The last taboo...

The last taboo...

LATE-ONSET PMS

The last taboo...

Catherine gave her periods little thought during her 20s and 30s. Every month, she had a day or 2 of stomach ache, but it was manageable — she swallowed a paracetamol, filled a hot water bottle and ploughed on with her day. Often she forgot she was experiencing it at all. But as she approached 40, everything changed.

Each month, she was hit by severe fever-like symptoms that wiped her out and left her in excruciating pain. “In the run-up to my period, I start feeling very hot for a day or 2, then I get blinding headaches and a flu-like feeling,” says Catherine, now 44. “A few days in, I become depressed. I feel overwhelmed by my 2 children and get offended by perceived slights from friends and family.

Then I get crippling pains in my stomach and feel unable to function at work — partly because of the pain and partly because my mind feels heavy and slow. This lasts for a week, and then my period starts and the symptoms vanish. My husband and general practitioner (GP) are dismissive, but for those 10 days or so I have really dark thoughts and I’m in so much pain I can’t concentrate. Yet because it’s ‘only my period’ I tell myself to just get on with it.”

Harder with growing age

It’s a story that Professor John Studd has heard time and again. A former consultant gynaecologist at London’s Chelsea & Westminster Hospital and professor of gynaecology at Imperial College, he now runs the London PMS & Menopause Clinic. He explains that premenstrual syndrome (PMS) affects around half of all women, with 1 in 20 suffering symptoms so severe that they temporarily stop them from living normally. But contrary to the misconception that symptoms of PMS tend to be worse in your teens, he says they actually peak in your 30s and early 40s.

What makes this even worse for sufferers is that PMS can often be misdiagnosed. “Women are either ignored, or told they have something else like postnatal depression or even bipolar disorder,” says Prof John. “Actually, they have a simple endocrine condition (the endocrine system produces and releases hormones to enable bodily functions).”

There is no known cause —although severe PMS is thought to be hereditary — yet the repercussions can be severe. “Sometimes women lose confidence in themselves, are unable to think straight and may withdraw from family and friends,” says Prof John. Of the contraceptive pill, widely believed to ease the symptoms of PMS, he says: “When you’re on the pill, it wipes out your cycles, so you don’t feel good and then bad. You just feel slightly under par.”

Jess suspects that this is why she’s suffering from PMS for the first time ever, at the age of 42. “I was on the pill since I was 17, and I can honestly never remember having any PMS symptoms in my teens or 20s. However, thinking about it now, I never felt anything really. My moods and sex drive weren’t up and down like they are now. I just felt a bit ‘meh’ the whole time. Then I came off the pill at 33 to have my children. When I turned 40 and decided I didn’t want to keep putting hormones in my body, my husband and I decided to use condoms. But since then, my PMS has been insane.

The week before my period, I question whether I even want to be with my husband. I don’t feel low or sad, just very angry about almost anything. Then my period arrives and I feel normal again. I wonder whether the pill masked it for years — and my GP has suggested I go back on it — but I don’t want to take hormones for another 10 years.”

Despite popular belief, the contraceptive pill is safe for non-smokers to take up until the age of 50, and studies show it reduces the risk of cancer of the ovary, uterus and colon. However, Prof John says women with PMS have to be careful when it comes to contraception. “The pill doesn’t solve the problem, it just masks it. Women with PMS have an intolerance to progesterone, the hormone released along with oestrogen during your menstrual cycle. They are intolerant either to their own, which causes their PMS symptoms in the first place, or in the case of the Mirena coil (an intra-uterine
contraceptive system), to the synthetic version it uses. One in 10 women with PMS will feel absolutely awful with the Mirena coil. However, it’s a very good
option for the remaining 9.”

So what can be done? While mild symptoms can be helped with diet and lifestyle changes, Prof John says that severe PMS requires medical intervention. He uses treatments that suppress ovulation, including oestradiol patches and implants. However, he says, there’s currently a lack of investigation — and awareness — into the use of oestrogen as a treatment for PMS. “Nobody is interested,” he says.

“Medical experts don’t want to know and psychiatrists don’t want to listen about the role that hormones play in affecting mood, when it’s just so obvious. Women are just supposed to tolerate it and not speak about it.”

Elizabeth, 41, agrees: “Over the past few years, my period pain has become unbearable. Usually it lasts a day or so, but if I’m stressed it can go on for days, and about a year ago, I was in so much pain I couldn’t get up off the floor and my husband took me to A&E (an accident & emergency department). After that, I got referred to a gynaecologist and had scans to see if there was anything serious, but the doctors I saw almost seemed irritated that I was taking up their time. No one found anything wrong with me, so I’m left with the option of going on the Pill or simply taking ever stronger painkillers.”

“What frustrates me is I want to solve the problem, and not cover it up by taking a load of pills each month. It feels like something you’re meant to just put up with or that will supposedly work itself out in time. There’s this faintly medieval attitude towards PMS: nobody likes to talk about it — and I’m just as guilty. But if we don’t talk about it, how will we ever find a cure?” she adds.

When to talk about it

When you’re over 40, it’s important to be aware that many symptoms of PMS could also be signs of other health conditions. Nutritionist Dr Marilyn Glenville explains what to look out for. “Before you see your GP, keep a track of your symptoms. If they always occur in the weeks before your period but stop when your period begins, they are undoubtedly associated with PMS. If not, be sure to tell your GP, as it could indicate other causes.”

If you increasingly have food cravings for sugar and bread, often feel fatigued and/or bloated, and become drunk on small amounts of alcohol — along with suffering from persistent thrush — don’t assume these things are down to PMS. Ask your GP to be tested for candida.

(Some names have been changed)


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