I was tickled pink to read the article PMT, PMS and PMDD: is there a difference? in O&G Magazine Vol. 20 No. 3 Spring 2018, by three psychiatrists about these questions of ovarian dysfunction causing hormonal upsets. Not that I am about to suggest that those of us who trade in hormones should seek a monopoly on these overworked elements, but a balance of expertise might have been more convincing.

In my reading of their review article, there seemed little reference to hormonal matters apart from some alarming comment such as ‘Thus, hormone levels and flux alone appear to be irrelevant, however, the relevant neurobiological and physiological changes may represent an underlying sensitivity to such changes’. In fact, there seemed to be no discussion of the actual levels of oestrogen and testosterone.

Full marks to them then for attempting to ram the contents of this elusive condition into a categorisation box, but sadly then to consider, in the main, psychotropic medication as their holy grail. In fact there was another reference to oestrogen in that ‘…there are no demonstrable differences in reproductive hormonal levels…’, by which I assume they are referring to oestrogen and possibly progesterone, but surely not testosterone! And if they were thrown by the absence of measurable hormonal fluctuations, then they have failed to understand what a slippery beast they are dealing with.

Recognising that PMS is not an easy matter, I have taken an alternative approach and evolved a ‘paradigm of understanding’ that I am happy to report yields well to treatment with hormones. I have presented this concept on three occasions and have succeeded only in boring the proverbial pants off my audience. Perhaps I should be so bold as to submit a copy of the paradigm not for publication as such but for the amusement of you, the Editor, and see how many paragraphs you can consume before your eyelids droop.

At least I could identify with the criteria set out in the DSM-V for PMDD. I would have changed the emphases perhaps. As for aetiology, good luck with that. And, as a bottom line, have the researchers made any attempt to relate the incidence of breast cancer with this condition; and what might the rates of hysterectomy (for any reason) be in this population of women?