Teresa Hall has two young daughters and a successful career in publishing. She has a happy marriage and a loving relationship with her children, and is good at her job and satisfied with her life. At least she is most of the time. For up to two weeks before her period, Hall often feels that she carries the woes of the world upon her shoulders. She is snappy with her children, aggressive with her husband and her confidence in her professional abilities dissolves, leaving her indecisive, paranoid and unable to concentrate. Problems magnify in her mind out of all proportion. "I can feel grief- stricken over things that happened ages ago," she says, "paranoid about what my friends or colleagues think of me, or heart-broken over some way in which I feel I've let my children down." Each month her period brings blessed relief. "For the fortnight after that, I am happy, energised, confident and pleasant to be with," she says.
Though she's aware of the cyclical nature of her behaviour, Teresa often feels ashamed of herself. And, beyond taking the evening primrose oil capsules recommended by her GP, she has no idea how to make her life better.
It's more than 50 years since Katharina Dalton, the gynaecologist who died last month, first described the hormone-related illness, premenstrual syndrome (PMS). Dalton was co-author of the first paper on PMS, published in 1952. She also founded the world's first PMS clinic, at University College Hospital in London. She ran the clinic, unpaid, for 40 years and published many books and papers on PMS and postnatal illness. She was an expert witness in the successful defence of Anna Reynolds, who killed her mother while suffering from postnatal illness, and Nicola Owen, an arsonist whose crimes were shown to follow her menstrual cycle. Not all medical opinion agreed with her methods of treatment, but, without doubt, Dalton helped to put PMS on the map.
Yet today's PMS experts, at a conference on women's menstrual health on Friday - organised by the National Association of Premenstrual Syndrome (Naps), which Dalton set up in 1983 - had to acknowledge that the serious nature of the illness and the size of the problem is still not widely understood.
For a start, PMS is far more widespread than previously believed, according to a new study of 960 women, aged between 20 and 35, that was presented at the conference. One-in-five women suffer significant symptoms of PMS, including irritability, anger, panic attacks, drinking too much and binge eating, along with feelings of worthlessness, anxiety and depression, together with a loss of efficiency and concentration - with migraine and breast tenderness being the most common physical symptoms.
And while PMS became part of the language in Dalton's lifetime, it remains poorly managed, with a recent study showing that 75 per cent of women with severe PMS don't seek medical treatment. "Bearing in mind that 45 per cent of the workforce is female, it's very worrying that there is not proper recognition that a substantial proportion are burdened by premenstrual symptoms," says lead researcher and Southampton GP Carrie Sadler. "These are very disabling symptoms, especially for working women with young children whose lives are already over-stretched. Yet there is still a wide perception that PMS is an excuse for women who can't cope."
So, how should a woman like Teresa go about intelligently managing her PMS symptoms? The first step is to complete a menstrual chart (available free from Naps website) over three months to identify cyclical symptoms. Women with PMS have no more hormonal changes than women who don't suffer - but "PMS sufferers appear to be particularly sensitive to these changes, probably because they have unusually low levels of certain brain chemicals, including serotonin", explains Nick Panay, a gynaecologist at Queen Charlotte's and Chelsea Hospital. …