London - Kirsty Baranowski stood in the middle of the road hammering on a taxi driver’s windscreen. She was incandescent with rage because he’d suddenly pulled out in front of her.
The outburst was completely out of character, but for 20 years she had been battling with violent mood swings in the run-up to her period.
“Normally, I was mild mannered,” says Kirsty, 41, who lives in Southfields, South-West London, with her children, Alexander, ten, and Sophia, nine.
“But in the week before my period the slightest thing could set me off. It was as if a red mist would descend and I’d just lose it.”
Kirsty’s monthly cycle would wreak havoc on her family life and resulted in the breakdown of her marriage.
“As soon as my husband Andrew came home from work we’d have a blazing row. He was bewildered by my behaviour and didn’t know how to help me.
“I felt wretched, too, because of breast pain and bloating - my stomach would swell up so much I’d look pregnant. I’d also get painful migraines. There were only seven days a month, after my period finished, when I felt normal.”
It would take 20 years for Kirsty to arrive at a correct diagnosis: she was suffering from Pre-Menstrual Dysphoric Disorder (PMDD). This is a severe form of pre-menstrual syndrome and is estimated to affect between 500,000 and a million British women.
Despite its prevalence, experts claim many women are being wrongly diagnosed as suffering from psychiatric illnesses such as bipolar disorder or schizophrenia.
Symptoms of PMDD include persistent anger and irritability, moodiness, being out of control, intense feelings of unhappiness and worthlessness, crying for no reason, difficulty concentrating and even suicidal thoughts.
“Ninety percent of the women I see in my clinic have been diagnosed with depression that has not responded to psychiatric treatment,” says Professor John Studd, a retired professor of gynaecology at Imperial College, London, who runs the London PMS and Menopause Clinic in Harley Street.
“The vast majority turn out to have a cyclical hormonal problem that could be corrected easily with hormone treatments to stop ovulation.
“Some have been misdiagnosed as having a psychiatric illness for 20 years or more and been treated with antidepressants, mood-stabilising drugs, mental hospital in-patient treatment and electro-convulsive therapy.”
The causes of PMDD are not fully understood. Experts used to suggest it was caused by abnormally high levels of hormones, but they now believe some women are simply more sensitive to these hormones. “The effect those hormones have on certain women’s central nervous systems is probably genetically predetermined,” says Nick Panay, consultant gynaecologist at Queen Charlotte’s and Chelsea Hospital, London.
The symptoms are at the extreme end of the spectrum of pre-menstrual syndrome - PMDD can lead to breakdowns and even attempted murder.
“I know a patient whose children were taken away because of her symptoms, but she was able to have them back once she received treatment,” says Mr Panay.
Between a third and half of sufferers have a family history of severe pre-menstrual syndrome. It is also more common in women who are obese or who have polycystic ovary syndrome, a menstrual cycle disorder that causes small cysts to form on the ovaries, leading to infertility, weight gain and high levels of male sex hormones. The symptoms of PMDD usually occur a week before the menstrual cycle begins and disappear a few days after the cycle starts.
They include a markedly depressed mood, persistent irritability or anger, noticeable lack of energy and physical symptoms such as joint pains, headaches, breast tenderness or bloating.
Most patients, like Kirsty, find they have only seven to ten good days a month. Their symptoms may disappear during pregnancy and then start again afterwards.
As is typical for women with the condition, for years Kirsty was fobbed off by GPs who told her that her symptoms were side-effects of the Pill.
“I’d had terrible mood swings and migraines since I was 15,” she says. “I went back to my GP time after time, but was just switched from one brand of the Pill to another, with no noticeable effects.”
But as she got older, Kirsty’s symptoms grew worse - particularly in her 30s, after having her children in quick succession.
“I’d felt so well in my pregnancies - no mood swings, depression, migraines or breast pain. But after my children were born I came crashing down again. That’s when I’d have furious outbursts, such as the incident with the taxi.
“The mood swings got worse. I was anxious and would cry in secret. I was a complete mess.”
In March 2005, she saw a private GP who had attended one of Professor Studd’s lectures and recognised the symptoms of PMDD.
“I felt so relieved someone had finally got to the bottom of what was wrong with me,” she says.
The main line of treatment is using the Pill to regulate hormones - though some types can make symptoms worse. Some women are also prescribed antidepressants. However, there is the risk of potential side-effects, including nausea, low sex drive and insomnia. They can also increase anxiety and restlessness.
A gynaecologist can prescribe hormone skin patches, gels or implants that can induce a medical menopause, which is reversible if the drugs are no longer taken. In severe cases, a hysterectomy and removal of the ovaries may be considered.
Kirsty was given an oestrogen gel to regulate her hormones.
“It felt like a shot of adrenaline,” she says. “I couldn’t remember feeling so good, apart from when I was pregnant.
“Unfortunately, I had to take progesterone for seven days to induce a bleed. The side-effects made me feel ten times worse. I started to have fits, during which my whole body would shake. I continued with the treatment, though, as one bad week a month was better than three bad weeks.
“In the week before a period, I spent most of my time in bed. Finally, one day in June 2006, my husband came home from work and found me curled up at the back of my walk-in wardrobe refusing to come out.
“He knew I’d reached rock bottom and took me to the Priory [a private mental hospital].”
Kirsty stayed there for four weeks and was offered medication. “By the time I left, I was certain I wanted a hysterectomy to be free of periods once and for all, even though I was only 35.”
Though Professor Studd, psychiatrists and her family felt she should wait, Kirsty was keen to press ahead and eventually her doctors agreed she should have the operation.
“Yes, it might seem a drastic solution, but my case was unusual in that I hadn’t responded to hormone treatment.
“I wasn’t worried about not being able to have more children - I wanted to be a good mother to the two children I had.”
She had a hysterectomy in July 2006 and has been free of the symptoms ever since.
“I woke up after the op and my head felt clear,” she says. “I felt elated and haven’t had any problems with depression, mood swings or any other PMS symptoms. It was like a switch had been flicked off.
“Unfortunately, it was too late to save my marriage. I don’t think Andrew could see me in the same light again after those terrible mood swings.
“But in other ways I feel as if my life started again in July 2006. I’m working as a nursery school teacher and studying for a teaching qualification.
“I can juggle all that, as well as cope with being a single parent and think much clearer. I’m really calm - there has been no more leaping out of my car to yell at taxi drivers.
“I just feel incredibly frustrated that over the years none of the GPs I saw gave any credibility to my pre- menstrual disorder. My family and I paid too high a price for that.” - Daily Mail
* Information: pms.org.uk