Ask a doctor: can PMS get worse in your 30s and 40s?

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By Lauren Taylor

Dr Clare Morrison, GP at online doctor and pharmacy MedExpress.co.uk,
says:

"Premenstrual syndrome is the name given to the range of symptoms which
occur for several days before the period starts each month. The main
features are low mood, irritability, fatigue, bloating, breast
tenderness, oily skin and increased appetite.

"The cause of these symptoms is the hormone progesterone, which is
secreted by the ovary from mid-cycle (ovulation) until the period
starts. The effect of progesterone is in contrast to the other female
hormone, oestrogen, which is produced both before and after ovulation.
In general, the two hormones have opposite effects on mood, with
progesterone decreasing the 'feel-good' chemical serotonin, and
oestrogen boosting its effect.

"It isn't entirely clear why PMS gets worse with age. It may be because
the ovaries need more stimulation to produce a fertile egg, as the
quality of each individual egg declines once a woman reaches her 30s. To
compensate for the poorer quality, the pituitary gland stimulates the
ovaries a bit more, so that the egg is produced earlier in the cycle,
and there's a greater chance that more than one egg will be released
each month. This is why older women are more likely to have
non-identical twins. All this causes more progesterone to be made by the
ovaries, and it starts being produced earlier in the cycle.

"This problem can become worse as the menopause approaches - the
'peri-menopause' - because not only is there lots of stimulation of the
ovaries (the quality of eggs becoming much worse in a woman's 40s), but
oestrogen production declines as well. The decline in oestrogen leads to
hot flushes, sweats, vaginal dryness and reduced libido. There is also
the tendency for heavier periods, anxieties relating to ageing, and more
stress, perhaps caused by ageing parents or teenage children.

"In addition, ageing may associated with a sedentary lifestyle, less
exercise, nutritional deficiencies and obesity, all of which increase
the likelihood of PMS. In fact, studies show that obesity increases the
risk of PMS threefold.

"Deficiency of magnesium is a much understated cause of health problems,
of which PMS is one. Weight gain, alcohol, processed food, and excessive
refined carbohydrate, all cause magnesium to be leached from the body.
Because magnesium is a natural 'relaxer' of muscles and the nervous
system, a lack of this essential mineral can cause both physical and
mental tension.

"This not only results in cramps, but also PMS, anxiety and insomnia. If
affected, I would suggest a supplement of magnesium citrate 100-200mg at
night, or try bathing with epsom salts (which consist of magnesium
sulphate) dissolved in the bath water. A lack of vitamin B6 (pyridoxine)
can also increase the risk of PMS, so it may help to take a supplement.

"Progesterone is the 'pregnancy hormone'. It prepares the body for a
possible pregnancy each month, and so it stimulates the appetite, which
can lead to weight gain. Rather than fighting the instinctive desire to
eat more (which could make the mood swings worse), I would suggest
eating small regular meals, and more healthy food. Eat a diet high in
lean protein, complex carbohydrates, healthy fats (such as olive oil or
oily fish) and plenty of salads and vegetables - i.e. a Mediterranean
diet.

"It also helps to get regular exercise, avoid alcohol and excess
caffeine. Try to get some early nights and avoid stress if you can. If
these strategies fail to solve the problem, see your GP. They may be
able to help with hormone treatment, such as the contraceptive pill, or
even antidepressants."

Catherine Devane