“Please, I’m Going To Murder Someone!” — (also known as P.M.S.)
A new patient, who clearly looked anxious and irritated, sat down across from me at my consultation desk. “I cannot take it anymore — -either my husband is going to kill me, or I am going to kill him!” I took a moment to decide whether this was going to become a police matter. I often have women, in all stages of peri- and post-menopausal despair, describing similar relationship dilemmas. This woman, however, was only 32. Intrigued, but feeling safe, I encouraged her to go on….(A full background history of the situation is the best way to get a handle on the current issues). “Every month, like clockwork, for a few days out of the month, I become like another person”, she said. “I can’t sleep, I’m anxious, I get bloated, my breasts are sore, I get short tempered. My family cannot stand me (and I can’t stand them). I don’t even recognize myself! Then my period comes, and I feel better, and I’ll have a few good weeks — -then, the whole scenario happens again.”
It was as if she opened the medical book and turned to the page labelled PMS — Premenstrual Syndrome. This is a syndrome that is fairly well recognized by those in my specialty. It has been discussed at least for the last 100 years, but the formal recognition and diagnosis was first described in detail by Dr Robert Frank at The New York Academy of Medicine in the 1930’s. From then until now, many theories about its existence and its origin have been batted around, with some believing it is a strictly psychological phenomenon, some believing it is hormonally related, and still others denying that it is a true syndrome at all.
Listening to the history and the time-line of the symptoms usually gives me the clue as to whether this may be a menstrually-related phenomenon. More importantly is to have some basis to successfully treat the symptoms that can be anything from bothersome to debilitating.
First — we look at the history of the patient’s menstrual periods: We pull out a calendar (yes — an actual calendar), and chart the last 6 months or so of the menstrual cycle. There are all kinds of apps to follow the menstrual cycle, but I find that when I ask people to recall the dates of the periods, and how they felt at different points in the month, their memories sometimes get fuzzy.