Dear Dr Nina: Is this PMS - or could I be perimenopausal?
Q I am 38 and have recently been experiencing more severe pre-menstrual tension than usual, and increased fatigue. I presumed I was too young for menopause but a friend suggested that I might be perimenopausal. Should I be tested for this and is there anything I can do about it?
Dr Nina replies: Premenstrual syndrome (PMS) is a collection of physical and /or emotional symptoms that 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 2pc to 5pc of women, symptoms are severe enough to cause significant disability.
There have been over 200 symptoms described. 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. Emotional symptoms include: crying spells, anxiety, depression, poor concentration, mood swings, irritability, disrupted sleep, reduced libido and food cravings. PMS is most common in women in their twenties and thirties but can occur at any age.
Perimenopause starts up to 10 years prior to the end of menstruation. During this time, periods may change or become more erratic. Hot flushes and urinary symptoms occur in some. Other menopausal type symptoms include vaginal dryness, skin changes, weight gain, and mood changes.
It is unlikely, but not impossible, that at 38 your symptoms are perimenopausal. Symptoms of perimenopause and PMS can be very similar. For PMS to be diagnosed, the symptoms must disappear with menstruation. If physical or emotional changes or fatigue are present throughout the month, then there may be a different diagnosis.
Perimenopause could be considered if this is the case. A simple blood test taken around day three of your menstrual cycle will help clarify the issue for you.
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 of PMS. Other possible remedies include yoga, meditation or relaxation, taking vitamins: E, B6/thiamine, and supplements of calcium with vitamin D, and magnesium.
Popular alternative remedies include evening primrose oil, chasteberry, ginger, dandelion, and raspberry leaf.
None of these remedies have proven effective in clinical trials. Their production is not regulated, and their safety or potency is not proven. Lifestyle is also important in perimenopause.
Phytoestrogens are a popular alternative remedy. Acupuncture can help in some women.
If you are experiencing symptoms that are affecting your quality of life, be they premenstrual or perimenopausal, talk to your GP, who can direct you towards a treatment plan that fits your needs.