WOMEN’S BODIES: MENSTRUAL PROBLEMS. QUESTIONS ABOUT PMS
What could cause PMS?
There are many theories, often contradictory, but none has been proved. The most widely held theory is that PMS is due to hormone imbalances. But of which hormones? Many believe that the ovarian hormones oestrogen and progesterone are the culprits. Other hormones named as suspects are prostaglandins (widely distributed in the body to aid control of many unconscious functions), prolactin (controls milk production and possibly other reproductive functions), antidiuretic hormone (helps control fluid balance), adrenal hormones (important in stress and fluid balance) and gonadotrophins from the pituitary.
Many women who complain mainly of premenstrual depression have a history of postnatal depression or depression during puberty – other times when there are significant hormonal changes.
Recent research suggests that cyclic changes in ovarian activity are linked to changes in the rate of production and/or release of endorphins (opium-like substances) in the hypothalamus: a part of the brain of paramount importance in the regulation of mood, behaviour, appetite, temperature and fluid balance. If this theory holds true, it should offer some interesting new means of combating PMS.
Among the non-hormonal causes suggested for PMS are vitamin deficiencies, mineral deficiencies, bad diet, faulty posture and negative attitudes to menstruation.
It’s hard to know exactly. It’s usually said that about nine out of ten women experience premenstrual changes, but not all changes are considered symptoms of ill health. Many women view breast changes as evidence (as menstruation is) of the cyclic ebb and flow of ovarian hormones. Around 15 per cent of women say that they feel better before periods. However, 5-10 per cent of women experience some disturbance of health premenstrually, and for a small number the syndrome can be regularly debilitating.
How is PMS diagnosed?
The clue to diagnosis is the regular recurrence of symptoms during the second half of the menstrual cycle, usually becoming worse as menstruation approaches. There is a symptom-free interval of at least a week after the period. Diagnosis can be helped by keeping a diary of symptoms over several months, which usually shows clearly the cyclic nature of PMS.
Another feature of PMS is its variability over the reproductive life span. There may be months or years when there are no premenstrual changes or changes so slight that they’re not considered worth mentioning. Symptoms often appear or become worse after a pregnancy, after stopping the Pill or after gynaecological surgery, and as with any other symptoms of ill health, are often worse during physical or emotional stress.
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