WEEKEND COLUMNISTS Premenstrual tension used to occupy a generous slice of my consulting time. A decade ago, at least one or two women a week wanted treatment for their PMT. What’s odd is that this demand seems to have ebbed away – an observation which has been confirmed by colleagues in different parts of the country.
Why could this be? I suspect that the reason PMT is no longer topical is because there are no new treatments for it. Indeed, the treatments that received so much publicity a decade ago – evening primrose oil and the antidepressant fluoxetine – have since been found wanting in evidence. This leaves us with the suggestion that the disease was made “fashionable” by those with cures to promote. There are similar examples – we also seem to be experiencing a fad for bipolar disorder. Thanks to the US psychiatric authorities, bipolar disorder is no longer diagnosed only when people have enormous swings into suicidal depression and delusional mania. Instead, smaller moodswings have been created into a pathological diagnosis.
Apart from potentially over-medicalising a large population, another problem is that the medication to prevent mood swings has side effects both in the short and long term. The evidence for treating people with milder symptoms is somewhat wanting. Nevertheless, a host of celebrities is clamouring to describe their ups and downs in terms of illness. Other diagnoses are vying for attention: fibromyalgia (pain in numerous areas of the body) and multiple chemical sensitivity (now renamed idiopathic environmental intolerance – keep up) where people complain that low levels of environmental chemicals cause chronic, allergy-like symptoms.
The message behind such campaigns is that “awareness” of all things medical is good for us. Media stories remind us of the importance of seeking diagnosis and treatment – when one wonders just how much medicine can actually do. If there is money to be made, you can guarantee that “awareness” is also being raised in full page colour adverts in medical journals. No one wins. People who do have a disabling disorder get lumped in with people who have a minor problem and no real medical need of treatment. Doctors, trying not to overtreat, are then at risk of undertreating those with severe symptoms. I’m sure there are just as many women as ever with symptoms of PMT, but I suspect they are getting on with life just as well without medical “help”.
Margaret McCartney is a GP in Glasgow
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