HORMONAL TREATMENTS FOR PMS
In severe cases of PMS that do not respond to diet and nutritional supplements, corrective hormonal therapy can be life-saving. If PMS is so severe that it is associated with uncontrollable mood changes, reduced ability to function, thoughts of suicide, marital disruption, child abuse or dangerous behaviour, then hormonal therapy is usually required to restore equanimity. Many of these women have been offered sedatives, anti-depressants and counselling and come along to the doctor desperately hoping that hormonal help will be at hand. Thankfully, it is and is often dramatically effective.
Progesterone                           
The use of natural progesterone has been popularised and advocated by Dr. Katharina Dalton, who is somewhat of a» 'PMS guru'' and she has shown it to be effective in relieving most types of PMS. Progesterone appears useful in relieving pre-menstrual depression, anxiety, mood changes, fatigue and low blood sugar levels and may reduce menstrual bleeding.
It is important to realise that Dr. Dalton only recommends the use of natural progesterone with a chemical structure identical to the progesterone produced by the ovaries. Natural progesterone is made from soya beans and sweet potatoes (yams).
Unfortunately, doctors often prescribe strong synthetic progesterones called "progestogens" for PMS sufferers, mistakenly believing that they will have the same effect as natural progesterone. This is not true and many of these synthetic progestogens are derived from male (testosterone-like) syn-Mietic hormones and so may cause side effects such as increased appetite, weight gain, fluid retention, acne, greasy skin and increased cholesterol. These synthetic progestogen hormones fit into the natural progesterone receptors found throughout the body and brain but cannot turn or switch on these receptors. Only natural progesterone can turn on the progesterone receptors just as a key turns and releases a lock. So you can understand that synthetic progestogens will not have the same beneficial effect as natural progesterone and indeed many PMS sufferers feel more depressed and tired when they take them.
Unfortunately, natural progesterone is not very effective if taken by mouth (orally) as it is destroyed by the liver enzymes after absorption. Therefore, it needs to be administered by either vaginal pessary, rectal suppository, deep oily intramuscular injection into the buttocks or by natural progesterone implants. By giving natural progesterone in these ways we are bypassing the liver so that the progesterone can be absorbed directly into the circulation and carried to the progesterone receptors on your cells
As you can see, the use of progesterone is quite complicated and should only be administered under regular medical supervision. In general, progesterone is very safe with side effects such as breakthrough bleeding being of nuisance value only. Pure natural progesterone does not cause birth defects or harm to the foetus if you become pregnant, but unless you are under a specialist for infertility, it is best to avoid all hormones (natural or synthetic) while trying to conceive. Generally, progesterone is started five days before the expected onset of PMS symptoms and continued daily up to the time of expected menstrual bleeding and should prevent most PMS symptoms. Each PMS sufferer is an individual and trial and error using different dosages, forms and schedules of progesterone may be required before the symptoms are under control.
Oestrogens
If progesterone therapy by itself is ineffective for severe PMS, then the use of natural oestrogen may break the cycle of vicious PMS. This is particularly so in older women with PMS whose ovaries are less able to pump out sufficient amounts of oestrogen and also in PMS sufferers who have undergone hysterectomy or tubal ligation. The treatment of PMS with natural oestrogen is similar to the use of natural oestrogen for the menopause. For details on this refer to my book titled Menopause — You Can Give It A Miss!
PMS may be relieved by natural oestrogen tablets, injections, implants or patches and you and your doctor may need to try different dosages and forms to get PMS under control.
This was so for 43-year-old Donna, who had first noticed severe PMS eight months after having her tubes tied. Donna was a top marketing executive with many employees under her supervision and she needed her wits about her every day of the month. She was disgusted by the onset of new and strange hormonal upheavals that she described to me as the 'PMT dichotomy'. Donna found that around the sixteenth day of every menstrual cycle she felt like two people inside one body — a kind of Dr. Jekyll and Mrs. Hyde. She described how suddenly she would become irrational and ineffective in the office while another part of her stood by appalled at what the PMS self was doing. She felt out of control until her menstrual bleeding started and then the two Donnas became one peaceful, together person.
Donna knew that she needed hormone therapy as her mental and emotional changes were severe, and her doctor prescribed progesterone pessaries. This took only the edge off her depression and she still felt crazy inside. Donna then began to experience hot flushes and sweating attacks during the week before her menstrual flow. At this time a blood test confirmed low levels of oestrogen and we recognised that her mind and body were crying out for oestrogen. We first tried natural oestrogen tablets which helped the hot flushes but not her mental changes. Finally, much to the relief of Donna and her office staff, I inserted an implant of natural oestrogen which within a week produced a total relief of her mood swings and fatigue.
When it comes to treating pre-menstrual mood swings, depression, fatigue and loss of libido, my preference is to use natural oestrogen implants, injections or patches rather than oestrogen tablets. Implants, injections and patches will produce blood levels of the natural oestrogen ' 'oestradiol'' sufficient to suppress the cyclical hormonal highs and lows of the ovaries. Oestradiol is very effective in overcoming depression and loss of libido and oestradiol implants are recommended by Dr. John Studd of St. Thomas Hospital, London, to treat PMS. A trial involving the treatment of fifty women with PMS using oestradiol implants over five to six years found that a beneficial and lasting response occurred in all PMS symptoms with 96% of cases of depression being relieved.
OTHER DRUGS USED TO TREAT PMS
Can Diuretics Help?
In women with severe premenstrual fluid retention and bloating it may be necessary to use diuretic drugs. Some women find that they retain so much fluid that they gain up to five kilograms of weight during the seven days before menstrual bleeding. This is called cyclical oedema and may be extremely uncomfortable with a new wardrobe being required at this time of the month. In such cases a special diuretic drug called a ' 'potassium sparing diuretic" such as Moduretic or Aldactone is excellent. These drugs remove unwanted fluid without causing a deficiency of the mineral potassium. Aldactone tablets in a dose of 25 to lOOmg twice daily from day 11 to 28 of the menstrual cycle can help reduce depression, fluid retention, acne and greasy skin.
Danazol
Danazol is recommended only for extreme PMS when other drugs and therapies have failed. It is a powerful synthetic steroid hormone with male hormone-like properties. Danazol in a dose of 200-400nitf daily suppresses the hormone cycle of the ovary, putting an end to ovulal Ion and menstrual bleeding. It can be effective for PMS, but women often slop inking it because of unacceptable masculine side-effects such as acne, ferial hair, weight gain, shrinking breasts and deepening of the voice.
Gonadotrophin Releasing Hormone Agonists (GnRH)
These are powerful synthetic hormones that act on the pituitary gland to completely inhibit the ovarian cycle. Their use results in a "medical menopause" with very low levels of oestrogen and progesterone and absence of menstrual bleeding. They could only be recommended for severe PMS when all other hormonal and drug therapy has failed and then only on a short-term basis. Their long-term use would result in very low levels of oestrogen with increased risk of osteoporosis and cardiovascular disease.
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