Picture the scene. Mr. and Mrs. Stone Age man are having a cosy night in their cave in front of the fire. Then Mr. burps, which really upsets his Mrs. and with angry grunts and butts, she shoos him outside into the dark to shiver. So many tens of thousands of years of evolution…and how little has changed.
Women (and their men) all over the globe have probably put up with premenstrual syndrome (PMS) since the beginning of civilization. It’s estimated that three quarters of us still do, particularly between the ages of thirty and forty-five. Indeed to many it’s part and parcel of being female. And of course we’re well aware PMS isn’t also called premenstrual tension (PMT) for nothing.
But irritability isn’t necessarily the most overwhelming issue. PMS is a collection of physical, psychological, and emotional symptoms, which can start two weeks before your period and ease soon after its started. Bloating, headaches, tiredness, breast tenderness, abdominal and back pain, and spots are all common.
With many millions of women affected and each one unique, PMS is inevitably experienced in different ways and degrees. But experts reckon one in twenty women have symptoms which seriously affect their life.
Jayne, twenty-six, is one such lady. “Ever since I can remember, I felt incredibly sad for the last two weeks of my cycle,” she says. “There wasn’t a day when I didn’t cry, usually at the drop of a hat, over really silly things. And if I wasn’t crying, I was angry.”
When she was fifteen, Jayne’s mother took her to see their doctor. “He wanted to put me on antidepressants,” Jayne remembers. “But I didn’t want to take strong tablets like that.”
It’s not certain what causes PMS, but there are plenty of theories. It seems sensible to accept that whatever’s going on is tied into hormonal changes that happen during the menstrual cycle.
One argument is some women are extra sensitive to the hormone progesterone released in the second half of the cycle. This oversensitivity can lead to a reduced level of the feel-good chemical serotonin in the brain—which brings us back to the antidepressant remedy.
But for many women—except those perhaps with the most severe sort of PMS—premenstrual dysphoric disorder—taking antidepressants is just too extreme.
Other ideas put forward as to the causes of PMS include vitamin B6 deficiency, and variations in the levels of nutrients such as magnesium and calcium. But evidence, at best, is patchy.
After his teenage patient refused antidepressants, Jayne’s doctor suggested exercise to improve her mood. It helped Jayne a bit, but had significant limitations.
“My boobs—which aren’t that big—really hurt in the run up to my period. Then any sort of bouncing was out of the question. I had a striking pain even when I wore a clamp-’em-to-you-style of sports bra.”
Breast tenderness is a widespread gripe—one Andrea, twenty-eight, has also had to deal with. “My 34D bras bit into me for the last two weeks of my cycle,” she says.
For Andrea’s boyfriend it was a mixed blessing. “He liked me bigger,” she says. “But I wouldn’t let him hug me because it hurt. My boobs felt like two aching lumps. I hated having them touched and they stopped me moving anywhere fast.”
In the end, Andrea went to see her doctor. “He put me on a combined Pill,” she explains. “It really worked. The next month, my boyfriend’s cuddle quota went way up.”
The idea behind prescribing the Pill to tackle PMS is straightforward. The Pill stops ovulation, which may trigger PMS in the first place. However, it doesn’t always work, as many Pills contain progestogen (similar to the hormone progesterone), which may aggravate PMS.
There are a number of newer Pills such as Yasmin, containing a different hormone, drospirenone, which some medics think is a better alternative. For severe PMS sufferers, some doctors suggest taking Pill packets back-to-back without a break (a recently launched Pill, Lybrel is designed to be taken this way), although some women could feel uncomfortable about doing that.
Jayne certainly prefers a more personal plan of action. “I told my boyfriend to go out with his friends rather than see me just before my period. It was my way of avoiding arguments when I was horrible to be with.”
Actually, there was a second less altruistic reason for her lack of inclination to socialise—breakouts. Initially appearing in the two weeks before her period, the breakouts ended up lingering all month long.
“The zits made me more upset than ever,” she says.
It was a chance visit to a health food shop two years ago that turned Jayne’s life around. Evening primrose oil tablets and a supplement called agnus castus (a fruit extract) were on promotion next to a poster printed with the words Is PMS your problem?
“The sales assistant said they help balance hormones. So I bought three month’s supply,” Jayne explains.
“It was marvelous, because after years of suffering, I began to feel far more positive and hardly cried at all. My breakouts slowly cleared. My boyfriend and friends see much more of me now.”
Most doctors would be skeptical about Jayne’s experience. Evidence supporting evening primrose oil is conflicting—but it seems taking at least 1000mg for a few months is required. Studies into agnus castus are promising, but scarce. At least there aren’t any reported side effects with either supplement.
Any alternative remedy, however, should be treated with caution. Excess vitamin B12 can damage the nervous system.
One thing is certain—there are numerous approaches to PMS, the symptoms of which may be blurry. How do you know they’re simply not an aggravation of pre-existing problems?
Many women find keeping a PMS diary enlightening, noting feelings daily and seeing if a pattern emerges.
Each diary tells a different story. What’s yours?