Many young women are being told they are experiencing depression
There's been a rise in the number of young women being told they've got depression, when they're actually experiencing hormonal problems, according to the only UK-wide charity for people with PMT.
The National Association for Premenstrual Syndrome (NAPS) says more and more women are contacting them because they reckon they've wrongly been prescribed anti-depressants including Prozac and Seroxat.
The charity is worried potentially thousands more are being misdiagnosed as having clinical depression, when their symptoms are actually linked to their periods and don't last all month.
Depressed and angry
Michelle, 23, from Aberdare, south Wales, becomes anxious, depressed and angry, just before every period.
She also has symptoms including painful stomach cramps, diahorrea and vomiting.
Michelle becomes anxious, depressed and angry
She said: "I can never sleep and I get so down that I hate my life and I hate myself. I scream, shout, slam doors in people's faces and throw things.
"Or I just get quiet, moody and withdrawn. It's a nightmare and it's just not fair on my friends and family. We've had arguments because of it."
Her GP has offered her anti-depressants several times.
"The thing is I am really happy and chirpy the rest of the month," she explained.
"I love going out. Clubbing, the gym, walking. I enjoy writing and painting. Everything's fine. I know I have got a lovely life. I haven't got depression, and I don't want to be reliant on drugs for the rest of my life."
"PMT can make you feel depressed or even suicidal" said Jackie Howe, who runs the charity.
"But anti-depressant drugs can be strong and addictive, and anyone who takes them could end up with a record of mental health problems on their NHS file.
"Too many GPs spot that women are extremely down and emotional when they come in to see them, and hand out anti-depressant prescriptions without digging any deeper."
But she admitted it can also be difficult for women to recognise that their symptoms are linked to their menstrual cycles.
Jackie added: "Women, especially younger women, often don't realise the effects hormonal changes can have on how they feel, so they don't link the feelings they are having to their periods."
The charity is also worried about cases where GPs have correctly diagnosed PMT, but still "dish out anti-depressants as a quick-fix".
"There is actually very good evidence anti-depressants can help some women with their PMT symptoms," said Dr Nick Panay, who is a specialist in menstrual problems.
"But there are other, less severe treatments that could be tried first."
He said the combined contraceptive pill can treat PMT, though certain brands can make some women more emotional.
Diet and homeopathic remedies may also be useful.
In the most extreme cases a few people are offered hysterectomies.
"The most important thing though, is support from friends and family", he said. "Because many women get mild PMT, those with more severe symptoms are often dismissed as people who can't cope. The reality is they are having an horrific time."
He agreed with NAPS that most PMT sufferers aren't clinically depressed though.
"For the rest of the month, these women are happy and positive people," Dr Panay added.
"But any problems they experience such as a bad day at work or a row with a partner, will feel huge to them when their hormones are raging. Things they could normally handle suddenly feel very difficult."
Feeling irritable or emotional
The Royal College of General Practitioners insists most GPs think carefully before prescribing any anti-depressants. But women's health spokesperson Sarah Jarvis admits diagnosis can be difficult.
She said: "The psychological symptoms of PMT and depression are very similar and so yes there can be a temptation to offer them anti-depressant drugs, because they can work for both."
Sarah said often it is the patients who are desperate for a "quick-fix" for their symptoms.
Feeling depressed, withdrawn or suicidal
Intense mood swings
Blackouts and fainting
Very painful cramps
Vomiting and/or diahorrea
"Women very often say 'I need something to help me, and I need it now'," she explained.
"They are very busy, they want answers and they want solutions straight away. So doctors do reach for the prescription pad."
Sarah said it takes time for things like exercise, the pill and diet changes to make a difference to PMT symptoms and many women are impatient.
NAPS has advised anyone who suspects they've got severe PMT to keep a diary for three months before going to see a doctor.
If you've got PMT, your symptoms can start over a week before a period is due, but they should disappear for at least 1-2 weeks per month.
"Write down how you are feeling every day," said Jackie.
"And don't visit your GP when you are feeling most vulnerable or emotional. Try and go when you are feeling okay, so you can have a proper conversation.
"Doctors do want to help, but they have limited time, and you need to demonstrate if you are usually level-headed."
Michelle said she would like to see more support available for women like her.
"Some friends have been really, really amazing, and I have had an understanding boyfriend in the past," she added.
"But in general people think you should just get over it, and it is hard when you are faced with that every month."
She said she would consider counselling or support groups.
Michelle added: "I would like extra advice on dealing with the emotional issues, because at the moment it seems like it's just anti-depressants or nothing, and who wants to be reliant on drugs forever?
"Even if the doctors can't make my symptoms go away I would like to be able to handle them so I can just deal with everyday life."