Taming the Beast

Every month is the same; your tummy blows up like a football, you snarl at the kids, overdose on chocolate and cry at the slightest thing.

“Is your period due, love?” your brave husband asks. “No!” you shriek. Inevitably, the following day you’ll be curled up with a hot-water bottle, popping painkillers and whimpering apologies because your period has indeed arrived.

If this sounds familiar, you’re probably one of the 40 per cent of Australian women suffering from premenstrual syndrome (PMS). PMS describes a host of physical and emotional symptoms that can occur in women for part of their menstrual cycle – usually the time between ovulation and the onset of bleeding – each month. Physical symptoms include sore breasts, fluid retention, migraines and stomach cramps. But it’s often the emotional ones that are hardest to bear. These can include moodiness, food cravings, aggression, irritability and tension.

Most women experience one or two symptoms. But 10 per cent of sufferers have as many as five or more. This is called premenstrual dysphoria (PMD). The cause of PMS is still not fully understood, so there is no cure, only a management of symptoms.

“Hundreds of studies have unsuccessfully tried to show hormone imbalance as the cause of the problem, but a big part of the picture lies in the brain,” says Professor John Eden, director of the Sydney Menopause Centre and Natural Therapies unit at the Royal Hospital for Women in Sydney. “It’s an urban myth that oestrogen dominance is the cause.”

Dr Elizabeth Farrell of the Jean Hailes Foundation for Women’s Health, agrees. “When you think about such a complex set of symptoms, how could brain chemistry not be a central cause?” she asks. PMS is more common in women over 30, worsens with age and disappears at the onset of menopause. There’s some evidence a family history may be a factor, but science is yet to find any true common denominator.

“Most women with PMS notice the symptoms each month but are able to carry on with their lives,” explains Dr Farrell. “The women with the most severe form, PMD, say they feel like a different person. They can’t care for their family or go to work, they feel like a bitch, some have feelings of self-loathing while others want to lock themselves away.” There’s no single treatment. At one end of the spectrum exercise brings relief; at the other end antidepressive medications such as Prozac may work wonders.
Treatment options

“There are three parts to the story,” explains Professor Eden. “We can manipulate the menstrual cycle – women who don’t ovulate don’t get PMS. We can deal with the altered brain chemistry with antidepressants. We can deal with everything else – stress, relationships, exercise, diet.”
 

1. Diet and exercise

“A diet that’s high in fibre, fruit and vegetables around the time of the PMS stage of the cycle can help,” says Dr Farrell. “Unfortunately, it’s usually a craving for sweet things that many women experience. Exercise can
also minimise the impact of symptoms. Vigorous exercise can improve brain chemistry and how the brain functions with an increase in the endorphins being released.” Acupuncture, relaxation, and massage can also help.

2. Natural therapies

The list of natural therapies, herbs and oils claiming to alleviate PMS symptoms is endless, but few have any scientific backing. Vitamin B6, calcium and magnesium may help some women, but the most scientifically-backed natural remedy is vitex agnus castus, or chaste berry. Even then, only one manufactured form of the berry – Premular Ze440 – has any recorded clinical trials. A trial published in the British Medical Journal concluded that the “dry extract of agnus castus fruit is an effective and well-tolerated treatment for the relief of symptoms of the premenstrual syndrome”. Women in the trial reported a reduction of up to 50 per cent in emotional symptoms. Before trying anything, do your research. Many herbs can have side effects and interfere with medications, so they shouldn’t be taken without professional advice.

3. Medical treatments

The oral contraceptive pill may relieve symptoms by preventing ovulation. The same result can be achieved from injected contraceptives. “They flatten out the cycle, help brain chemistry and ease symptoms,” says Dr Farrell. In the case of PMD, some GPs prescribe antidepressants. The most effective is Prozac. “A small dose is taken in the premenstrual phase,” says Professor Eden. “Changing brain perception helps the physical symptoms.” If you suffer from PMS, see your GP for help.