Revenge of 'the curse' � is there no escape?

Premenstrual syndrome is linked to severity of
menopausal suffering. Estradiol levels may play a role

By Bryan Hoyle

"It's just not fair!" grumbles 53-year-old Martina Ivanova. "PMS was the bane of my existence. I mean, I once gained two kilograms from binging on Doritos, and don't even ask about the mood swings. I used to think that when I hit menopause, I'd finally catch a break. But all menopause meant was jumping out of the frying pan and into the hot flashes."

Family doctors are familiar with the litany of complaints about premenstrual syndrome (PMS) from their patients. Depression, aggression, mood swings, panic attacks, binging and physical discomforts are just some PMS woes. Many women yearn for menopause as a relief from the monthly suffering. But the post-PMS world can be plagued with another battery of miseries.

A new study may bring cold comfort to those suffering from hot flashes. The report in the May issue of Obstetrics and Gynecology chronicles how women prone to PMS are more likely to suffer from the menopausal fallout of hot flashes, depression and poor sleep. The study was done under the direction of Dr Ellen Freeman, PhD, research professor of Obstetrics and Gynecology at the University of Pennsylvania, Pittsburgh.

Dr Freeman and her colleagues followed the course of 436 women who were experiencing PMS. The women completed a survey at seven different times during the five-year study that collected information about daily symptoms, sleep quality and standard indicators of depression like sex drive and mood. As well, each woman's menstruation pattern was followed and the levels of a number of relevant hormones, such as estradiol, were determined just prior to ovulation up to 14 times during the course of the study.

Of the starting group, 320 completed the full five years of the study. During that time, 176 subjects became menopausal, while the remaining 144 did not.

At the beginning of the study, younger women were significantly less likely to report PMS than their older counterparts. In fact, the likelihood of PMS was inversely related to age. Even more interesting, compared to the PMS-free women, women who were experiencing PMS at the beginning of the study were significantly more likely to get hit with hot flashes, depression, poor sleep and a lowered libido during menopause. This held true even after factors like age, race, diagnosed depression and estradiol levels had been accounted for.

In addition, the troublesome symptoms of menopause, with the exception of a dwindling sex drive, were significantly associated with fluctuations in the level of estradiol.

"Clinicians should recognize that their patients with a history of PMS may experience more troublesome menopausal symptoms," wrote the investigators. But family doctors and their patients can take some solace in the researchers' other conclusion, that the menopausal miseries "are experienced early in the transition to menopause."

The researchers hoped that further studies will uncover physiological reasons why some women suffer from the menopause woes for a few months, while the symptoms last over a decade for others. These answers could pave the way for effective treatments during the menopausal transition.