PMS

Summary

Premenstrual syndrome (PMS) can be successfully managed with lifestyle changes, dietary modifications, complementary therapies and prescription medications. Lifestyle changes to manage PMS include regular exercise, not smoking, cutting back on alcohol and caffeine and getting more sleep. Nutritional supplements may help some PMS symptoms, but check with your doctor first.

Premenstrual syndrome (PMS) refers to the range of physical and emotional symptoms that many women experience in the lead-up to menstruation (the period). Most menstruating women are affected, with symptoms ranging from relatively mild to severe. Women aged between 30 and 40 years appear to be at most risk.

Since the cause remains unknown, PMS can’t be cured or prevented. However, it can be successfully managed with appropriate self-care and a range of different treatments. Consult with your doctor before starting any PMS treatment program.

Keeping a PMS diary

There are more than 150 recognised PMS symptoms, and PMS differs from one woman to the next. Common symptoms include irritability, moodiness, fluid retention, breast tenderness and food cravings. There are no specific tests for PMS, so diagnosis depends on ruling out other possible causes.

In most cases, you can identify PMS by keeping a symptoms diary. Include the details of your menstrual cycle – for example, the first and last days of your menstrual period – and any ovulation symptoms. Keep this diary for at least three menstrual cycles. If your symptoms are due to PMS, the following pattern should occur:

  • Symptoms are experienced in the two weeks before your period starts
  • Symptoms resolve with the period
  • Once the period is over, you experience at least seven days with no symptoms
  • Symptoms start to return about mid-cycle or in the week before your period starts.

If symptoms continue throughout the menstrual cycle without change, PMS is probably not the cause – see your doctor for further investigation.

PMS management

PMS can be successfully managed with lifestyle changes, dietary modifications, supplements and medications. You may have to experiment to find the balance of treatments that works best for you. It’s a good idea to continue your PMS diary and record any symptoms while you trial the remedies. Be sure to consult with your doctor or health care practitioner during this trial period.

Lifestyle changes

Recommended lifestyle changes include:

  • Exercise regularly, at least three times a week – try to exercise daily in the premenstrual period.
  • Don’t smoke.
  • Cut back on caffeine and alcohol in the two weeks before menstruation.
  • Ensure that you get enough sleep.
  • Manage your stress in whatever way works for you – for example counselling, Tai Chi or meditation, walking or gardening.

Dietary changes

An Australian study found that women experiencing PMS symptoms crave high fat and high sugar foods like chocolate, biscuits and icecream. They also were found to increase their food intake by about 20 per cent. You can manage your weight and help reduce your PMS symptoms by making a few dietary changes, including:

  • Eat smaller meals more often – for example, have six ‘mini-meals’ instead of three main meals.
  • Reduce your intake of salty foods.
  • Include more fresh fruits and vegetables and wholegrain foods in your daily diet.
  • Boost your dairy food intake, but switch to reduced fat or non-fat versions.
  • Don’t keep high fat and high sugar foods in the house.
  • Make sure you always have tasty and healthy snack alternatives on hand.
  • Record your food choices in your PMS diary – charting your food intake may help you become more aware of high fat and high sugar snacking.

Supplements

Check with your doctor before taking any type of supplement. Complementary therapies should be viewed as a medicine and should be treated with the same respect.

Supplements that have been shown to help reduce PMS symptoms include:

  • Calcium – about 1,200mg per day of calcium carbonate can reduce PMS symptoms by half. You need to take these supplements for at least three cycles before you may notice an improvement.
  • Magnesium – about 200mg per day of magnesium can reduce PMS-related bloating, fluid retention and breast tenderness by 40 per cent. You need to take these supplements for at least two cycles before you may notice any improvement.
  • Chaste tree – a study showed that the herbal supplement chaste tree (also known as chaste berry, or vitex agnus castus) reduces PMS symptoms by half. The study was conducted on a specific extract of Vitex agnus-castus (Ze 440) available in Australia as Premular ® and was shown to reduce symptoms of irritability, mood swings, anger, headache and breast fullness. This herbal treatment needs to be taken for at least three months and should only be prescribed by qualified herbalists.
  • Vitamin E – about 400 units of vitamin E per day may reduce breast tenderness. Vitamin E taken with selenium supplement of 25–50 micrograms daily may be beneficial. High doses of selenium can cause toxicity and should not exceed 100 micrograms per day.
  • Evening primrose oil – this supplement may reduce breast tenderness. Therapeutic doses are 3000–4000mg daily.
  • Vitamin B6 (pyridoxine) – evidence is mixed about the effectiveness of vitamin B6 supplements. High doses of vitamin B6 are toxic to the nervous system. Use with caution and avoid long-term use.
  • Other supplements – Black cohosh, and dandelion are anecdotally thought to reduce PMS symptoms. However, their effects have not been established. There are some concerns that black cohosh may harm the liver in some individuals. Always consult your doctor before taking any supplement, including herbal supplements.
  • St John’s Wort – is a mood stabiliser and has been shown to improve mood. This supplement may interact with other medications so always check with your doctor before taking St John’s Wort.

Medical treatments

There is no cure for PMS. If lifestyle changes and supplements do not work, there is also a range of hormone treatments and medications available to help you manage your symptoms.

Hormonal treatments

The aim of hormone treatment is to suppress ovulation and reduce the hormones of the premenstrual phase. Many different hormone therapies have been trialled for PMS:

  • The combined oral contraceptive pill – ‘the pill’ may relieve premenstrual symptoms. The monophasic pill is preferable, where all the hormone tablets are the same dose. Studies show mixed results. A pill-free interval of 3–4 days seems to give better results.
  • Oestrogen therapy – high-dose non-oral oestrogen to inhibit ovulation has been effective. The oestrogen is given either as a patch or an implant. Unless the woman has had a hysterectomy, progesterone-like therapy will also be needed. This may cause side effects similar to PMS.
  • GnRH agonists – these medications are usually prescribed as a treatment for endometriosis or fibroids and are used for a maximum of six months. They stop ovulation and periods, creating a temporary menopause. Tibolone is often added to relieve menopause-like symptoms.
  • Mirena IUD – this IUD (intra uterine device) releases a low-dose progesterone-like hormone and may reduce symptoms in some women.
  • Danazol – this medication may also stop ovulation and reduce PMS, but has significant side effects.
  • Implanon – this progestin only rod contraceptive suppresses ovulation and may reduce symptoms
  • Depo-Provera – this injectable contraceptive stops ovulation and may relieve PMS symptoms. Side effects may include irregular bleeding and mood changes.
  • Bilateral salpingo-oophorectomy – removing both ovaries can abolish PMS but can also lead to menopause and severe menopausal symptoms if oestrogen and progesterone-like treatment is not given after the operation.

Medications

There are a number of medications that have been trialled for PMS:

  • SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective noradrenaline reuptake inhibitors) – this group of medicines are mood stabilisers and antidepressants and can improve PMS symptoms significantly. These medicines increase the brain chemicals serotonin and noradrenaline respectively, both of which appear to fall during the premenstrual phase in women who experience PMS. The simplest SSRI is St John’s Wort, but the most studied form is fluoxetine.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – these drugs are taken in the premenstrual phase of your cycle and help to reduce breast tenderness and pain. However, long-term use of NSAIDs can cause serious side effects such as stomach ulcers.
  • Anti-prostaglandin and anti-inflammatories – medicines such as Nurofen, Naprogesic or Ponstan may help when nausea and pain occur.
  • Diuretics (fluid pills) – these rarely help, except when there is genuine fluid retention. Spironolactone seems effective for breast pain and bloating.

Many of these treatments can have side effects, so make sure you are well informed about them before you and your doctor decide on your treatment.

Complementary therapies

Many women feel they benefit from a variety of natural therapies, although a lack of controlled studies means there is no clear evidence of their benefits.
Options include:

  • Cognitive behavioural relaxation therapy – uses one or a variety of relaxation techniques to relieve psychological and/or physical symptoms.
  • Complementary therapies – such as acupuncture or naturopathy.

If you would like to use complementary therapies, it is important to seek advice from a qualified professional and to let your doctor know about any herbal or complementary therapies you are using.

Where to get help

Things to remember

  • If symptoms don’t resolve with menstruation, PMS is probably not the cause – see your doctor for further investigation.
  • The main treatment for severe PMS symptoms is low dose SSRIs (antidepressants).
  • Regular exercise or herbal remedies may be effective.
  • PMS responds well to self-care but may need medications to help relieve symptoms.

Premenstrual Syndrome / Tension (PMS / PMT)

What is Pre-Menstrual Syndrome / Tension (PMS/PMT)?

PMS and PMT refer to the physical and emotional symptoms which occur between ovulation and the onset of the menstrual period.

Unfortunately some women will not experience symptom resolution with the onset of their period and may not experience symptom relief until as late as the third to fifth day after the onset of their period.

How do I know I’m suffering from PMS and not depression?

In PMS, symptoms occur (and, thankfully, resolve) at regular, more or less predictable fixed, points during the monthly menstrual cycle. Frequently patients will tell me they are aware of when they ovulate and often know exactly how soon after ovulation their symptoms will occur: “I know when I have ovulated and then I know when my symptoms are going to arrive………….”

What are some of the common symptoms of PMS?

No two patients have absolutely identical symptoms and, in a given individual, may vary considerably from cycle to cycle. There is a range of symptoms including:

  • Brain and mood symptoms include depression, over-sensitivity, irritability, anger, anxiety, concentration problems, brain fog, and sleep problems.
  • Appetite changes and food cravings include increased desire for sweet, chocolate or salty food, eating binges, increased desire for alcohol.
  • Physical changes may include constipation, headaches, bloating, increased by day, or both, palpitations, joint pains. Fluid retention may cause swollen breasts and swelling of the hands or feet.
  • Hair and Skin may become more oily, acne breakouts may occur.
  • Energy and vitality may drop hugely resulting in fatigue, loss of interest, social withdrawal and loss of libido. Sometimes patients may become super-charged and highly energetic and find themselves doing 18 to 20 hour ironing and cleaning session once a month!

Which women’s age group does PMS most frequently affect?

PMS sufferers are usually women in the 30 to 45-year-old age group. The problem is less common in younger women.

What causes PMS?

  • PMS is hormonal – it is neither a psychological disorder nor a female conspiracy!
    In the past, some doctors both men and even women considered PMS was a feminist-initiated plot for revenge on husbands and boyfriends (!) Thankfully, nowadays we know better.
  • Doctors used to blame low progesterone but rapidly falling oestrogen levels are probably more significant in the majority of PMS sufferers.
    PMS is hormonal and related to an excess, deficiency or imbalance between the hormones oestrogen and progesterone.
  • Rapidly decreasing estrogen levels approaching the monthly period means ‘happy’ body chemicals are present at that time.
    Decreasing estrogen levels coming up to the menstrual period, cause decreased production of endorphin, serotonin and dopamine. In addition, at this time, there is an increase in the enzymes that break the ‘happy’ substances down –hence a double whammy –lower supplies and quicker breakdown of whatever is available. Hence with less up-beat, calming natural substances around it’s no surprise that most women – even the non-PMS sufferers – may feel a bit ‘off’ and anxious in the day or two immediately preceding their menstrual period.
  • Falling estrogen levels may cause anxiety and irritability.
    Falling estrogen levels may set off a burst of nor-adrenaline in the brain activating a fight-or-flight response thus adding to the feelings of irritability and anxiety.
  • Progesterone levels fall steeply just before the bleeding days.
    Falling progesterone levels cause a drop in endorphin levels contributing possibly leading to feelings of depression and irritability.
  • Professor John Studd’s research has shown rapidly falling estrogens rather than rapidly falling progesterone is the most common abnormality.
    There was a vogue for giving all women suffering from PMS progesterone to take but this has not proven effective in may cases and , additionally, many women have reported feeling ‘doped’ and ‘spaced out’ by the inappropriate prescription of progesterone.
    Many women with PMS have normal progesterone on laboratory testing – though there will always be exceptions – hence the importance of carrying out detailed laboratory testing.
    Another clue to the importance of falling estrogens is that many women feel at their absolute worst on the day prior to bleeding and the first day of their bleed –this is the point when oestrogen levels have fallen most sharply.
    Yet another clue to too-rapidly-falling estrogens is that some women may get quite significant night sweats coming up to their period. Therefore, PMS is not always about progesterone deficiency research demonstrates it is not an open-and-closed case. The best solution is: check the hormone levels in the laboratory and then a logical solution is possible. Test and then treat what you find – not what you think might be the problem.

How can PMS be treated?

Investigation of PMS

A full medical history including a menstrual history is critical and, usually, will be helpful in raising suspicions of a hormonal deficiency or imbalance. At a minimum, check oestrogen and progesterone levels during the menstrual cycle on day 1 to 3 and again on day 18 to 21. Checking FSH on day 1-3 is helpful to exclude early ovarian failure. I also like to measure the testosterone level, the thyroid hormones, and will sometimes include adrenal salivary testing.

Treatment of PMS

Treat based on the medical history and the blood test results.
Do not just presume that it is an estrogenic deficiency or progesterone. Pay attention to the thyroid and adrenals, also.
Prof John Studd in the UK used oestrogen supplementation with some excellent patient outcomes and there are studies to prove it.

If progesterone levels are low after ovulation then it makes sense to boost progesterone levels.

If there is a low oestrogen level and relatively normal post-ovulation progesterone thus creating a reduced estrogen to progesterone ratio then it makes sense to boost oestrogen levels as a first step. This may apply especially to women who begin to experience PMS soon after mid –cycle just as they have ovulated and when estrogen levels are falling fast and progesterone are actually rising.
Sometimes a useful clue to falling oestrogen levels is the complaint of night sweats and/ or a dry vagina resulting in discomfort during intercourse.

Bio-identical hormones are now available to treat PMS.
Nowadays with the increasing availability of bio-identical hormones, it is possible to balance hormones with treatments, which are biologically identical to those present in a human female’s body usually applied in a cream form thus avoiding the hazards, which may be associated with the use of oral synthetic hormonal preparations.

Other Important Considerations in PMS Treatment

Treat the whole patient:
Treat any vitamin (e.g. B6) mineral (e.g. magnesium) or hormonal problems (e.g. weak adrenals) which may be present.
Is the liver o.k.? The liver which ‘balances’ estrogen and progesterone may need nutritional support.
Make sure that the patient’s bowels and digestive system are functioning well.
Assess brain / neurotransmitter balance if necessary.
I do not prescribe antidepressants for PMS, since my view, PMS this is primarily a hormone-related problem.
I do not advocate the use of antidepressants in the treatment of PMS since the problem is primarily hormonal.

Progesterone for premenstrual syndrome

Ford O, Lethaby A, Roberts H, Mol BWJ
Published Online:
April 18, 2012

There is little good evidence for treating premenstrual syndrome with progesterone. Five per cent or more of women experience symptoms, severe enough to damage work and relationships, only in the days leading to their menstrual periods. Blood progesterone levels usually rise after ovulation and fall again before menstruation. It has been suggested that premenstrual syndrome (PMS) might have been caused by too little progesterone or falling levels.

This review found some evidence for relief with progesterone but trials differed in route of administration, dose, duration of treatment and selection of women taking part. Outcomes also differed. The studies had flaws in methods or in handling outcome data or both.

Adverse effects which may or may not have been the result of the treatment were generally mild.

Further research would be needed to test claims for the effectiveness of higher doses of progesterone. They are neither refuted nor borne out as yet. Using each woman’s own symptoms to select participants and to judge treatment effects would be more accurate than checklists of largely irrelevant symptoms. Knowing how many women had fewer days with symptoms, fewer or milder symptoms, or the converse, would be more valuable than the calculations based on subjective data for groups of women.

Cochrane Collaboration.

Psychiatry Clin Neurosci. 2014 Apr 16. doi: 10.1111/pcn.12189. [Epub ahead of print]

Gonadotropic hormone and Reinforcement Sensitivity Systems in Women with Premenstrual Dysphoric Disorder.

Abstract

AIM:

Behavior inhibition and behavior approach system (BIS/BAS) determine the sensitivity to aversion and rewarding stimuli respectively. This study aimed at evaluating the BIS/BAS of premenstrual dysphoric disorder (PMDD) and effect of estrogen and progesterone on the BIS/BAS.

METHODS:

Women with PMDD without treatment and control subjects were recruited from the community. The PMDD diagnosis was based on psychiatric interviewing and the result of two-menstrual-cycle follow-up. A total of 67 women with PMDD and 75 control subjects were recruited and entered the final analysis. They were evaluated with BIS/BAS scale and for estrogen and progesterone levels in both premenstrual and follicular phases.

RESULTS:

The results revealed that BAS score was higher among women with PMDD in both premenstrual and follicular phases. Progesterone level negatively correlated with fun-seeking, and its change in the menstrual cycle also negatively correlated to a change in fun-seeking score among women with PMDD. Women with PMDD had a higher score in BIS in the premenstrual phase and the BIS score correlated to depression, anxiety, and hostility among them.

CONCLUSION:

These results suggest reward sensitivity of women with PMDD is vulnerable to the effect of progesterone change in the menstrual cycle. Furthermore, the sensitivity to aversive stimuli plays an important role involving core symptoms of PMDD. The reinforcement sensitivity of PMDD deserves further detailed study.

This article is protected by copyright. All rights reserved

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About Ms Jekyll & Hyde

‘If I didn’t have sex organs, I wouldn’t waver on the brink of nervous emotion and tears all the time’

Sylvia Plath, journal entry, 1950

Ms Jekyll & Hyde is a 35 year old British visual artist and educator. She suffered from a severe form of the endocrine disorder Premenstrual Syndrome (PMS), also known as Premenstrual Dysphoric Disorder (PMDD). Determined to be cured, she had a hysterectomy with removal of the ovaries in February 2012, as it is currently the only permanent cure for severe PMS.

She began the Ms Jekyll & Hyde blog in January 2012 , intending to create the straight-talking resource she wished she had when she finally figured out that she had severe PMS/PMDD. She believes that currently most doctors are woefully ill-informed about how to diagnose and treat this disorder, this must be changed. But women must also empower themselves with knowledge in order to get the best out of a seven minute consultation with their GP. [Note: There is compelling evidence that writer Sylvia Plath had severe PMS/PMDD.]

Since her twenties, Ms Jekyll & Hyde has been plagued by horrendous mood swings which worsened in her early thirties, including having suicidal thoughts; this played havoc with her relationships and career. Over a period of a decade she saw a number of GP’s for depression, in the UK and in Australia, but none of them suggested she track her depression alongside her menstrual cycle. GP’s prescribed anti-depressants (SSRIs) and offered Cognitive Behavioural Therapy (CBT).

By 2009 (aged 32) she wondered if she might have Soft Bipolar, Bipolar II or Cyclothymia. She was terrified at facing a life long battle with the ‘Black Dog’, or worse. Divorced, she wondered if she would be able to sustain a relationship.

After more research, Ms Jekyll & Hyde finally put a name to what she believed was wrong – severe PMS/PMDD. She had about two ‘good’ weeks per month (some women only have one good week!) and was exhausted from years of rebuilding her sense of self-worth and confidence after every crash.

She experimented with taking SSRIs only during the ‘bad’ half of the month – she responded to them within hours*, but even tiny doses made her feel woozy and exhausted for days.

In January 2011 (aged 34), she discovered the NAPS forum and Professor John Studd’s site, and wept with relief, feeling sure that hormone treatment would help her. After a private appointment with Prof. Studd, who prescribed hormone therapy (HRT), she transferred her treatment to the NHS and is under the care of a leading specialist in PMS, in London. Determined to be cured, and after extensive research, she had a hysterectomy with removal of the ovaries in February 2012, as it is currently the only permanent/’true’ cure for severe PMS.

Ms Jekyll & Hyde lives with a wonderfully jolly and understanding chap in the South of England, the couple are child-free by choice. A visual artist who has exhibited internationally, her other interests include feminism, folklore, rambling and choral singing.

Severe PMS is the sort that destroys careers and marriages is paradoxically easier to treat because the severity requires proven treatment administered by a medical practitioner. These treatments essentially rely on suppression of ovulation and thus removing the hormonal changes (whatever they are) of the ovarian cycle and hence removing the cyclical symptoms of PMS.

Professor John Studd DSc, MD, FRCOG

All truth passes through three stages
First: It is ridiculous
Second: It is violently opposed
Third: It is accepted as being self-evident

Schopenhauer

Updated March 2012

*A trait common to PMDD and Bipolar Disorder. See Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder, by Jim Phelps M.D.; and Severe PMS and Bipolar Disease – a tragic confusion by Prof. John Studd

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Contact

If you would like to contact Ms Jekyll & Hyde directly please comment on one of the posts on this blog. She would particularly love to hear from women who have found a permanent (or semi-permanent) cure for PMDD/PMS. You don’t need to use your real name if you don’t wish to. Once she’s recovered from surgery (and has tweaked her HRT!), Ms Jekyll & Hyde plans to campaign publicly to raise awareness about severe PMS/PMDD.

General questions

If you’ve a general question about PMDD/PMS, check out the links on the right hand side of the blog, particularly Professor John Studd’s site. Once you’ve ‘read up’, start using the NAPS forum (most questions have already been answered on there), do make use of the search facility first. There is a lot of information to take in so it’s good to make notes / keep some kind of record of what you’ve learnt as you go along.

If you’ve a general question about hysterectomy, check out HysterSisters or the Hysterectomy Association, both have excellent forums.

Disclaimer

Ms Jekyll & Hyde is not a doctor, she is just sharing information. Do your own research, think about it, pick what works for your body and your life – take care of your body AND your brain. Please don’t scare yourself unnecessarily by doing online research ’til late if you’re feeling terrible, everything seems worse in the middle of the night!

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Bloating and menstrual cramps

Bloating

Avoid adding too much additional salt (in cooking and at the table), eat fresh food and avoid ready prepared meals which have too many additives. Trry not to have meals that have smoked meats (i.e. bacon), smoked fish or smoked cheese as these encourage fluid retention. Also wear comfortable clothes that are not too tight at this time of the month (elasticated waistbands and a supportive bra are ideal). If all else fails then see your GP about a mild diuretic but they are not the ideal answer.

Menstrual Cramps

Nurofen is usually good. If that doesn`t help then  see your GP for a prescription for Mefenamic Acid (Ponstan).

Does PMS run in families

We often hear women say that their mothers had headaches or were bad-tempered before their periods, and add that it was not referred to as PMS then, of course. It is tempting to assume that PMS can be inherited. However, there are also a lot of women who remark that their mothers are unsympathetic because they themselves never had any trouble before periods. So what does this mean?
On their own, these comments are not significant. We don’t all have the same eye colour as our mothers and that is genetically inherited. Half our genes come from our fathers. We may inherit different genes for the same characteristic. For example, we may inherit blue eyes from one parent and brown eyes from the other. In this example brown eyes develop because although the form of the gene for blue eyes is present, it has no effect. The form of the gene for brown eyes is said to be dominant.
If two people who have inherited both forms of the gene for eye colour marry, some of their children could be blue eyed because they have inherited the form of the gene that makes blue eyes from both parents. This is the end of the digression into the genetics of eye colour, and I haven’t even mentioned green or grey eyes. Inheritance is rarely simple and how people look and their surroundings, as well as their genes affect how they behave.
European women who lie in the sun go brown, but they do not give birth to brown babies because of their sunbathing. The effects of the environment are not inherited. Some women tan more easily than others and this ability can be passed on to their babies. The kind of skin a person has depends on both genes and surroundings.
Do fat children inherit their tendency to put on weight from fat parents, or do fat parents tend to overfeed their children? It is hard to tell.
So what is the case for PMS? Does it depend on the genes or events during a girl’s life, or what she is brought up to expect, or a combination of these and other factors?
Since it is impossible to have the same person reared twice under different conditions, and unethical to experiment on people by asking them to have babies together just to see if the girls grow up to have PMS, it is difficult to find out. Clues can be found here and there is the literature of medicine and social studies. Asking lots of questions might offer pointers, and twin studies are useful.
In 1977 Weissman and Klerman compared the incidence of depression in men and women as it was described in the medical literature. Their review went back over forty years. They admitted that the apparent greater frequency of depression in females might be accidental due to the way symptoms were reported. Alternatively, the difference could be real and due to biological susceptibility such as genetic effects or female hormones, or psychological factors like social discrimination or female-learned helplessness. There were no firm conclusions here.
Two researchers called Ghadirian and Kamaraju published a report in 1987 in which they suggested that a subgroup of the women who have mood swings which are related to the menstrual cycle might go on to have serious psychiatric disorders and that these might be genetically predetermined (my italics). This was based on a study of only three women and the tone of the article was very much of the “we must bear this in mind” variety.
Taghavi studied three generations of women who had PMS. There were eleven in all. Seven were successfully treated with amitryptaline, a tricyclic antidepressant. His report, published in 1990 stated that there was a possibility of a genetic predisposition in some forms of PMS especially where depression was a symptom. This was still a very small sample on which to base a conclusion.
More recently (1996) Gruber, Hudson and Pope reviewed the literature about a group of conditions that all have treatment-resistant depression, and which seem to be on the border between psychiatry and other branches of medicine. PMS was one such condition. Others were fibromyalgia, chronic fatigue syndrome (ME), migraine, irritable bowel syndrome and atypical facial pain. They were interested in the fact that chemically different groups of antidepressants could all be used to treat this group of disparate conditions. They argued that it was unlikely to be that these medicines were all helping just the symptoms of the different disorders by chance. It was more likely that the disorders were themselves related to each other in their cause that was possibly genetic.
They urged caution however, because like so many other authors who have attempted to combine the results of many studies, they found that there was little consistency in experimental design, diagnostic criteria and methods for measuring the experimental outcome. The doses of antidepressants used varied. Sometimes other treatments were used at the same time. Studies did not always assess both psychological and physical symptoms.
All the studies mentioned so far need more than a pinch of salt.
Research into human genetics often involves twins. Identical twins have the same genes. They are naturally occurring clones. If they are brought up separately then it might be possible to distinguish the effects of genes and surroundings. Fortunately for the twins, this happens rarely. Even so, if there are greater similarities in a particular feature between identical twins than non-identical twins, then it is more likely that the similarities are due to genetic constitution.
Kendler, Silberg, Neale, Kessler, Health and Eaves investigated the symptoms experienced in the premenstrual and menstrual phases by 827 pairs of female twins.
Statistical analysis of their findings suggested that premenstrual and menstrual symptoms were independent of one another, but both were thought to have some genetic causes. They were also thought to be independent of neurotic symptoms. The genes, which predispose to Premenstrual Symptoms appears to be largely distinct from those that predispose either to menstrual or neurotic symptoms.
This seems conclusive. There was a large sample of twins. Unfortunately only relatively few symptoms were retrospective self reports. It is a well-known difficulty with PMS research that after a month or two, women do not remember accurately what symptoms they have had nor how serious they were. Consequently it is necessary to make a daily record of their experience of PMS from the beginning of the study. This is called prospective recording.
Another twin study was the subject of an article published in 1993 by a researcher called Condon. 157 identical twins 143 non-identical twins completed the questionnaires. The results suggested that there are several genes, which affect PMS. This is like human height. There are several genes that affect how tall a person will be in good conditions. Each gene can exist in a dominant from which confers tallness or in a form that confers shortness. Height will vary according to whether one or several genes of the dominant form are inherited. Condon concluded that in PMS there seemed to be several genes that influenced whether a woman developed the condition. Each gene existed in more than one form and it was the combination of the forms inherited that determined if she had PMS.
That seems to be straightforward. However there were two other explanations for the same results. Identical twins shared greater environmental similarities than non-identical twins, Condon stated. He also thought that PMS might be a reflection of underlying neuroticism that was genetically inherited.
There have been many articles arguing whether PMS and other more serious mental disorders are related. Does one cause the other? Do they have the same cause? Are women who have PMS more likely to have a family history of mental instability? And so on. That could be the basis of another article for NAPS News.
The most recent work published about twins was by van den Akker, Eves, Stein and Murray in 1995. They investigated the genetic and environmental factors affecting PMS, depression and a general neuroticism trait. From statistical analysis of results from a large group of twins, they concluded that there was a genetic contribution to personality, but not to PMS symptom reporting in particular.
Just when it seemed there might be something definite to write about PMS, we have to admit that we are not sure yet. Finding out about PMS is like trying to grasp a greased pig. Genetic factors may be part of the cause of PMS or they may not. All that can truthfully be said is that they can’t be ruled out entirely on the evidence so far.
Olive Ford

Does PMS run in families


We often hear women say that their mothers had headaches or were bad-tempered before their periods, and add that it was not referred to as PMS then, of course. It is tempting to assume that PMS can be inherited. However, there are also a lot of women who remark that their mothers are unsympathetic because they themselves never had any trouble before periods. So what does this mean?
On their own, these comments are not significant. We don’t all have the same eye colour as our mothers and that is genetically inherited. Half our genes come from our fathers. We may inherit different genes for the same characteristic. For example, we may inherit blue eyes from one parent and brown eyes from the other. In this example brown eyes develop because although the form of the gene for blue eyes is present, it has no effect. The form of the gene for brown eyes is said to be dominant.
If two people who have inherited both forms of the gene for eye colour marry, some of their children could be blue eyed because they have inherited the form of the gene that makes blue eyes from both parents. This is the end of the digression into the genetics of eye colour, and I haven’t even mentioned green or grey eyes. Inheritance is rarely simple and how people look and their surroundings, as well as their genes affect how they behave.
European women who lie in the sun go brown, but they do not give birth to brown babies because of their sunbathing. The effects of the environment are not inherited. Some women tan more easily than others and this ability can be passed on to their babies. The kind of skin a person has depends on both genes and surroundings.
Do fat children inherit their tendency to put on weight from fat parents, or do fat parents tend to overfeed their children? It is hard to tell.
So what is the case for PMS? Does it depend on the genes or events during a girl’s life, or what she is brought up to expect, or a combination of these and other factors?
Since it is impossible to have the same person reared twice under different conditions, and unethical to experiment on people by asking them to have babies together just to see if the girls grow up to have PMS, it is difficult to find out. Clues can be found here and there is the literature of medicine and social studies. Asking lots of questions might offer pointers, and twin studies are useful.
In 1977 Weissman and Klerman compared the incidence of depression in men and women as it was described in the medical literature. Their review went back over forty years. They admitted that the apparent greater frequency of depression in females might be accidental due to the way symptoms were reported. Alternatively, the difference could be real and due to biological susceptibility such as genetic effects or female hormones, or psychological factors like social discrimination or female-learned helplessness. There were no firm conclusions here.
Two researchers called Ghadirian and Kamaraju published a report in 1987 in which they suggested that a subgroup of the women who have mood swings which are related to the menstrual cycle might go on to have serious psychiatric disorders and that these might be genetically predetermined (my italics). This was based on a study of only three women and the tone of the article was very much of the “we must bear this in mind” variety.
Taghavi studied three generations of women who had PMS. There were eleven in all. Seven were successfully treated with amitryptaline, a tricyclic antidepressant. His report, published in 1990 stated that there was a possibility of a genetic predisposition in some forms of PMS especially where depression was a symptom. This was still a very small sample on which to base a conclusion.
More recently (1996) Gruber, Hudson and Pope reviewed the literature about a group of conditions that all have treatment-resistant depression, and which seem to be on the border between psychiatry and other branches of medicine. PMS was one such condition. Others were fibromyalgia, chronic fatigue syndrome (ME), migraine, irritable bowel syndrome and atypical facial pain. They were interested in the fact that chemically different groups of antidepressants could all be used to treat this group of disparate conditions. They argued that it was unlikely to be that these medicines were all helping just the symptoms of the different disorders by chance. It was more likely that the disorders were themselves related to each other in their cause that was possibly genetic.
They urged caution however, because like so many other authors who have attempted to combine the results of many studies, they found that there was little consistency in experimental design, diagnostic criteria and methods for measuring the experimental outcome. The doses of antidepressants used varied. Sometimes other treatments were used at the same time. Studies did not always assess both psychological and physical symptoms.
All the studies mentioned so far need more than a pinch of salt.
Research into human genetics often involves twins. Identical twins have the same genes. They are naturally occurring clones. If they are brought up separately then it might be possible to distinguish the effects of genes and surroundings. Fortunately for the twins, this happens rarely. Even so, if there are greater similarities in a particular feature between identical twins than non-identical twins, then it is more likely that the similarities are due to genetic constitution.
Kendler, Silberg, Neale, Kessler, Health and Eaves investigated the symptoms experienced in the premenstrual and menstrual phases by 827 pairs of female twins.
Statistical analysis of their findings suggested that premenstrual and menstrual symptoms were independent of one another, but both were thought to have some genetic causes. They were also thought to be independent of neurotic symptoms. The genes, which predispose to Premenstrual Symptoms appears to be largely distinct from those that predispose either to menstrual or neurotic symptoms.
This seems conclusive. There was a large sample of twins. Unfortunately only relatively few symptoms were retrospective self reports. It is a well-known difficulty with PMS research that after a month or two, women do not remember accurately what symptoms they have had nor how serious they were. Consequently it is necessary to make a daily record of their experience of PMS from the beginning of the study. This is called prospective recording.
Another twin study was the subject of an article published in 1993 by a researcher called Condon. 157 identical twins 143 non-identical twins completed the questionnaires. The results suggested that there are several genes, which affect PMS. This is like human height. There are several genes that affect how tall a person will be in good conditions. Each gene can exist in a dominant from which confers tallness or in a form that confers shortness. Height will vary according to whether one or several genes of the dominant form are inherited. Condon concluded that in PMS there seemed to be several genes that influenced whether a woman developed the condition. Each gene existed in more than one form and it was the combination of the forms inherited that determined if she had PMS.
That seems to be straightforward. However there were two other explanations for the same results. Identical twins shared greater environmental similarities than non-identical twins, Condon stated. He also thought that PMS might be a reflection of underlying neuroticism that was genetically inherited.
There have been many articles arguing whether PMS and other more serious mental disorders are related. Does one cause the other? Do they have the same cause? Are women who have PMS more likely to have a family history of mental instability? And so on. That could be the basis of another article for NAPS News.
The most recent work published about twins was by van den Akker, Eves, Stein and Murray in 1995. They investigated the genetic and environmental factors affecting PMS, depression and a general neuroticism trait. From statistical analysis of results from a large group of twins, they concluded that there was a genetic contribution to personality, but not to PMS symptom reporting in particular.
Just when it seemed there might be something definite to write about PMS, we have to admit that we are not sure yet. Finding out about PMS is like trying to grasp a greased pig. Genetic factors may be part of the cause of PMS or they may not. All that can truthfully be said is that they can’t be ruled out entirely on the evidence so far.
Olive Ford

Is diet important

My first pregnancy triggered severe PMS with the return of my periods in
February 2001. After extensive reading I tried Dr Katerina Dalton`s
recommended three hour starch diet with moderate (but not complete) success,
but my adherence to it lapsed due to complacency at feeling a bit better.
Symptoms returned with a vengeance.
Well, I guess part of the answer is not to lapse make sure there are no
long gaps between meals or snacks, particularly in the two weeks leading up
to your period. Most women have a higher metabolic rate at that time, so
you may require a few extra calories anyway. Make sure each meal or snack
contains something starchy. Experts now believe that the type of starch is
important too, as you need starch which releases its sugar into the blood
stream in a sustained manner for a long period of time. Starches which
release their sugar quickly can cause a temporary lift, but this may be
followed an hour or so later by a definite slump. Starches which do this
include chips, mashed potato, highly refined breakfast cereals, most wheat
crackers and crispbreads, rice cakes, white and wholemeal bread. You need
to concentrate on starches which do not cause a sudden rise in blood sugar,
followed by a rapid fall. Therefore the best starches include oat based
cereals, oatcakes, rye crispbreads, granary or seeded bread, fruit breads,
basmati or brown rice, pasta, yogurts, smoothies, fruit and fruit juices.
  1. Hi Dr Collinway,

    My name is Renee. I suffer with PMDD. I’ve read your blog about john studd. I’m based in Brisbane and I’m feeling like I need to take control of this once and for all, 15 years of suffering feels like enough for me. I’ve lost the man I love thanks to a mirena. Is PMDD something you help with?

  2. You need to see a hormone doctor ASAP to return to normality

  3. This is why I love the work that I do so much.

  4. Dr Holloway

    Ms Jekyll and Hyde’s described me in her blog. I am almost 50 years old and have been suffering with PMS (more likely PMDD) ever since I can remember. I had trouble having children. The doctors couldn’t find anything ‘wrong’ with either myself or my husband, so I spent years chasing hormonal remedies. I had my first child through IVF in my late 30s and, ironically, became abundantly fertile in my 40s, producing another two children naturally. During this fertile phase of life I found my PMS symptoms subsided immensely, with only some rare episodes of hideousness. Now that I am nearing menopause, and am probably perimenopausal, the PMS symptoms have returned with a vengeance – playing havoc with my self-esteem and career.

    Is it still possible to get in touch with Ms Jekyll and Hyde?

  5. Dr Holloway,
    Just a quick note to say thankypu for all your help. I had a total hysterectomy with ovary removal in nov 13 to cure PMDD and 3 months on i feel like I’m living a different life. For years PMDD had controlled my lifestyle and relationships. Thankyou for helping me pre-surgery, for your support in advocating for me with the surgeon. I have my life back, I am happy and healthy, my husband is happy and my children will finally get to know the calm, confident and happy person I really am. This has been a lifechanging journey.

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