Q I am 25 years old. For the past year, I have been troubled by headaches, breast pains, mood swings and occasional depression one or two weeks before my menses. I have been taking Evening Primrose oil for a few months. Sometimes it works, sometimes it doesn't. Why is this happening? Will it lead to breast cancer? What should I do?

A Premenstrual syndrome (PMS) is a group of symptoms linked to the menstrual cycle. These symptoms occur one to two weeks before menses and usually go away after the period starts. They are of a wide variety. Mood swings, tender breasts, headache and depression that you described are common.

It is estimated that about 75 per cent of menstruating women experience some form of premenstrual syndrome. The physical and emotional changes may be particularly intense in some months and only slightly noticeable in others.

For most women, these are not severe enough to affect their daily routines and activities. In a small proportion of women however, they can be severe and disabling. And there is severe depression and feelings of hopelessness. There may be an underlying psychiatric condition which requires medical intervention.

Exactly what causes premenstrual syndrome is unknown. Several factors may contribute to the condition. Cyclical changes in hormones are important factors. Chemical changes in the brain may also be involved. Fluctuations of a brain chemical, serotonin, is thought to play a crucial role in mood states. This may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems. Some PMS symptoms have been associated with low levels of vitamins and minerals, eating excessively salty foods, and drinking alcohol and caffeinated beverages. It is not known if PMS is linked to breast cancer.

Treatment with medications and lifestyle adjustments can help you reduce or manage the symptoms of PMS. The success of medications varies from woman to woman. Commonly prescribed medications include: antidepressants, painkillers, water pills (diuretics), hormonal and herbal medications.

Lifestyle adjustments include:

Regular exercise
- Diet: Eat smaller, more frequent meals; limit salty foods; take more fruit, vegetables and whole grains; choose foods rich in calcium and magnesium; avoid caffeine and alcohol.
- Reducing stress: get enough sleep; practise muscle relaxation or deep-breathing exercises; try yoga or massage.

Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen the symptoms.

If you have any questions, e-mail them to sthealth@sph.com.sg

DR PETER CHEW
Consultant obstetrician and gynaecologist
Gleneagles Hospital