clinical gynaecologist
clinical gynaecologist

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Premenstrual Syndrome

Ovarian Cycle Syndrome

The common cyclical condition of premenstrual syndrome (PMS) has been renamed premenstrual dysphoric disorder (PMDD) by the American Institute of Psychiatrists.

This is an unfortunate name because dysphoria, the opposite of euphoria, does not correctly include the range of physical and emotional symptoms and reinforces the view that it is a psychiatric condition, which it clearly is not. The symptoms of depression, anxiety, irritability, breast pain, headaches, bloating, weight gain and loss of libido and energy etc etc etc are clearly an endocrinological disorder, not psychiatric. The principal causation of this is ovulation or ovarian activity and not menstruation. If ovulation is suppressed by various drugs such as transdermal oestrogens or GnRH analogues, which stop ovarian function, the cyclical symptoms due to the cyclical hormonal changes (whatever they are), disappear. Thus, suppression of ovulation is a very effective treatment for this condition.

There are other conditions, which are well known to deteriorate premenstrually. These include asthma, epilepsy, depression, rheumatoid pain, which are all somehow dependent on the hormonal changes of the ovarian cycle and not to menstruation. The monthly exacerbation of these symptoms can be ameliorated by suppression of ovulation.

There is a move to rename this condition to include the somatic symptoms of headaches, bloating, joint pain etc but it is important to include ovulation, or ovarian activity or the ovarian cycle in the name. This will clarify the causation of the condition and offer some clues to effective management.

The term Ovarian Cycle Syndrome has been used in the past to describe the cyclical symptoms that occur after hysterectomy with the ovaries left behind. These women frequently have cyclical depression, anxiety and irritability for 10 days or more (ie PMS without the M!) followed by 2 or 3 days of headaches or migraine (ie menstrual migraine without the menstruation!).

I believe that the term Ovarian Cycle Syndrome should be used to include all of the cyclical, physical and emotional symptoms that occur monthly following ovulation and that this name should replace PMS or PMDD. If we do not achieve this recognition of the true hormonal cause of this disorder, more and more women will suffer the results of many years of multiple anti-depressant and anti-psychotic therapies.

Professor of Gynaecology
October 2008