PMS and Perimenopause
PMS and Perimenopause
Can it be treated with an estrogen patch?
There have been a few questions about estradiol patches for PMS, so I think it’s time to review PMS, its intersection with the menopause transition (perimenopause), as well as the different therapies and when menopause hormone therapy (MHT) might be a good choice and when it may not be the best first choice.
What Is PMS/PMDD?
It helps to know the basics before discussing therapies because we all need to be on the same page, especially as the term PMS gets used a lot colloquially and not always accurately. If this part doesn’t interest you and you want to know more about MHT and PMS, you can skip to the “What About Menopause Hormone Therapy” section towards the end and then read on from there for the TL, DR (too long, didn't read) summary.
Up to 80% of women have bothersome physical and/or emotional symptoms that appear in the luteal phase (after ovulation) and then disappear shortly after menstruation starts. When two or more (at least one physical, Table 1, and one emotional, Table 2) are present in the luteal phase of most cycles, and they negatively affect quality of life, then the diagnosis is premenstrual syndrome or PMS, which affects 12 to 20 percent of women.
Tables 1 and 2: Common Physical and Emotional Symptoms of PMS
Premenstrual dysphoric disorder, or PMDD, is a severe form of PMS that affects 3 to 5 percent of people. With PMDD, there is a greater focus on emotional symptoms, and five symptoms from Table 3 (below) must be present, with at least one from each column. These symptoms must cause significant distress and significantly impact the quality of life.
Table 3: Diagnosis of PMDD Requires a minimum of 5 of the following symptoms
Okay, so you’re looking at the three charts above and thinking, "Um, some of those symptoms sound a lot like perimenopause." Yes, yes, they do. Hold on to that thought because we will get there very shortly, I promise.
Understanding the Cause of PMS/PMDD
PMD/PMDD doesn’t occur before puberty; it is related to specific phases of the