A B C D E F G H I J K L M N O P R S T U V W

PMT - PMS - PREMENSTRUAL TENSION SYNDROME

What is PMT ?

Most women are aware of some of the changes in their body which come before a period. These symptoms may start hours or days before the period. They are natural and normal and there are women who notice nothing at all. The premenstrual syndrome (PMS) is when these symptoms are more severe. They can be divided into physical and emotional, and start up to 2 weeks before the period. Physical symptoms include breast tenderness and enlargement. Women may put on weight, retain fluid and get abdominal distension. Headaches may occur and migraine may be worse in those people subject to attacks. There may be a feeling of pelvic congestion and intercourse may be uncomfortable. Constipation is common. The emotional and personality changes may be very profound. Depression can be severe enough for suicidal feelings. A woman may become short-tempered and strike out verbally and physically at her family. She may make wrong and irrational decisions at work and may have to take time off work. In extreme cases she may not trust herself to drive a car. She may have less desire for intercourse.

How does PMT occur ?

The premenstrual syndrome only starts after ovulation in the middle of the cycle and stop when bleeding of the next period occurs. It has been assumed that the cause is therefore hormonal. The symptoms may be related to the balance between the two hormones oestrogen and progesterone.

Why does PMT occur ?

We do not know why one woman should suffer so much before her period and another notice nothing. Some women do seem to be more sensitive to hormone changes than others. Other causes of stress in a woman's life may contribute.

Treatment Involved for PMT

If a woman is not ovulating she is very unlikely to get the premenstrual syndrome. There is little point in measuring your hormones as there are no special levels at which symptoms occur. Treatment involves first of all finding out which symptoms a woman has are due to PMS. You may be asked to keep a record or diary of symptoms and the dates of periods over 2-3 months. The treatment recommended may depend on which symptoms are the most troublesome. Although most of the treatments used help the beneficial effect tends to decrease with time and it is often necessary to change treatment. Many women find some relief from taking evening primrose oil and vitamin B6. These do not need a doctor's prescription and can be bought from the chemist. Taking the contraceptive pill or hormone replacement therapy (HRT) helps symptoms in many but not all women. Taking progesterone from the time that symptoms start until the onset of the period also helps some women. One way to take this is as a pessary in the vagina or suppository in the rectum. Pure progesterone is not absorbed by mouth but similar drugs can be effective when taken as tablets.

If the normal menstrual cycle is stopped by using drugs such as Danazol or GnRH (gonadotrophin-releasing hormone) analogues (these are also used in the treatment of conditions such as endometriosis) this will stop PMS symptoms. These treatments can only be used for a few months at a time. Treatment with anti-depressants such as Prozac may be recommended alongside hormone therapy. Diuretics (drugs to make one pass more water) should only be used for symptoms of fluid retention where there is a confirmed increase in body weight before a period. Complementary (alternative) medical treatments like acupuncture and hypnotherapy may be helpful. Some women find that techniques such as yoga and meditation improve symptoms. As a last resort PMS can treated by removing the ovaries. A hysterectomy is usually done at the same time. This is not suitable for women who wish to keep their fertility. They will need to take hormone replacement therapy afterwards. A trial of treatment with drugs that stop the periods is usually done before considering surgical removal of the ovaries, as it is unlikely that surgery will help any symptoms that are still present when the periods do not occur.

During Treatment for PMT

A sympathetic approach is essential. For many woman the acknowledgement that their symptoms are due to PMS may relives anxiety about other possible causes. If no improvement is seen after three cycles of treatment, you must consider an alternative. If taking the pill, hormone replacement or a diuretic, there must be regular medical supervision every six months. Following hysterectomy you may still get some symptoms of premenstrual tension if the ovaries are not removed.

If PMT is Left Untreated

In a very few women the symptoms get worse and worse. The family and marriage structure may break down. The threat of this should never be ignored and advice must be sought before things get to this stage.

Effects on Family of PMT

This is a condition which affects family, friends and workmates. It is very helpful if your husband can visit the doctor at the same time. He can explain things to the doctor which you may not see yourself. He may also understand things better when the doctor has talked to both partners.