THE PRE-MENSTRUAL SYNDROME

THE STORY OF PAULA

In its most severe manifestation the pre-menstrual syndrome is a disorder that can ruin your life. This was brought home to me one day by a 42-year-old librarian called Paula who came to see me as her last hope. Paula had First noticed severe mood changes before menstruation, shortly after an early puberty at the age of 10. By the age of 18, her pre-menstrual depression was so severe that she attempted suicide with an overdose of her mother's sedatives. She was diagnosed as manic-depressive and prescribed the drug Lithium. This reduced her mood swings, but she still felt unwell with headaches, bloating, sore breasts and extreme fatigue for ten days before her menstrual bleeding. Paula was gradually taken off Lithium so that she could become pregnant and by the third month of her pregnancy, she felt wonderful. She said "For the first time in my life, I feel in control, peaceful and free of headaches and I love the feeling of those huge amounts of hormones filling up my body". Paula had a natural birth and things were going well until six weeks after childbirth, severe postnatal depression began. Paula again attempted suicide and was again prescribed Lithium. Twelve months later at the age of 31, Paula, terrified of another episode of postnatal depression, begged for sterilization by having her tubes tied (tubal ligation). After consulting six gynaecologists, the tubal ligation was unfortunately performed and, not surprisingly, she then began to experience severe PMS. For twelve days before every period she felt dead and found herself in a deep pit of depression and anger. Her head ached, her abdomen swelled and she became aggressive with her husband and child. Paula felt trapped knowing that every month after ovulation she would feel as if a switch inside her brain turned on producing volcanic changes in her personality and body. Once her menstrual bleeding started, the switch would be turned off and the depression, aggression and headaches would miraculously vanish. After menstruation she felt in control, but was haunted by feelings of remorse and guilt for the disruption she had caused. Her husband could recognise the night and day effect caused by this hormonal switch and he could see that she needed help. Paula visited eight different gynaecologists and tried
diuretics, sedatives, anti-depressants, the oral contraceptive pill, synthetic progesterone, psychotherapy and chiropractic treatment. In a desperate attempt to save her marriage she asked for a hysterectomy and reluctantly, feeling that she had tried all possible therapies, her last doctor removed her uterus.
Paula felt better for three months after her hysterectomy until during the fourth month she noticed that her depression and anger returned for two weeks. For the next six months she found that for two weeks out of every four she was again in the grip of severe mood changes. She returned to the doctor begging to have her ovaries removed. Thankfully, this time the doctor refused and referred her to a psychiatrist.
Paula had classic PMS in a severe degree and was in urgent need of natural hormone therapy. Her hysterectomy had relieved her headaches and fatigue but had done nothing to quell the cyclical surges and falls of sex hormones from her ovaries. She felt great when her ovaries were pumping out oestrogen and progesterone and terrible when they stopped. Paula's case supports the research finding that when the uterus is removed and the ovaries left in place, the symptoms and hormonal changes of PMS may persist, although often to a lesser degree.
I suggested to Paula that her brain would function properly if we maintained a stable and adequate level of the natural oestrogen, oestradiol, in her blood every day. She willingly accepted an initial course of natural oestrogen injections followed up with an implant of natural oestrogen. Three months later Paula felt civilised and happy again and remarked that the constant hormone levels in her blood provided by her oestrogen implant made her feel the way she felt during pregnancy. Paula could now cope, and every day was cool. She felt as if a prison door had been unlocked and she would no longer be trapped in a vicious hormone cycle. Such can be the drama of severe PMS.
Women are "hormonal creatures", riding upon the waves of hormonal surges and indeed this is largely responsible for the alluring mystery that womanhood presents to males. However, for a significant percentage of women, the price of this hormonal uniqueness is too much to pay. Thankfully, we no longer have to be victims of wild hormonal imbalances as modern day hormonal therapy can re-programme our hormonal cycle. One could say the self-programmable bionic woman has arrived!
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