Wednesday Bubble: PMS and the ‘pause

Posted by Liz on Apr 10, 2013 in Uncategorized | 0 comments

Hey all you perimenopausal women! Have you been taking a familiar walk of late? If you are anything like me, wondering how the walk down (Peri)Menopause Lane has turned out to be an PMS nightmare of epic proportions, take some comfort in knowing that you are not alone. In fact, while I remained convince most of my life that PMS would disappear as my menstrual cycle went awry, it’s been anything but. If possible, it’s worse than ever.

Turns out that a primary culprit may be exogenous (outside or external) progestogen, the type found in hormone replacement therapy (HRT) or oral contraceptives. PMS symptoms — depression, anxiety, mood swing, anger, lethargy, bloating, weight gain, headache or joint or breast tenderness — tend to flare during the luteal phase of the menstrual cycle, that is, before ovulation. And women who are subject to PMS during this time are believed to have a heightened sensitivity to the increase in progesterone levels (even if levels are lower in relation to estrogen during perimenopause) as well as malfunctioning neurotransmitters that cause the central nervous system to go a bit haywire. Add outside sources of progesterone and you’ve got a veritable pot of angst ready to boil over at a moment’s notice.

But what if you are not taking exogenous progesterone? Well, you still may have a heightened sensitivity to the increase in progesterone levels that occur post-ovulation. For perimenopausal women in particular, experts recommend stopping smoking and trying to maintain a healthy weight, especially if your practitioner recommends the addition of estrogen. In a related editorial, there is also a reference to a fruit extract known as Chasteberry (Vitex agnus castus) which was shown to control irritability and mood swings in a scientifically-sound, placebo-controlled trial.

If you prefer to go the pharmacology route and don’t want to take hormones, there has been some work done that shows that SSRI antidepressants (in much lower doses than those used for depression) can be useful in PMS (but of course, can subject women to certain side effets, such as tummy woes, insomnia, headache; these can be better avoided through cyclical use). The last resort? Hysterectomy, at least according to experts (rather extreme, don’t you think?). Mostly though, consider other options – exercise or vitamin B6 also have some clinical evidence to back their use. Finally? Before you take that walk down Menopause Lane, take a breath. Chances are that the worst of it will be behind you before you know it.