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PREMENSTRUAL SYNDROME (PMS)

The Royal Australia College of Obstetricians and Gynaecologists

DOES IT EXIST?
Each month before your period you may have realised that you seem to change as a person for a few days, and then as your period starts you begin to feel better. A couple of weeks pass and the unpleasant feelings recur. At some stage you may have asked yourself "Do I have PMS, and what can I do about it?

WHAT IS PMS?
PMS or PMT is a condition in which symptoms commonly occur 2-14 days before your period starts. However, most women complain of symptoms for about seven days each month. There is a similar condition known as Menstrual Distress Syndrome, in which some women experience symptoms all month, but find that they are worse before their period. Nine out of ten women have premenstrual symptoms, but of these, about two of them will find the symptoms prevent them from living a normal life.

PMS tends to affect women between 30 and 45 years of age, but it is possible for PMS to occur at a younger age. Women often notice their symptoms begin after childbirth, or an important personal event. Very often women with PMS have higher than average stress levels, and have always had to cope with problems throughout their lives.

WHAT ARE THE SYMPTOMS OF PMS?
Most women feel some or all of the symptoms listed below. There seem to be three main groups of symptoms.

Mood changes:

• Irritability- 'flying off the handle' easily
• Tension- 'like a tight knot in your stomach or head'
• Aggression- yelling at or smacking the children
• Depression- 'feeling low'
• Loss of self-esteem- no confidence in yourself
• Sleep disturbance- unable to sleep or waking easily

Fluid retention:

• Bloating of the stomach
• Breast swelling and soreness
• Swelling of the ankles, knees, hands and face

Physical symptoms:

• Headaches
• Pains- in the legs, arms, back etc
• Nausea
• Food cravings
• Binge eating and other symptoms

WHAT CAUSES PMS?
Unfortunately the cause of PMS is at present unknown. Many theories have been developed to explain PMS, but none have completely explained the cause. However we recognise it as a complex condition where there appears to be some link to emotional, physical and hormonal factors. Recent research has suggested a decrease in some of the brain chemicals or neuro transmitters such as serotonin, in the premenstrual phase of the cycle may be implicated.

HOW CAN YOU BE HELPED?
When you seek help it is important to establish the pattern of your symptoms so as to determine whether or not you have PMS. The simplest way for you to do this is to chart your symptoms daily over 2 or 3 cycles. While you are charting your symptoms you may be aware of events or pressures in your life which seem to make you feel worse. You will find an example of a chart that can be used to record your symptoms attached to this leaflet.

Your doctor will also take a full medical, including your gynaecological history, and will examine you to make sure there is no other cause for your symptoms, for example, an ovarian cyst. Your doctor will also ask you about your lifestyle, your stresses and background.

WHAT TREATMENTS ARE AVAILABLE?
Hormones:
Oestrogens, particularly oestradiol, the main oestrogen in the reproductive year, is taken in tablet form or is used as a patch. Progestogens have been used, particularly dydrogestrone. The oral contraceptive pill may also be suitable for younger age groups.

Anti prostaglandins:
Antiprostaglandins are used for painful periods, and they may also help with premenstrual pain. Two commonly used antiprostaglandins are Ponstan and Naprogesic.

Serotonin enhancers:
These medicines increase serotonin in the brain and help mood changes in particular. These medicines are also used for depression in the non-PMS sufferer.

Diuretics:
Diuretics are used to help remove excess fluid, and may improve the symptoms of bloating and breast soreness. Chlotride is the most commonly used diuretic.

Bromocryptine (Parlodel):
Bromocryptine is an antiprolactin, i.e. a prolactin antidote. (Prolactin is the hormone responsible for milk production in the breast). Bromocryptine may help when the major symptom is breast soreness or tenderness.

Natural therapies
Pyridoxine (Vitamin B6) is often used in various doses, particularly if you have mood changes.
A combination of vitamins, minerals and herbal extracts are also available in a number of preparation in Health Food Stores or Chemists.

Psychological counselling:
Simply being able to discuss the symptoms and the stresses in your life with your doctor, counsellor or self-help group is often sufficient to enable you to cope.

However, other more formal programs of counselling or therapy may be advised, for example a cognitive therapy program in which you may learn ways of coping better with your life and its stresses.

Diet and exercise:
Improving your overall general health and fitness can help you to cope with the symptoms and to manage your life batter. Increasing fibre, fresh vegetables, fruit, and plenty of water as well as exercise, particularly in the premenstrual phase may help you to reduce the intensity of the symptoms.

SUMMARY
As you have read, there are many different ways of treating premenstrual syndrome. You may have to try a number of different treatments to find which helps you most.
These treatments will only be of benefit if you also learn about and understand what triggers your symptoms. Hence, with help and guidance from your doctor, and by increasing your awareness of your symptoms, you will learn to accept responsibility for them. This will reduce the severity of your premenstrual symptoms.

PREMENSTRUAL SYNDROME DAILY SYMPTOM RATING CHART

Month beginning ………………………………..

My last period started on………………………..

Each night before retiring, please record your experience during the day of the feelings and sensations listed below. Write a number in the box opposite them to indicate how intensely this symptom or feeling was experienced.

The Royal Australian College of Obstetricians and Gynaecologists and its officers, employees and agents ("the College") disclaims all responsibility for any loss or damage which may be suffered by any person relying on the above information whether that loss or damage is caused by any fault or negligence on the College's part or otherwise.