Hormones and PMS

The menstrual cycle’s amazing physiology does unfortunately throw up a few curve balls for different women and sometimes you hear comments about ‘raging hormones’ and how they relate to how someone is feeling. One area that is particularly frustrating for some women is premenstrual syndrome (aka PMS). While it can be mild to non-existent and often made light of by the community, for some women it is a distressing repetitive problem that interferes with their lives.

What happens during the premenstrual phase of my cycle?

From the time you ovulate (release an egg) mid-cycle until menstruation commences there is a rise in your body’s progesterone level. This hormone serves an important role in preparing the body for the possibility of pregnancy each month. Unfortunately, depending on the individual, there are a number of annoying bodily symptoms noticed temporarily. Some women are what I refer to as progesterone sensitive, and really do feel these effects to a troublesome degree.

What kind of symptoms are normal in PMS?

Typical symptoms for PMS are abdominal bloating, breast tenderness, pelvic cramping, constipation, irritability, anxiety and lowered mood, transient weight gain of 1-2kg due to fluid retention, acne, change in appetite and libido, headaches and sleep disturbance.

Do all women get PMS?

No. Some women look at the above list and don’t recognise a problem for themselves, while others might tick every box. It’s safe to say that most women experience some of these symptoms at some time. You might also notice some symptoms in one period, but not in your next menstrual cycle.

When should I see a doctor to discuss PMS?

The simple answer is when you feel that PMS is interfering with your life. This may be due to distress with the physical symptoms, the emotional disturbance, or problems with your interactions interpersonally at work and socially. This may be very different to when your friends would seek help. Listen to your own body, and talk to your doctor when PMS is impacting your life.

What are some of the things that might help with PMS?

After discussing your history and any relevant examinations to make sure you are healthy, I discuss options regarding remedies to improve the symptoms. These can include, lifestyle factor modification regarding diet, exercise, alcohol intake etc. Vitamin deficiency correction can play a role in PMS, including B-group vitamins, calcium and magnesium supplements and ensuring vitamin D levels are adequate. Natural remedies are also discussed, for example, evening primrose oil capsules or chaste berry supplements may assist. Acupuncture may be helpful and worth a try.

Medical treatments that can alleviate PMS  often include the oral contraceptive pill, mirena or kyleena IUD insertion, Implanon (hormonal implant contraceptive). Anti-androgenic pills are very helpful if acne and fluid retention are a major issue.

“The worst thing for me is  that I feel really depressed every month before my period”

Some women suffer not just a little irritability, but quite severe cyclic depression symptoms. This is recognised by doctors as premenstrual dysphoric disorder.

Patients feel quite disabled and unable to adequately function for around 7-10 days leading up to each period. Fortunately, this responds very well to modern antidepressant treatment. SSRI drugs (zoloft, lexapro, cipramil for example) typically in a very low dose are remarkably effective at turning this situation around.

But aren’t these things just a normal part of a woman’s life?

It all depends on the degree of the symptoms. For many women, PMS isn’t a big deal and not a particular bother. For others, the problem is real and should never be discounted. Don’t be shy to discuss these symptoms if you are fed up with them, you certainly won’t be the only one who has.

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Author: Dr Peter England, Obstetrician and Gynaecologist.
Read more about Dr Peter England

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