Approximately 5% of women experience severe premenstrual symptoms which include depression, anxiety, irritability and loss of confidence, and physical symptoms including bloating and mastalgia.
PMS is ‘a condition which manifests with distressing physical, behavioural and
psychological symptoms, in the absence of organic or underlying psychiatric disease, which regularly recurs during the second half of each menstrual (ovarian) cycle and which disappears or significantly regresses by the end of menstruation’.
The degree and type of symptoms can vary significantly from woman to woman. The precise aetiology of PMS remains unknown but cyclical ovarian activity and hormonal fluctuation throughout the month has been implicated.
Absence of PMS before puberty, in pregnancy and after the menopause supports this theory .
It can be graded as mild, moderate or severe depending on the degree of symptoms.
Since patients can find these symptoms very debilitating and often get depressed, patiently listening to them and good support from their doctors and family is always helpful. I advise women to do regular exercise throughout the month like walking, jogging, cycling and swimming. Maintaining a optimal body weight and eating a well balanced diet also helps amongst other things in order to get a sense of confidence back.
Also reducing tea, coffee, salt intake in the second half of the cycle is helpful. So is yoga.
There are medicines available in extreme cases to help with symptom control that can be prescribed by a doctor. These are usually hormonal pills to maintain a balance throughout the cycle or a group of drugs called SSRI's. Also in some cases vitamin supplements like evening primrose oil and vitamin E are prescribed. In extreme cases injections and surgery may have to be considered.