Somewhere between 80-90% of women experience mild to severe physical or psychological discomfort in the days before their period.
Yet despite PMT (pre-menstrual tension) being a medical condition for which 20% of women seek treatment, its causes are poorly understood and effective drug treatments remain elusive. Here we detail why drug treatments prove ineffective and examine some alternative treatment options for women with PMT.
What is PMT and what causes it?
A diagnosis of PMT covers any pre-menstrual symptoms that affect a woman’s ‘quality of life, social engagements and/or work performance’. Symptoms vary in their severity and duration but common ones include:
- Emotional symptoms
- Depressed, sad, down, low mood
- Anxious, tense, on edge, wound up
- Angry or irritable
- Physical symptoms
- Breast tenderness
- Muscle or joint aches
- Stomach bloating or diarrhoea
- Carbohydrate craving or increased appetite
These symptoms affect women across continents and cultures, yet despite over 40 years of research into the potential origins of PMT an exact cause has yet to be identified.
For most women, it is likely that their PMT symptoms occur due to a complex interplay of different factors – emotional, physical and environmental.
Unfortunately, the existing medicine cabinet available to treat PMT is concentrated on individual factors – antidepressants which affect serotonin levels (SSRIs like Prozac and Seroxat) to regulate mood, hormones via contraceptive pills, NSAIDs – anti-inflammatories to combat the immune response and spironolactone which regulates adrenal function.
Of all of these options, a recent study has shown that to date the only drugs clinically effective for PMT are anti-depressants (SSRIs) and the side-effects of taking anti-depressants far outweigh the limited benefits. Taking daily anti-depressants to treat low mood which may occur for only 3-4 days a month is the medical equivalent of using a sledge hammer to crack a nut.
This high side-effect / low benefit risk ratio is what makes drug therapy a poor first choice treatment for all but the most severe cases of PMT.
The drugs don’t work. So what does?
If we understand the cause of PMT to be a combination of physical, emotional and environmental factors, then an integrative approach to treatment – taking into consideration a woman’s individual symptoms and preferences – is a great starting point for treatment as it offers potential benefits with low risk of side effects.
An integrative treatment strategy might combine exercise, meditation, active relaxation (such as yoga or tai chi) with external factors like improved diet, acupuncture, massage, herbal medicine, nutrition, supplements and/or pharmaceuticals.
This integrative approach to gynaecology is practiced by James Thirlwall where an evidence-based integrative medicine provides patients with highly individualized treatment plans to treat symptoms of PMT and other gynaecological conditions.