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.
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………….”
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:
PMS sufferers are usually women in the 30 to 45-year-old age group. The problem is less common in younger women.
Investigation of PMSA 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 TreatmentTreat the whole patient:
Veronica (Dublin 14)