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THE PRE-MENSTRUAL SYNDROME

Katrina had married at the age of 19 against the advice of parents and friends. By the age of 22 she had two beautiful toddlers and a successful husband who doted on his children. Katrina should have been blissfully happy, but she wasn't. For two weeks before her periods, she became morose, irritable and hurtful to her family. She lost interest in sex and felt ugly and unloved. When her menstrual flow began, the dark clouds dissolved and she became her carefree self again but with bitter memories of how she had hurt those she loved. She became the caring mother and wife and resumed her painting and pottery as an expression of her creative spirit. Life was good again up until ovulation began and then, with monotonous regularity, the dark storm clouds gathered around.
Bettina, aged 37 had a vastly different lifestyle to Katrina. She was the typical 20th-century career woman, an executive in a multi-national corporation. She told her friends that she had simply forgotten to have children and marriage was not on her agenda in the context of her sixty-five-hour working week. There were many who envied her, but underneath her cool executive veneer, Bettina was starting to crack. She jumped down the throats of her colleagues, mixed up appointments and became confused for about seven days before each period. She made obvious and serious mistakes and blamed others for not covering up for her inadequacies. The only way Bettina could cope during the week before her period, was by drinking more alcohol and chain-smoking. She was wracked by vascular-tension headaches for three days before her periods and needed frequent doses of painkillers to keep going. As soon as her period began, her headaches vanished and she became once again the cool, calm, collected executive with the seemingly perfect veneer. Deep down Bettina knew that if this monthly imbalance continued she would be burnt out by the age of 45.
Perhaps you can see yourself in these two very different women. As a doctor I see hundreds of such cases in my surgery every year. It is the classic, woeful tale of pre-menstrual syndrome or PMS. Most women will have heard of PMS as it has received extensive coverage in the press and media, but it still remains a misunderstand and poorly treated issue.
PMS is surprisingly common and surprisingly variable. About 50% of women in their reproductive years will notice unpleasant mental and physical changes in themselves sometime in the two weeks before the menstrual bleeding begins.
PMS is the medical term used to describe the collection of different mental and physical problems that may occur during the second half of the menstrual cycle. There are many different problems and symptoms and the important clue is not their nature but the cyclical timing of the symptoms
If the symptoms are due to PMS, they will begin in the second half of the monthly menstrual cycle, sometime after ovulation and will disappear once the menstrual flow begins. The symptoms will then reappear after ovulation occurs in the next menstrual cycle and so the cyclical repetitive nature of PMS will become apparent. Some women will notice symptoms for the full two weeks preceding bleeding while others will feel unwell for only several days before bleeding. Some months may be worse than others with a variation in the intensity and type of symptoms. There are many possible symptoms of PMS and indeed Dr. Katharina Dalton, a world authority on this subject has identified 150 of them. Once again, it is not the type of symptoms but the cyclical relationship of the symptoms before menstrual bleeding that distinguishes PMS from other medical disorders.

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TAKING ESTROGEN

With the onset of menopause, many women suffer from hot flashes and night sweats. Arlene March, 56, a Los Angeles psychotherapist, says she started getting hot flashes 5 years ago. “I’d be working,” she recalls, “and suddenly feel intense heat all over my body. I’d break out in a sweat. I’d have to stop work. Then Dr. Mishell prescribed estrogen pills, and I’ve not had a day of discomfort.”
Some women experience a drying and thinning of vaginal tissues in the absence of estrogen, making sex painful. They also might suffer urinary tract infections and incontinence. Estrogen therapy often helps.
Among the physicians consulted, the most cautious was Dr. Morris Notelovitz, founder of the nation’s first Menopause Center, at the University of Florida, and head of the Women’s Medical and Diagnostic Center in Gainesville, Florida. He says each symptom needs a different treatment and advises that genital tract problems be given estrogen treatment for a couple of years at most. He also urges special measurements of the bones before prescribing estrogen therapy for osteoporosis.
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WOMEN’S HEALTH

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