Barmy, or hormonally imbalanced?

Women used to be considered mentally unstable in the days before their period. Women were considered to be a financial liability in the work place, not only because they took time off for spastic dysmenorrhoea, and to have babies, but also because they were mentally unstable. Times and laws may have changed our attitudes but female physiology is still the same.

It is only during the past decade that the premenstrual syndrome has been accepted as an entity. Strict criteria identify it as a combination of irritability, lethargy and impairment of ability to cope with normal everyday events, which occurs during the latter part of the menstrual cycle. For many years it was considered to be an affective disorder and all that was required to alleviate the symptoms was to tell the sufferer to ?pull yourself together.? Sympathy was not indicated, but a diet high in roughage with added vitamins was and, as the problem occurred to a minor degree in up to 40% of women, with less that 3% being severely impaired, it was considered a minor variant of normality. Occasionally the symptoms were used as an excuse for misdemeanors or for committing felonies, and probably some of the cases which came before the courts could be explained on the grounds that the propagator was not fully responsible for her actions. Men tended to regard women as being out of season for one week, much too fertile for safety for one week, desirable for one week, and straight forward barmy for another week and that premenstrual depression was due to an unhappy sex life with unfulfilled aspirations. The medical profession was baffled because there was no test for the disorder, and sufferers tended to try herbal remedies, or to go on the gin, which only made matters worse.

It was obvious that if the disorder actually existed it must be something to do with the ovarian hormones. The two ovarian hormones ( oestrogen and progesterone), which control the maturing of the lining of the uterus prior to its being shed at a period, must be to blame. Sometimes putting the woman on the pill helped. However estimations of the levels of ovarian hormones in the blood gave no clue to the cause of the premenstrual syndrome – they were almost always normal.

It had been found by trial and error that drugs such as alprazolam, used to treat anxiety, and fluoxetine, which is an antidepressant and prevents the re-uptake of a chemical called serotinin by nerve cells in the brain, were a help. It was also found that by depressing the activity of the pituitary gland, which controls the production of the ovarian hormones, the symptoms of PMT could be prevented, but that giving additional progesterone brought the symptoms back again. Not only that but giving additional oestrogen did the same thing and yet, when there was only oestrogen present in the blood during the early part of the cycle, the PMT sufferers felt fine. The various methods of controlling PMT by altering the transmission of nerve impulses in the brain and/or altering the functions of the ovary worked – up to a point. Sometimes even giving a placebo caused improvement in the sufferer. It was all too difficult.

Recently some experimenters have suggested that perhaps we are dealing with an unidentified sex hormone which has negative mood effects and is released late in the menstrual cycle. Other investigators believe that a proportion of women deal with their ovarian hormones in different ways and have suggested that progesterone is split, in the body, into two compounds, one of which stimulates and one which inhibits the nerve impulse transmitting chemicals in the brain. If the two actions were slightly out of balance this would account for the positive effects of the two drugs, mentioned earlier, which interfere in different parts of the nerve impulse pathway and imply some minor differences in brain function.

The premenstrual syndrome was known to Hippocrates and we haven?t found the cause yet but, like so many other medical conundrums, helpful treatment, found by trial and error, might lead us to an answer. After all in the 1920?s we knew almost nothing about the cause of pernicious anaemia though we did know that eating raw liver and dried hog?s stomach helped the patient and later we were able to work out the reasons why.