Pre-menstrual tension

Pre-menstrual tension, with its symptoms of bad temper, impatience and fatigue, is now recognized as something that affects about 40 per cent of women every time they have a period. This is the strongest example of how the sex hormones – which control the monthly cycle – can upset the way you feel, although there are other events linked to hormone activity, such as pregnancy and menopause, which can also have a very powerful effect on your emotions.

What links hormones to changes in mood?

The experts know surprisingly little about why these sex hormones, which are after all quite natural body chemicals, should have such peculiar emotional effects. What they do know is that the ‘menstrual clock’ which controls sex homone production is a very delicately balanced mechanism, so that variations in normal hormone levels happen quite easily.

The way you feel depends on the messages your brain receives. It is a part of the brain known as the hypothalamus which controls your menstrual clock and coordinates your sex hormone activity, but it is also involved in regulating a number of other important things, including your water balance, appetite and | mood. Because these ‘control centres’ are so &™ close together, an upset in any one of these I functions can affect the others.

Basically four hormones are involved, each of which has its role to play in regulating the month’s events – from stimulating the release of a new egg from the ovary through to the end of the cycle when, if the egg is unfertilized, the spongy lining of the womb is shed and the whole process starts all over again.

This all sounds very basic, but it actually involves a highly complex series of sex hormone messages acting upon the right parts of the body at the right times. It means that each hormone messenger goes through a variety of highs and lows throughout the month in order to do its job – and this is a perfectly normal pattern.

When you get a marked variation from the normal fluctuations it creates a Small differences may cause only mild changes in mood, but for some women their hormone production fluctuates so widely from the usual pattern that they regularly suffer emotional symptoms as a result – they become easily upset, annoyed, frustrated or even hysterical.

The two major female sex hormones are called and Pre-menstrual tension (PMT) sufferers tend to have lower than normal levels of progesterone and higher levels of oestrogen than normal. This creates ‘difficult’ feelings in the few days before menstruation (and sometimes during the period too) because those are the days when the hormone levels are changing rapidly and balance between them is very critical.

Some women who have never suffered from PMT start to experience it after having a child. During pregnancy, the placenta (’afterbirth’) takes over production of progesterone and the ovaries stop supplying it altogether. After the birth of the baby the ovaries may have difficulty readjusting to produce sufficient amounts of the hormone again – leading to progesterone deficiency and all the unwelcome emotional upsets of PMT.

The sort of feelings experienced, particularly in PMT, may often be no more than minor irritation, but for some women they reach truly nightmare proportions. Mood swings and unprovoked aggression are one kind of reaction; great tiredness, general lack of normal skills and efficiency are another. Just a few typical phrases from the many patients who have consulted a London specialist about these problems tell the story of this monthly misery: ? Tor the few days before her period she is sharp-tongued, impossible to live with. . . .’ ? so nervy and irritable that I am sorry for any one who has to live with me. . . .’ ? I do not batter my children but I do verbally, and I think that can be almost as damaging. . . .’ D’l get so slow and stupid before my period. . . .’

D’all I want to do is curl up in a corner away from all my responsibilities. . . .’ ? ’it is as though there is somebody inside saying terrible things. I blame my son and tell him I hate him and hit him. . . .’ ? ’the whole world gets on my nerves and I can only look at it with a jaundiced eye. . . .’ The tensions and depression in some cases are acute, verging on the suicidal, likewise the fits of temper can be so severe that they are very frightening. It may mean outbursts at home that involve smashing dishes, slapping the children or striking the husband, or it can end in serious crime.

Research in all kinds of areas now points to the ‘hidden effects’ of hormone imbalance during the four days just before a period, and in the first four days of menstruation itself. Here are just a few facts from the revealing evidence relating to these eight days of the female cycle: ? schoolgirls’ work deteriorates; they are more likely to fail important exams ? half of all female emergency hospital admissions to psychiatric, accident, medical and surgical wards take place D half of all suicides in women are attempted at this time ? half of all female crime is committed, including crimes of violence and drunkeness.

If a woman is suffering from the symptoms of sex hormone imbalance then her children are bound to be affected, however loving and caring a mother she is. Children find it difficult to accept the changing moods in their mothers. They cannot understand why some days she is ready for an energetic game of football yet on other days she only wants to sit on the park bench doing nothing, nor do they appreciate why one day when they spill water on the floor mother says ‘Don’t worry, I’ll clear it up’ and another day they get a spanking.

Studies of children under five attending a family doctor because of a cough or cold showed that half of the mothers who accompanied their child were themselves in the crucial eight days of their cycle, presumably suffering from tension, tiredness and depression, and felt they could stand the sick child no longer.

Further research into acute admissions to a children’s ward at a big city hospital showed that half of all the children were admitted during the mother’s ‘bad’ time of the month. Some of the children were admitted as a result of an accident, and it is difficult to avoid the conclusion that if the mother is accident-prone at this time, the child she is caring for will be more at risk too. She may be too lethargic to notice a child climbing a dangerous tree or running in the path of an oncoming car, or her own clumsiness could result in, say, the accidental scalding of the child.

The simple answer is ‘no’. Whereas women only release an egg once a month, about half way through each menstrual cycle, men produce sperm throughout the month. The hormone that triggers the production of sperm in men is testosterone, and there are only slight variations in its daily level.

The research that has been done into certain behaviour patterns, such as the times when schoolchildren or prisoners act disruptively, has shown great differences between the sexes. While schoolgirls and female prisoners misbehave more at certain times of the month -clearly related to each individual’s menstrual pattern – the behaviour of schoolboys and male prisoners fails to follow any cycle.

However, it’s not uncommon for some men to show behaviour changes, such as lateness for work, on a monthly cycle, but these changes actually appear to be linked not to a cycle of their own but to their menstrual pattern.

Husbands’ and wives’ body temperatures have shown a similar link. At ovulation a woman’s temperature suddenly drops but is followed by a rise which remains constant until menstruation.

It’s been demonstrated that a husband’s temperature will rise at the same time as his wife’s ovulation, then return to normal but, if the husband lives apart from his wife or she takes the Pill to stop ovulation, his temperature no longer shows this characteristic rise. As yet no one has been able to clearly explain this mysterious link.

Among women suffering from the regular ‘downs’ of PMT, taking the Pill is much more likely to make things worse. Contraceptive pills contain varying amounts of a synthetic compound called This is very different from the sex hormone which is produced naturally by the body. Progestogen has the effect of lowering the level of the hormone in the blood. Women suffering from PMT already have a hormonal imbalance, with too little progesterone, so the Pill is likely to make this worse.

In fact this kind of woman is the one most likely to stop taking the Pill early because of the increased depression, weight-gain and headaches – all of which are common reactions to taking oral contraceptives. And for those women suffering from PMT there is little to be gained in changing from one kind of Pill to another.

The menopause is another time when sex hormone imbalance can affect the way you feel, and the types of emotional problems experienced by some women are in many ways similar to those of PMT. In fact, the women who suffer most from depression, fatigue and irritability at this age tend to be those who have been relatively free of PMT, while PMT sufferers at least have the consolation of looking forward to a fairly trouble-free menopause. This is because they have relatively high levels of the hormone oestrogen; it is oestrogen production which suddenly decreases in the menopause as the ovaries cease to function.

If a woman is suffering seriously from tension or depression as a result of hormone imbalance – whether associated with the monthly cycle, with post chirdbirth problems, or with the menopause – a sympathetic doctor can certainly do something to help by prescribing hormone replacement treatment.

In terms of self-help for PMT sufferers, it has been found that eating frequent, regular meals during the ‘difficult days’, to stop the blood sugar level falling, is very effective. Simple avoiding action – not planning important events, parties, interviews etc. during the PMT days is a commonsense precaution.

Many women will find it reassuring to have these emotional problems out in the open: if you experience these feelings you know that you are not a freak, not cracking up, not falling out of love with your man, or turning into a bad mother.

It also makes a big difference if people around you, husband or boyfriend, children and parents, are aware of the problem. It may not make a sufferer any easier to live with, but at least everyone who is part of her personal life understands what is causing the trouble. If the effects become too upsetting, traumatic or impossible to cope with, then both the sufferer land her family know it is time to seek advice from a doctor.