Premenstrual syndrome (PMS) is quite common – 90% of women experience changes to their mood and physical wellbeing in the 1-2 weeks before their period. Unfortunately, many women do not seek help and think that nothing can be done.
The symptoms of PMS can include both mood problems and physical symptoms. These occur only in the second half of the menstrual cycle (so, after ovulation). Women describe feeling tearful, easily upset and irritated (things that don’t normally upset you drive you crazy!). Physical symptoms include fuller, painful breasts, bloated tummy, constipation and sugar cravings due to low energy levels and tiredness.
Premenstrual Dysphoric Disorder (PMDD) is a much more intense and debilitating condition. Your doctor will need to ensure that other mood problems such as major depression or generalised anxiety disorder are not the true causes of your distress.
What causes PMS and PMDD?
We used to believe that PMS and PMDD were the result of hormonal imbalances in a woman’s cycle. More up to date information suggests the following causes:
- increased sensitivity to progesterone (a hormone) in women with an underlying serotonin (a neurotransmitter or chemical messenger important in mood) deficiency
- disturbances in levels of allopregnanolone (a progesterone breakdown product) and the GABA (another neurotransmitter) system
- lower levels of endogenous opioids (the body’s natural pain killer chemicals)
It’s also possible that these sensitivities to hormones and levels of neurotransmitters are genetic – passed on through families.
What does work for PMS/PMDD
It’s important to tailor the solution to your particular needs. Factors to consider are the need for contraception, how severe the symptoms are, how regular or predictable your cycle and symptoms might be. Also important are underlying medical conditions, health concerns and family history.
Medications that increase levels of serotonin such as medications from the SSRI class can be very helpful. The most effective include: sertraline, citalopram, escitalopram and fluoxetine. These also tend to have the least side effects and can be used in low doses. These can be used these medications daily, or only in the second half of the menstrual cycle or from the start of symptoms.
The other option is to control the menstrual cycle (and provide contraception) with the oral contraceptive pill. It’s best to do this with a continuous dose formulation with a short sugar pill phase – to reduce the chance of ovulation. Sometimes we run the pill packets back to back and skip periods completely.
For more severe cases (such as PMDD) completely suppressing periods with a GnRH agonist (injectable hormone blocker) with hormone ‘add back’ or replacement therapy as well as an SSRI is a useful option.
What doesn’t work for PMS/PMDD
There has been a great deal of research looking at natural or alternative therapies to manage PMS/PMDD. Unfortunately, the list of what doesn’t work is quite long. For example:
- herbal medicines: Chaste tree, Gingko biloba, Evening Primrose Oil
- dietary supplements: calcium, magnesium, vitamin E, vitamin B6, multivitamins
- reflexology, chiropractic treatments, biofeedback
- extra doses of progesterone – either synthetic or bio identical
Start by charting your cycle and your moods to enable me to pick the patterns and tailor an approach to suit your needs.
Dr Tonia Mezzini has been helping women to manage their moods and hormones for many years. If you would like expert advice on PMS or PMDD, make an appointment to see Dr Tonia Mezzini today.
Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with:
- Vulval pain syndromes and vulval skin conditions
- Low libido and pain with intercourse
- Polycystic Ovarian Syndrome
- Gender-affirming hormone therapy
- Complex contraceptive choices
- Sexually transmitted infections such as recurrent genital herpes
- Recurrent bacterial vaginosis
- Recurrent thrush
- Menopause and hormonal concerns
- Chronic pelvic pain in men and women
- Painful periods and endometriosis
- Information about sexual health
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- Androgen deficiency in men