My daughter, 14, has just begun to menstruate. She suffers, like I did, from terrible PMT and becomes angry with everyone, gets excluded from school, and is violent and destructive at home. She winds up all the family to breaking point. Her parting shot is to go into her room, pull down all the furniture so we can't open the door, and cry herself to sleep. The defiance, fury and insults can continue into the next day. She also eats far too much chocolate, crisps and junk food. She doesn't want to talk to any outside agencies and our GP thinks we simply have to weather the storm. I have bought her evening primrose oil and vitamin B6, but is there anything else you could advise to prevent our summer holiday ending in misery?
The gynaecologist: Nicholas Panay
Your doctor's advice smacks of someone who doesn't understand PMS, which can be a serious problem. Bingeing may exacerbate your daughter's condition, but complex carbohydrates will steady her blood sugars and therefore her mood swings. Try increasing her calcium and vitamin D: studies of women taking higher levels of these show lower levels of PMS. However, her PMT sounds like it needs more than dietary interventions. Ask your GP to refer her to a gynaecologist with a special interest in PMS. Treatments include a new contraceptive pill 'Yasmin' - three packets can be taken back to back (tricycling) to reduce bleeds to four a year. HRT-type patches to suppress the cycle can also work, and Prozac can be very effective provided it is monitored by a specialist. I suggest she tries the National Association for Premenstrual Syndrome (0870 777 2177; pms.org.uk), which offers a helpline and expert advice.
· Nicholas Panay is a consultant gynaecologist and runs the West London Menopause and PMS Centre
The psychologist: Olga van den Akker
The first thing to check is that it is truly PMS and not another internal (eg thyroid) or external disturbance (boyfriends, bullying etc), as your daughter's symptoms sound severe for one so young. Keep a diary of when she binges, and becomes violent and argumentative. If you detect a cycle to her behaviour, she probably has PMS. B6 and St John's Wort are promising in the treatment of PMS (a 2001 study showed St John's wort had some success at treating six- to 16-year-olds with major depressive disorders, without side-effects). However, any medicine, alternative or not, needs to be monitored and taken for a short time. My feeling is your daughter needs medical help. Sit her down when she is calm, perhaps when she's just finished her cycle, explain that she's not alone and allow her to express her feelings, whatever they are, without fear of retribution. In this environment she may be more willing to consider a referral to a gynaecologist.
· Dr Olga van den Akker is Head of Psychology at Aston University and specialises in reproductive health
The holistic doctor: John Briffa
The female cycle is regulated by oestrogen and progesterone. In natural medicine, PMS is often thought to be related to an imbalance in these hormones - specifically an excess of oestrogen over progesterone in the second half of the cycle ('oestrogen dominance'). This can cause mood swings, breast tenderness, fluid retention and hunger (especially for carbohydrate-rich foods). Eating a diet based on meat, fish, eggs, fruits, vegetables, nuts, seeds and just a little sugar and starchy carbohydrates will often alleviate these symptoms (perhaps by stabilising blood-sugar levels). However, dietary changes are only realistic once the hormonal imbalance has been dealt with, so I suggest that your daughter takes the herb agnus castus. The recommended dose is 40 drops of tincture taken in the morning. Agnus castus usually significantly improves PMS symptoms within two to three menstrual cycles.
· Dr John Briffa is a holistic doctor specialising in nutritional medicine (drbriffa.com)
· If you have a health question for our experts, email health@observer.co.uk
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