The Time of Onset

THE TIME OF ONSETThe onset of the pre-menstrual-syndrome is either at puberty, after a pregnancy or the pill. In those cases which start at puberty the progesterone deficiency will have been present since the start of menstruation. During pregnancy considerably higher levels of progesterone are continuously present in the blood for nine months, and not just present for two weeks and then absent for two weeks as in the non-pregnant woman. During the early weeks of pregnancy this extra progesterone is produced by the ovary, and as the placenta, or afterbirth, develops in the womb it becomes a progesterone factory producing greater and greater amounts of progesterone. During Labor, after the baby is born, the placenta, or progesterone factory, comes away and some women find difficulty in adjusting again to producing sufficient ovarian progesterone and it is these who develop the pre-menstrual-syndrome. They are often women whose pregnancies have been complicated by pre-eclampsia (high blood pressure and swelling of the ankles) or postnatal depression.

The pill contains a man-made artificial steroid called a 'progestogen'which acts as a contraceptive and which also lowers the progesterone level in the blood. This means the pill produces a progesterone deficiency in those women whose progesterone production is not flexible enough to counteract the action of the progestogen.

In puberty, oestrogen is responsible for the development of the secondary sex characteristics. It is responsible for the pubertal breast development, for the development of hair in the armpits and lower abdomen, for the development and enlargement of the womb, and more especially for developing the muscles of the womb and ensuring it has a good blood supply. Oestrogen decreases the production of grease in the skin and so prevents acne.

If ovular menstruation occurs before the womb is fully developed, the door to the womb is not supple enough to open easily for the flow of menstrual blood. It is rather like trying to blow up a balloon for the first time, which is very difficult, but if it has once been fully inflated then on the next occasion it is easy to inflate. If the womb is gradually stretched during the nine months of pregnancy then sub-sequently the door will open up at menstruation without pain. Or if the muscles of the womb are gradually increased by the prolonged action of oestrogen the painful periods are gradually eased during the mid-twenties.

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