PRE MENSTRUAL TENSION

Pre-menstrual tension, or PMT, can make a woman’s life a misery prior to menstruation. Medical treatment can relieve some symptoms but self-help and understanding from friends can also alleviate much of the distress.

Not every woman going through the menstrual cycle has problems in the pre-menstrual phase. While some women experience changes in their body or moods they do not find these distressing enough to seek treatment; others even report that they feel particularly productive and fit during the pre-menstrual phase. It has been estimated however that over 50 per cent of women suffer from some type of noticeable pre-menstrual symptom and of these about 10 per cent need treatment.

THE MENSTRUAL CYCLE

If you experience pre-menstrual tension, commonly called PMT, or suspect that you might, it is important to understand what happens during the menstrual cycle. The one described below is a 28-day cycle but this is only an average; the length varies from woman to woman and may be longer or shorter than this.

During menstruation the uterine lining is shed and the body gets ready to begin a new cycle. The period lasts for about five days and as soon as menstruation stops the pituitary gland in the brain sends a hormonal message to one of the two ovaries, telling it to ripen an egg.

The hormone oestrogen is then produced from the Graafian follicle (made up of the egg and the cells surrounding it); one of the functions of oestrogen is to begin preparation of the lining of the uterus for any possible pregnancy. The amount of oestrogen that is produced continues to rise until it is time for ovulation.

On or near the 14th day of the cycle the egg is fully ripened. The pituitary gland then releases anther hormone to stimulate late the release of the egg which travels into the Fallopian tube adjacent to the ovary. The follicle left behind after ovulation now starts to produce oestrogen and progesterone. These hormones make the uterine lining thicker and more spongy, ready to nourish a fertilized egg. It is at this stage of the cycle that a pregnancy can occur but this will be possible for only a day or so.

If the egg is not fertilized it quickly begins to degenerate. The levels of oestrogen and progesterone begin to fall and as a result the uterine lining cannot be maintained. The lining is shed-menstruation-and the cycle begins again. It is during the second phase of the menstrual cycle that women who suffer from PMT may experience symptoms.

SYMPTOMS AND RELATED PROBLEMS

The physical symptoms of the pre-menstruum (the days immediately preceding menstruation) vary a great deal in type and severity from woman to woman. For example, one woman may experience slight tenderness and swelling of the breasts while another may experience swelling in most parts of her body, making her feel clumsy and awkward. Swelling and bloatedness are related to water retention: not all of the water that is taken into the body is passed in urine, but some of it accumulates in body cells and tissues. This results in weight gains and some women put on as much as 1.5-3 kg (3-6 1/2 lb) just before menstruation begins.

Other physical symptoms associated with PMT are skin problems such as spots or blotchiness, an increase in the likelihood of cystitis and general feeling of being ‘under the weather’. In addition. Women who suffer from conditions such as epilepsy, asthma, migraine and conjunctivitis may find that the condition worsens at this time. Women who wear contact lens may find that their lenses become uncomfortable.

The reasons for some of these physical symptoms are not yet fully understood. What is known is that the symptoms are likely to improve dramatically once menstruation begins and return at the next pre-menstrual phase.

The psychological symptoms that are related to PMT are also likely to improve as soon as the peered starts. A woman with PMT may feel depressed and anxious in the days before her period, suffer from lack of energy and a marked increase n irritability, be less interested in sex or find it difficult to concentrate. Because any one of these problems can exist independently of the pre-menstruum, this can make it difficult for a doctor to diagonse PMT.

In recent court cases, PMT has been used as a defense for women charged with violent and criminal behvaiour, and some women have been acquitted on the grounds of diminished responsibility due to pre-menstrual tension. But the question of whether the pre-menstrual phase can produce such behaviour is still at issue.

A number of research studies have also suggested that women are more likely to commit crimes and acts of aggression during the pre-menstrual phase and that they are most likely to attempt suicide in the days before a peered. Many of the studies are based on women who have been convicted of an offence so it is difficult to know whether PMT has brought about the offence itself or made it more likely for a women to be caught.

CAUSES

Although a number of explanations have been put forward, scientific debate is still going on about the causes of PMT. Some doctors believe that it is directly related to problems with the production and balance of progesterone and oestrogen in the body. Others have suggested that the brain may not be producing the correct amount of an important chemical called pyridoxine.

However, there my be other factors involved that are not strictly medical. It may be that many women are ashamed of their body’s reproductive processes or associate the menstrual cycle with something negative-for example some women still refer to their peered as ‘the curse’. But because it is difficult to measure the effect of such ideas on individual women it is also difficult to arrive at any proof for such theories.

Other scientists say that PMT may be caused by a mixture of medical and social factors; while there is no doubt that the body and its chemistry do change throughout the menstrual cycle this fact alone may not be an adequate explanation of the causes.

DIAGNOSING THE PROBLEM

Any problems that particularly occur during the pre-menstrual may be a sign that you suffer from PMT. You may find that your mood swings and physical symptoms follow a pattern that coincides with the days before menstruation. One way to discover if this is the case is to record these changes in a diary, on a calendar or on a special chart. From this you may discover that you are especially clumsy, short-tempered or tired in the days before your period. Your record will be useful not only for yourself but for your doctor if you decide to seek medical help.

Keep your record for at least three months; if you do discover that there is a clear pattern of negative symptoms you may find that you are able to help yourself.

SELF HELP

Try to adjust your routine in the days before a period so that you do not put yourself under physical stress. This applies particularly to dieting, which may increase the likelihood of faintness or dizziness. Do not go on a very strict diet during the pre-menstrual phase and make certain that you eat regularly - little, but often - when pre-menstrual problems arise.

A leading expert who has worked for many years on pre-menstrual problems recommends that your liquid intake should be restricted to about four cup a day if you suffer from water retention. She also suggests a reduction in the amount of salt in the diet as salt increases water retention.

Exercise can also help a great deal and it will make you feel generally fitter. Relaxation exercise can help with tension, both physical and emotional.

If you find that your pre-menstrual problems affect your emotions - you feel irritable or depressed, for example - then it is important to explain to those who are close to you just what is happening. You may wish to tell them that your reactions to difficulties are likely to be more intense during this time and to ask for their understanding and support. It is impossible to avoid all sources of difficulty during this phase but forward planning may enable you to avoid particularly stressful occasions and obligations. However, there is no reason why PMT should prevent you from doing things you wish to do and of which you are normally perfectly capable.

HELP FROM YOUR DOCTOR

PMT can be helped by various types of medication but it is clear that at present no one form of treatment is helpful to all.

Most doctors will prescribe one of two types of treatment: hormone tablets or Vitamin B6. Progesterone therapy is based on the theory that PMT is caused by a lack of progesterone and that therefore it can be cured by improving the hormone balance. You will be given tablets, suppositories or an injection. The amount and frequency of treatment will depend on your symptoms, the type of progesterone used and how successful the therapy is in your case. The amount may be increased if your symptoms do not improve.

Some doctors prescribe oral contraceptives to help with OMT, but this may not be suitable for you and may not even work if it is suitable. The pill prevents a normal menstrual cycle from taking place but it unlikely to have any lasting effect once you stop taking it. Some women find that they have PMT just as severely on the pill as they do off it.

Vitamin B6 can either be prescribed by your doctor or bought from a chemist. Tablets are taken starting three days before symptoms are expected until the peered starts. At first the dose may be 20 mg twice a day, but this may be increased if no effect is noticed. No more than 200 mg a day should be taken and, if you do buy the vitamin over the counter, it is advisable to ask your doctor about the dosage and any alterations you should make to your diet while you are taking it.

The Vitamin is intended to replace the brain chemical, pyrioxdine. Beneficial effects may take some time-a month or two-to be noticed but many women report that Vitamin B6 has put an end to monthly problems such as depression. Anxiety and headaches.

Tranquilizers and anti-depressants may be prescribed if your doctor is unsure whether or not your problems are caused by PMT. A record of your symptoms will be useful if you are sure that they are related to the pre-menstrual phase. Many women say that tranquilizers and anti-depressants make them suffer even greater problems from such things as lethargy and lack of concentration and they are therefore of no use to them.

In the past, diuretics have been used a great deal to help with water retention during the pre-menstrual phase. They should not be bought over the counter at a chemist’s and should only be taken if prescribed by your doctor. Taking too high a dose of diuretics can cause other problems and they should therefore be used with care. Cutting down fluid intake and salt may be a more useful way of helping to reduce water retention.