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Premenstrual Syndrome

Whilst it is extremely rare for a woman to have a hysterectomy due to Premenstrual Syndrome alone, it can be a contributing factor in overall gynaecological health. Premenstrual syndrome (PMS) (also known as Premenstrual Tension or PMT) is the name given to the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman’s monthly period.

It is estimated that almost all women of child-bearing age have some premenstrual symptoms, although it is usually at its worst between the late 20’s and early 40’s. About one woman in every 20 with PMS gets symptoms which are severe enough to affect their day to day life and normal routine, this is known as Premenstrual Dysphoric Disorder (PMDD).

It is thought that PMS occurs in women who have a higher sensitivity to progesterone and that it is ovulation that triggers it’s onset each month. Some research has shown that over-sensitivity to progesterone can reduce the level of a serotonin in the brain which can lead to symptoms. It is though this is why increasing serotonin levels with selective serotonin reuptake inhibitors helps in some cases of PMS.

Other factors that could contribute to PMS include weight, as research has shown that those with a Body Mass of more than 30 and who do little exercise are more likely to suffer from PMS. Stress can aggravate symptoms, this might be because it has an influence on normal hormonal cycles. Finally, changes in hormone levels might also be a contributing factor and PMS usually improves when a woman has gone through the menopause.

Symptoms

Diagnosing PMS is tricky because the symptoms presented are often experienced with other medical conditions. However, if symptoms regularly occur in the week before a period and go within a few days after it has finished then a GP might diagnose PMS. More than 100 different symptoms of PMS have been recorded although it would be rare to get more than one or two at any time; the most common are listed below.

Physical symptoms

  • swollen hands and feet
  • bloating
  • pain and discomfort in your abdomen (tummy)
  • headaches
  • changes to your skin and hair
  • backache
  • muscle and joint pain
  • breast tenderness or swelling
  • insomnia or disrupted sleep
  • dizziness
  • tiredness
  • nausea
  • minor weight gain

Psychological symptoms

  • mood swings
  • tension
  • tiredness
  • confusion and forgetfulness
  • irritability
  • anxiety and low mood
  • tearfulness
  • problems concentrating
  • restlessness
  • decreased self-esteem

Behavioural symptoms

  • loss of libido / interest in sex
  • food cravings

All of these symptoms usually improve when the monthly period starts, and they disappear a few days afterwards.

What Treatment Is Available?

Combined Contraceptive Pill – the contraceptive pill works by suppressing ovulation to prevent possible pregnancy and in theory should help reduce the symptoms of PMS as well. However, not all combined pills can be effective because they contain progestegen. One called Yasmin® might be more effective because the progestogen it uses has less effect on PMS than other brands.

Oestrogen – can be given in combination with progestegen to suppress ovulation. Suppressing ovulation, which triggers symptoms may help in some cases.

Selective serotonin reuptake inhibitors (SSRIs) work by increasing levels of serotonin in the brain which is thought to be affected by a sensitivity to progesterone; they are commonly given as a treatment for depression but can work even if you don’t have depression. More recent research has shown that they don’t need to be taken all the time either – just in the second half of the monthly cycle can be enough to provide relief. However, they are not without their own side effects and their benefits must be weighed up against these.

Gonadotrophin-releasing hormone analogues given by injection and in combination with hormone replacement therapy can also be used to suppress ovulation.

Surgery that removes both ovaries also prevents ovulation and is likely to cure PMS. However, this should only be done in the most severe cases.

Alternative Health Treatments

  • Dietary changes. Some research has shown that reducing the amount of carbodhydrate before a period can help to ease some symptoms. Reducing the amount of alcohol and caffeine has also been shown to help some women.
  • Exercise. Women who exercise regularly have been shown to have fewer problems with PMS. Therefore increasing the amount of exercise taken may help
  • Vitamin B6 has been helpful for some women because of its effect on brain chemistry – it may work in the same way as SSRI’s do.
  • Vitamin E can be helpful for breast tenderness.
  • Magnesium – Women with PMS have been found to have lower levels of red blood cell magnesium than women who don’t have symptoms and it is thought to be useful to supplement especially when suffering menstrual migraines
  • Herbs such as Agnus Castus, Black Cohosh, Skullcap and Milk Thistle have all been found to be helpful to some women. However these should not be taken if women are also taking HRT, contraceptive pill, hormonal treatment or other fertility treatment.
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