Premenstrual tension (PMT, premenstrual dysphoric disorder, premenstrual syndrome or PMS) may vary from a slight discomfort for a couple of hours before the onset of a woman’s menstrual period to a severely distressing condition.
During the two weeks leading up to a menstrual period, the body retains fluid. If the balance between the sex hormones oestrogen and progestogen is not quite right, an excessive amount of fluid may be retained in the pelvis, brain, breasts, hands and feet to cause gradually increasing discomfort in the pelvis and breasts, with swelling of the hands and feet, pounding headaches and depression. The worst sufferers will experience abdominal pain, swollen tender breasts, anxiety, irritability and clumsiness, and may be unable to concentrate, work or exercise effectively. The most severe form is known as premenstrual dysphoric disorder when symptoms seriously interfere with a woman’s lifestyle, mental and physical functioning, and relationships. Depression, very rarely severe enough to lead to suicide, and a psychosis that has been used in court as a defence for murder, can be extreme complications. The symptoms usually disappear within a few hours when the period starts.
The oral contraceptive pill or similar hormones can be used to regulate the hormonal balance and prevent excess fluid retention, and diuretics (tablets that remove fluid from the body) may be used alone or in combination with the contraceptive pill. Other medications that may be beneficial include antidepressants (eg: citalopram), vitamin B6, mefenamic acid, naproxen, indomethacin and evening primrose oil. Other approaches include a sensible balanced diet, and avoiding coffee, chocolate and rich foods in the two weeks before the period.
The majority of women can be helped adequately by good treatment.