Wednesday, March 18, 2009

Dr Jekyll and Ms Hyde

By Natalie Angier with Janet Witzleben

Laura gave herself a haircut, and it looks terrible - choppy and uneven, with frizzy tufts sticking out. She does that every now and then, takes a pair of scissors and slashes at her hair. "When I feel ugly, I get angry, she says. "So I cut my hair, thinking, "There, you see? Now you look as ugly as you feel.' "

She shifts in her chair and massages her legs, which throb with pain, as does her back,. "I am going to ovulate today; I know it. And then there is two weeks of hell to live through until my period comes. I feel like I could kill somebody." She slams her fist on the table, then looks ashamed. Such outbursts are all too common in her life. A couple of months ago her husband left her, angered by her rages; shortly before that, she slapped her youngest child for no reason. Remembering the incident, she begins to weep. "I try so hard to be a good mother. But when I feel this way, it is as if there's a monster inside me that I cannot control."

Laura, a 34-year -old air hostess, has been battling her demons - her pains, her madness, her wild swings of mood - for more than 15 years. Because the problems seemed to ebb and flow with the tide of her menstrual cycle, she had long suspected a biological link, but doctors insisted it was "all in her head." In frantic attempts to get it our of her head, she drank too much and went into psychotherapy. Then Laura discovered she had been right all along - her pains were not in her symptoms of premenstrual syndrome, or PMS, a disorder related to menstrual cycle.

Who suffers? Severe cases of PMS (like Laura's) are confined to less than 10 percent of women, and few of those will ever be driven to criminal violence. But mild PMS is quite common: researchers estimate it affects as many as 40 to 60 per cent of all woman to some degree.

The intensity of the symptoms varies from woman to woman, and sometimes from month to month. Someone with mild PMS may feel irritable and fat a few days before her period; "Laura Teeters" on the brink of hysteria for 14 out of 28 days. All PMS sufferers spend last seven days without any symptoms - the glorious time that one victim describes as her Dr Jekyll Phase.

Most experts think PMS is caused by a hormonal or hormonally related imbalance, a mis-step in the complex nimute of progester-one, estrogen and other chemicals that regulate menstruation. At the beginning of each cycle, the pituitary gland sends a signal to the ovary, and an unripe egg begins to develop in a tiny protective cluster of cells. At the next pituitary prod, those cells manufacture es-trogen, which among other things helps build up the lining of the womb. When the egg is large enough, the cell cluster bursts and the egg slips down one of the Fallopain tube,
where fertilisation can take place, and then on to the uterus.

Meanwhile, the ovarian cells have been producing progesterone, the hormone that turns the lining of the womb into a spongy bed ready to accept a fertilised egg. If fertilisation does not occur within a day or two after ovulation, the egg dies and passes from the womb. Two weeks later the unused uterine lining is shed as men-sturation.

Weighing the Risks: Progesterone therapy does have its draw-backs, however. Because natural progesterone - advocated by most researchers - is metabolized in the liver, it cannot be administered by mouth, and must be either injected or used in suppository form. And it must be taken frequently, throughout the PMS period.

Although the drug has not been approved by the US Food and Drug Administration for use in treating PMS, a few clinics have been given permission to use small doses (200 milligrams a day) for research purposes. This may not be enough for some women. But doctors prescribe larger doses as long as they tell their patients that the drug has not been approved.

Although Dr Dalton sometimes prescribes very high doses - up to, 1,600 milligrams a day - she has never observed any side effects. But Dr Golub, president of the Society for Mentrual Cycle Research, warns, "Progesterone has risks - you are fooling around with the body's hormones, and women have to weigh the dangers."
Dr Harrison agrees: "I warn women that some animal studies of progesterone have shown mammary tumors." Harrison emphasizes that PMS symptoms can be mitigated by diet changes - cutting out sugar and caffeine, cutting down salt and fats - and by reducing stress. Adds Dr Golub "We don't have scientific evidence yet that progesterone is the answer." US Lawyer Laura Dulski, agrees that PMS pleas will be rare. But, Benson maintains, "you cannot deny that some women suffer from the disorder because you are afraid all women will suffer discrimination."

Though PMS is as old as the human race, "until very re-cently it was ignored or trivialised as a silly female problem," says Dr Harrison, ans American gynaecologist, who specialises in the disorder. But two unusual legal decisions have forced the medical profession to look anew at PMS!!!!

Thus levels of estrogen, progesterone and other hormones rise and fall dramatically through the month, but the precise disrup-tion that leads to PMS still eludes The Scientists. Among the theories: too little progesterone; too much estrogen in relation to progester-one; too much Prolactin, an important pituitary hormone.

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