Sunday 18 November 2018

Dear Dr Nina: I have terrible PMS... I know I’m making life hell for my husband and kids

Period pain
Period pain
Surgery should only be considered as a last resort for PMS

Nina Byrnes

Question: I’m in my late thirties and have three children. I’m absolutely sure that I don’t want any more. The reason I’m writing to you is because I’m at the end of my tether. I suffer from terrible PMS. There are about 10 days in the month when I feel okay, but other than that, I am either experiencing irritability and anger, or in agonising pain. I have tried everything — supplements, the pill, and nothing has made any difference. I have a healthy balanced diet and exercise regularly. I know I’m making life hell for my husband and kids. I want to get a hysterectomy, but my husband thinks it’s a bit drastic. Can you outline for me what a hysterectomy will do to my body and will it solve my problem?

Dr Nina replies:  Premenstrual Syndrome (PMS), is a collection of physical and /or emotional symptoms that occur to some extent in up to 85pc of women. They start in the second half of the menstrual cycle and disappear once menstruation starts. For most women symptoms are manageable and mild, but for an estimated 2-5pc of the population symptoms are severe enough to cause significant disability.

Common physical manifestations of PMS include: bloating, fluid retention, constipation or diarrhoea, headaches, nausea, muscle aches and pains, fatigue, weight gain, breast tenderness, skin changes, and a flare in cold sores or acne.

There is a particular form of PMS where severe emotional symptoms predominate. This is called Premenstrual Dysphoric Disorder (PMDD). Symptoms can mimic depression and include low mood, irritability, anxiety, social withdrawal, severe fatigue, poor concentration and in rare cases, suicidal thoughts or feelings. In order to be diagnosed as PMDD, the symptoms must only be present in the two weeks leading up to monthly menstruation.

There is no known cure for PMS. Lifestyle change can really help. Regular exercise, a diet high in whole grains, fruit and vegetables, avoiding caffeine, salt, sugar and alcohol, and getting enough sleep (approx. eight hours) can all go a long way towards improving symptoms.

Other possible remedies include yoga, meditation or relaxation, taking vitamins: E (400 IU), B6/thiamine (50-100mg), and supplements of calcium (1,200mg with vitamin D), and or magnesium (400mg). For those who require pain relief, Ibuprofen or other anti-inflammatory medication can help. If fluid retention remains a big problem diuretics are occasionally prescribed. Oral contraceptive pills, which stop ovulation, are used in some cases.

For PMDD anti-depressants can help and are worth trying. Another medical option is GnRH analogues. These block a women’s hormones, bringing on a menopausal state.

Surgery should only be considered as the last resort for PMS. The womb and ovaries need to be removed in order to stop the monthly hormone swings. It is a drastic and irreversible solution. It’s also important to consider that having your womb and ovaries removed will plunge you into an early menopause, which in itself can carry a number of undesirable symptoms, such as hot flushes, vaginal dryness and irritation, mood swings and bone mineral loss. In order to stop these symptoms HRT would be required.

My advice would be to talk to your doctor. Ensure all medical options have been exhausted before considering a surgical cure.

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