Goodbye monthly blues

Pre-menstrual syndrome (PMS) is a condition that one in three women experience up to two weeks before menstruation and is more common in women over 30. Symptoms usually stop when a period starts.

PMS is caused by the changes in levels of the hormone progesterone in the body, due to menstruation, but it is not known why some women suffer more than others.

Symptoms vary and range from mild stomach cramps and tiredness to unbearable pain and emotional disturbances, including mild to moderate depression, irritability, tearfulness and uncharacteristic outbursts of anger. There can also be pain in the abdomen and breasts, headache and dizziness, restlessness and insomnia, oedema, diarrhoea and sometimes nausea.

A more severe form of PMS is called premenstrual dysphoric disorder (PMDD), in which the emotional symptoms are exaggerated, but this occurs in only a small percentage of women. Evidence suggests that yeast infections (such as thrush) may exacerbate PMS.

HOW TO GET DIAGNOSED

If you go to your GP, you will be given an examination to check no problems have developed with the womb or ovaries. (Occasionally, a problem with the ovaries or womb, such as a tumour, can produce symptoms that resemble PMS.)

No specific tests are available for PMS, but your GP may take some blood tests to measure hormone levels. It may help the doctor if you keep a diary of your symptoms before the first visit, or between subsequent GP visits.

If the GP feels you have PMDD, he may refer you to a specialist.

WHAT TREATMENTS ARE AVAILABLE?

There is no specific medication, and often it's a case of trial and error to find what works for an individual case. However, some common medications include:

Mefenamic acid: An anti-inflammatory drug which reduces the swelling of the womb that causes a lot of the pain of PMS. It should be started about 12 days before the next period and the dose increased during each period.

Combined oral contraceptive pill: This can control the hormone fluctuations that can exacerbate PMS.

Anti-inflammatory painkillers (Ibuprofen): Relieves pain from inflammation associated with PMS.

Progestogens: Taken for the week before the period is due, these address hormone fluctuations.

Diuretics: A weak diuretic taken for the week before each period helps to alleviate water retention.

Mild tranquillisers: Help to reduce symptoms of anxiety.

Anti-depressants: These may be indicated in cases of PMDD, which can cause severe depression.

Bromocriptine: This hormone inhibiting drug is good if breast tenderness is a major symptom. (Excess amounts of the hormones oestrogen and progesterone can cause breasts to swell.)

WHAT ARE THE ALTERNATIVES?

Medicinal alternatives - herbal as well as vitamins and minerals - have been found to help relieve symptoms and are often recommended alongside conventional medicines.

Agnus Castus (Ze440) is a herbal remedy native to the Mediterranean and West Asia. Recent scientific research published in the British Medical Journal found a specific strain of Agnus Castus extract - Vitex agnus castus Lextract Ze440 - can significantly reduce the symptoms of PMS.

In the study, 170 women with PMS were given a 20mg tablet of Agnus Castus Ze440 daily, and it was found that their symptoms improved by more than 50 per cent. The greatest improvements were seen in those suffering irritability, mood swings, headaches and breast fullness.

Agnus Castus works by regulating progesterone levels - increasing the production of hormones which stimulate ovarian secretion of progesterone. The specific strain of Agnus Castus Ze440 is distributed in the UK by Healthspan. Call 0800 731 2377 (Mon-Sat, 9am-6pm) or go to www.healthspan.co.uk.

In several studies, gamolenic acid (GLA) has been shown to help with breast pain (mastalgia) and stomach cramps associated with PMS. Evening primrose oil, starflower oil and blackcurrant oil all contain GLA.

The reason GLA is believed to work is that it is a rich source of long-chain fatty acids, which are the precursors of prostoglandin - the hormonal substances present in the uterus which control muscle cramps.

PMS is associated with low levels of prostoglandins, which may lead to more intense stomach cramps.

Vitamin B6 supplements have been shown to help suppress the actions of a steroid hormone called aldosterone. This results in a diuretic effect, preventing bloating.

In addition, high doses of vitamin B6 decrease blood oestrogen and increase blood levels of progesterone (PMS is associated with an increase in blood oestrogen levels and low blood progesterone), so providing symptomatic relief.

However, vitamin B6 supplements should not be taken continuously. You should start taking the recommended daily dose a week before your period begins (or as soon as you start getting symptoms) and continue on until the end of your period. In addition, Marmite, brazil nuts and bananas contain significant levels of B6.

Magnesium is good for helping relieve mood swings and anxiety, as it is involved in the activation of the neurotransmitter serotonin, which helps regulate mood.

Green vegetables, fruit, wholewheats, nuts and seeds all contain significant amounts of magnesium. There is also a fair amount of magnesium in comfort foods such as bananas, chocolate and peanut butter. You could also take a daily supplement seven days before your period and until it is finished.

CAN DIET HELP?

Many nutritionists believe that diet can significantly affect the severity of symptoms of PMS. Common advice on how to reduce symptoms of PMS via diet include:

Limit refined sugar as it increases excretion of B vitamins, magnesium and chromium.

Restrict salt intake to less than three grams per day.

Eat less red meat, as evidence shows hormones in red meat contribute to menstrual cramps.

Limit alcohol to one unit per day. Alcohol destroys B vitamins, magnesium and chromium, and is a potent depressant in some people.

Reduce intake of caffeine, as it intensifies anxiety.

Avoid liquorice, as it stimulates the production of aldosterone (a hormone that can cause excess water retention).

Increase your intake of complex carbohydrates to 40 per cent of your diet.
Wholegrains and green leafy vegetables are beneficial because they are high in fibre and B vitamins and release sugar slowly.

Increase intake of potassium-rich foods (sunflower seeds, dates, figs, peaches, bananas, tomatoes) as they are beneficial for guarding against water retention.

Have a little chocolate, which contains iron and magnesium. Iron helps with tiredness and irritability, and magnesium helps regulate mood. It also contains calcium (from milk), and studies in the 1990s found that calcium helps relieve PMS symptoms.

WHAT ABOUT LIFESTYLE?

There are some lifestyle changes that can also help relieve symptoms of PMS. Regular exercise, such as aerobics or jogging, helps - but the exercise must be done all the time, not just when symptoms are present.

Try to avoid stress at home and at work in the time before a period is due. Try to pinpoint and avoid any emotional triggers or stress that make the symptoms worse.

To get rid of that bloated feeling, drink plenty of water. Your body will retain water if your intake is short of what your body needs. If you drink loads, your body will flush through and you won't feel bloated.