethargy. At such times women may become clumsy, emotional and accident prone, giving way to bursts of illogical anger, all to often vented on family and husband.

A fuller list of symptoms is detailed below, divided into the clusters, which have been identified by doctors researching the problem. Happily no woman is going to suffer all these problems. But the victim of severe PMS often experiences quite enough of them to destroy the quality of her life for a large part or each month.

Physical

Pain
Muscle stiffness
Headaches 
Stomach pains 
Backache
General aches, Pains and tiredness
Water Rentention
Gain weight 
Skin disorders
Painful breasts
Feeling bloated
Other Physical Symptom
Dizziness/fainting
Cold sweats
Feeling sick or vomiting
Hot flushes

Mental

   
Negative Effect 
Crying spells
Loneliness
Anxiety 
Restlessness
Irritability
Mood swings    
Depression 
Tension
Concentration
Difficulty Sleeping
Forgetfulness
Confusion
Difficulty Concentrating 
Clumsiness
Accidents
Difficulty making decisions
Behavioural Changes
lowered performances
at school/work etc
Take naps/stay in bed
Avoid social life
Loss of efficiency

Although clumsiness and accidents can hardly be properly described as mental symptoms, they may well be the result of confusion and loss of concentration. And to this formidable list should probably be added loss of confidence, and what can be called a sense of rejection or ‘worthlessness’. Women affected in this way dislike themselves and suspect everyone else must feel the same way about them. As well as this wide spread of symptoms, chronic disorders, allergies and conditions such as asthma, epilepsy and migraine and even the common cold tend to recur during PMS phase when both the pain threshold and resistance seem to lowered.

Effect on the family

One of the most worrying aspects for women suffering from PMS is that they know many of their symptoms spill over and affect family, husband and marriage. To the burdens they already carry, this adds to the additional one of a sense of guilt, and yet they feel helpless to do anything about it.

General practitioners confirm, it is often the husband who first registers the onset of PMS in his wife, before the woman herself even realises the phase has begun. One husband has described the effect on normally equable and happy wife as ‘a horrible personality change’.

Feeling physically and mentally wretched can, of course, bring with it considerable loss of sex drive. Added to the effects of irritability and tension this can put considerable stress on marriage, especially when it is repeated month after month.

Effect on work

It is quite clear from many of the symptoms listed that efficiency and vitality are going to be reduced. This has an obvious effect on work, whether within the home, school, college or job.

Irritability, lack of concentration, confusion and loss of confidence can be particularly destructive when working with other people. Victims of PMS may sometimes refuse promotion or stay in less demanding jobs, simply because they know that during the PMS phase they will not be able to cope or may even be forced to take days off. People at work (even the boss) are often forced to recognise emotional or irritable reactions in women, together with a degree of inefficiency, as being related to what they term ‘the time of the month’.

Effect on society

The effects of PMS do not stop at the patient and her family, or even the people she works with. They affect society too, and not just in terms of unhappy or broken marriages, children in care absenteeism or reduced efficiency at work.

Research has also shown that more than 50% of female crime from shoplifting to baby battering takes place during the PMS phase. Study of inmates in one women’s prison showed that 62% of crimes of violence had been committed in the pre-menstrual week, compared with only 2% in the first week after menstruation.

Dr Katharina Dalton, a British doctor who has specialised in menstrual problems, also found that the attempted suicide rate is much higher in the second half of the menstrual cycle, as are convictions for shop-lifting, a crime known to be associated with depression.

Who suffers from PMS?

The majority of women who suffer a minor reaction to the fall in hormone levels precede menstruation. They may just feel a little more tired, irritable, emotional or depressed. Sometimes they also have a touch of backache and slightly sore breasts. All these symptoms are relatively mild, and because they only start one or two days before menstruation and disappear when the period gets underway, it is something, which can be tolerated without worrying the doctor. But at least the experience enables women to understand what severe PMS lasting sometimes as long as two weeks can be like.

It is estimated that some 40%of women suffer badly enough from PMS at times to seek medical help. It may start soon after the onset of puberty or it may only start after the birth of a baby.

There seems to be no particular type of women especially liable to the problem, and the idea that it only affects highly-strung neurotic women has been largely disproved.

Of course, in some cases, the effects of PMS can be superimposed on an existing neurotic state, which surfaces under the double burden. One woman, points out that severe PMS over the years, is enough to actually make women become neurotic.

A British study reported pre menstrual irritability in 25% of single women and in over 40% in married women. This difference could be accounted for by the fact that the birth of a child may often trigger the condition.
Another study among university and nursing students showed 33% experienced typical PMS symptoms, including acute depression, irritability, physical lethargy and uncomfortable bloatedness. A further 58% admitted some milder symptoms.

Old attitudes and treatments

It must now be clear that PMS is not only a relatively common female ailment, but one which can cause a lot of misery and disruption both at home and at work.

In view of this, it is suprising how little attention it has received medically or socially until quite recently. In many ways there are these parallels with the menopause. All to often both ‘the change of life’ and PMS have been dismissed as something women must ‘put up with’.

Evolutionary process?

In evolutionary terms, it seems likely that the human female is still only in the process of adaptation to the peculiarly human system of monthly menstruation, so that PMS may simply be an adverse response to hormonal fluctuations. In view of the fact that it may take several million more years for evolution to iron out this faulty mechanism, it is just as well that research in to PMS and its treatment is now going ahead and processing results.

There has been a tendency in the past for some doctors to identify the problem of PMS as basically a psychological one, and the very name, pre-menstrual tension, once in common use, rather encouraged this.

The temptation to take this point of view is obvious, because the mental symptoms are more consistent and also tend to be the ones that women complain about most to their doctors. This is because they are the ones which spill over most to affect family and job.

Then there is also the fact that while some 40% of women consult their doctors about PMS at some time, the other 60% appear to be able to cope entirely free of symptoms. So the ones that do complain have sometimes been treated as neurotic or at best as ‘female nuisances’.

When compassionate doctors have endeavoured to treat the condition, it has usually been with painkillers for headaches, tranquillisers or anti-depressants for the psychological problems, and diuretics for water-retention.

New attitudes and new treatment

The modern medical knowledge of female hormones which has led to development of the contraceptive pill, and more recently to effective treatment of the menopause problems, is now leading to a better understanding of PMS.

Hormonal fluctuations

The evidence implicating a hormonal basis for PMS is considerable. There is the fact that PMS starts first either at puberty or after the birth of a baby, both times when the hormonal balance is changed. Equally it disappears apparently miraculously during menstruation or pregnancy, again times when hormonal state is different.

Most important of all is the absolute regularity of true PMS, always in the same phase of the cycle and almost always starting on the same day of the cycle in each individual woman. Recent work has shown that woman who have PMS may either suffer from a deficiency of progesterone, or an imbalance between oestrogen and progesterone (the two important female sex hormones), in the second half of the cycle.

Additional circumstantial evidence lies in the fact that a drop in level one of these important female hormones, progesterone, is already implicated in some forms of depression and tiredness such as the familiar post-natal blues.

What to do if you think you have PMS

It is not always easy for your doctor to diagnose PMS, as you may present only when problems get particularly bad and with somewhat varying physical symptoms. So, if you think you may be suffering from this problem, you can help your doctor considerably by keeping a simple menstrual chart. This will not only indicate the symptoms but show if they are truly cyclic in nature, always coming in at the same point in the month, which is the real key to PMS. An example of how to complete a menstrual chart is shown. When you have completed your symptom chart take it back to your doctor. If necessary your doctor will decide on treatment if needed.

Tomorrows woman

The demands of life today can be heavy for both the 50 plus women facing the buffeting of menopause, and for the younger women suffering PMS. In both age groups many women are coping with part or even full time jobs, as well as looking after homes and families. What is more they are doing this without the help once available, as the extended family and the close knit community become more and more a thing of the past.

This is one of the disadvantages of modern living, and to compensate women need whatever advantages are available. Fortunately these include today better and more effective medical treatments. So don’t be afraid to approach your doctor if you feel you need help.

MENSTRUAL CHART

Indicate on the chart the days on which symptoms trouble you, using the appropriate letter or letters from the key below

Fill in months                     Days of the month
(e.g. may.)

1st month

 

MARCH

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

T

 

T

T

T

F

TBFP

TBFP

 

M

 

M

 

M

 

M

 

 

2ND MONTH

APRIL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

T

T

F

TBF

TBF

TBF

 

MF

 

MF

 

M

 

 

 

 

 

 

 

3RD MONTH

MAY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

T

F

TBF

TBF

TBF

TBF

 

M

 

M

 

M

 

M

 

 

 

 

 

 

 

Key to symptoms

   
F = Fatigue
D= Depression
P=Pain-backache or headache
T=Tension or irritability
B=Bloated feeling
M= Menstruation

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