PMS

Premenstrual Syndrome (PMS) is characterised by physical, behavioural, and psychological symptoms that impact on women’s lives in a cyclical fashion during the luteal phase of the menstrual cycle. The luteal phase of the menstrual cycle is the 2^nd part of the menstrual cycle between ovulation and the next period. Severe PMS can often occur for the first time in the perimenopause due to the hormonal changes that occur during this time.

Lifestyle factors such as diet, sleep hygiene, and exercise, can help mild to moderate PMS along with complementary therapies and supplements such as acupuncture, magnesium, vitamin B6, vitamin D, and agnus castus. Moderate to severe PMS, or the most severe form of PMS called premenstrual dysphoric disorder (PMDD), will often require medical treatment which falls into 2 categories: hormonal treatment and selective serotonin reuptake inhibitors (SSRIs).

Hormonal treatment works by suppressing ovulation in the case of the combined oral contraceptive pill ( COCP) or some progesterone only pills. These also have the added benefit of providing contraception. However, some women can get PMS symptoms from the hormones in these pills thus counteracting any benefit from ovulation suppression. Body-identical MHT can also be of benefit in some women, particularly during the perimenopause or in younger women  who can’t tolerate the COCP.

SSRIs are thought to improve symptoms by increasing the level of serotonin in areas of the brain affected by hormonal fluctuations. SSRIs can be taken continuously throughout the menstrual cycle, or taken during the entire luteal phase only, or started when symptoms begin.

Options of last resort include gonadotropin-releasing hormone (GnRH) agonists and a surgical menopause which induce a temporary and permanent menopause respectively. GnRH agonists should always be used on a trial basis prior to any consideration of a surgical menopause. The latter is reserved for severe refractory symptoms which are majorly impacting quality of life, interpersonal relationships, and general function.