Healthy Eating for Women

From earliest times men have written about women’s changing moods and behaviour and attributed them to their female anatomy and their menstrual cycle. In the twentieth century, Frank (1931) coined the term premenstrual tension (PMT). He perceived a link between symptoms in the latter half of the menstrual cycle and the fluctuations of the reproductive hormones. From the 1950s, Dalton has campaigned for the better recognition and treatment of such symptoms and widened the concept, calling it premenstrual syndrome (PMS). Since then, PMS has received much publicity, in both the lay and medical press. There is still much debate about the syndrome’s definition, aetiology and treatment, but following considerable research and debate, there is now a better understanding of PMS and a range of ways of managing the problem. It is a complex and fascinating topic that raises many questions about the interactions between hormones and physiological changes and life events and stress. Women today are taking an active and positive role in acquiring knowledge and information about health issues and many women hear about PMS and identify similar symptoms in themselves.

With information, patience, and encouragement, women can work out ways to understand and manage their symptoms and this may include seeking medical advice from their general practitioner (GP).
Definition Many women notice change in their emotional and physical feelings during the menstrual cycle. While for the majority such changes are acceptable, for others they are distressing. These distressing premenstrual changes are now described as ‘premenstrual syndromeâ€^TM rather than ‘premenstrual tensionâ€^TM, in recognition of the variable nature of the symptoms, which may not always include tension. The definition of PMS has been fraught with problems, since the type of symptoms and their severity can vary enormously both between women and between cycles for individual women. There are a number of definitions of PMS available. O’Brien (1990) gives a widely accepted example:

a disorder of non-specific somatic, psychological or behavioural symptoms recurring in the premenstrual phase of the menstrual cycle. Symptoms must resolve completely by the end of menstruation leaving a symptom-free week. The symptoms should be of sufficient severity to produce social, family or occupational disruption. Symptoms must have occurred in at least four of the six previous menstrual cycles.

He does not specify which symptoms, because these can be so variable. More than 150 symptoms have been described, but the commonest include: low mood, irritability, anxiety, tension, clumsiness, poor memory, food craving, sleep disturbance, bloating, breast tenderness, abdominal pain, back ache, weight gain, fatigue. Some women notice only mood changes, others only physical symptoms, but it is more common for both to be experienced together. There are no specific symptom clusters and individual women tend to report their own unique combination of symptoms. However, most of the women looking for help have a predominance of psychological symptoms because these interfere most with relationships in everyday life.

Recently, a severe premenstrual syndrome with predominantly mood symptoms has been defined in the appendix of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM IV, 1994), called ‘premenstrual dysphoric disorderâ€^TM (PMDD). Operational criteria have been described so that research into this severe condition can be more consistent. Epidemiological data using these criteria reveal a subgroup of women with a disorder that is very like an affective disorder and which may be best treated as one. This has allowed women with the most disabling pattern of PMS symptoms to be researched specifically, with encouraging results for all sufferers. While being yet another medical label for women, this may be helpful with regard to management approaches.

Distressing changes may start up to 14 days before menstruation, although it is more common for the symptoms to last for up to a week, and disappear at or shortly after the start of menstrual bleeding. Many women say that the severity varies from cycle to cycle, depending on general life events and stresses. Until the timing in relation to menstruation is established, PMS can be confused with more general problems such as anxiety or depression, and may be misdiagnosed or mistreated. Hence, the first step in diagnosis is careful and regular symptom recording to establish the nature and timing of the problems. Women should be asked to complete menstrual charts, recording their moods and other symptoms for at least two cycles.

Some women complain of symptoms that seem to be related to the menstrual cycle but wax and wane at other times in the cycle, e.g. at ovulation. Some definitions allow such variations, e.g. Magos (1990):

distressing physical, psychological and behavioural symptoms not caused by organic disease which regularly recur during the same phase of the menstrual cycle and which significantly regress or disappear during the remainder of the cycle.

Again it is crucial to establish the pattern by prospective daily symptom diary kept over several cycles

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