have PMDD are advised to track their
symptoms for at least two months
before visiting their GP, and in
recent years there has been a flurry
of tracking apps designed to ease the
process of getting a diagnosis.
After living with the condition
from the age of 11, Brett Buchert,
who co‑founded the leading tracking
app “Me v PMDD” with her mother,
wanted to create a tool tailor‑made to
the complexities of PMDD.
Buchert, who is based in St
Petersburg, Florida, said: “After
diagnosis, I kept tracking as a form
of symptom management using
various period and mood trackers, but
wanted something that made sense for
PMDD – given that the severity of my
symptoms varied over my cycle and
most trackers only asked about the
presence of specific symptoms.”
Once an individual has been
formerly diagnosed, a range of
treatments are available, dependingon the severity of their condition,
including antidepressants, combined
oral contraceptives and, as a last resort,
hysterectomy with bilateral salpingo‑
oophorectomy (an operation to
remove the uterus, ovaries, cervix and
Fallopian tubes).
For many PMDD sufferers,
such as Girling, the decision to
undergo a hysterectomy, is often an
excruciatingly difficult one. She says:
“Growing up, I knew I wanted to be a
mum, so I had this massive battle in my
mind – it was my womb or my life.”
The causes of the condition continue
to perplex the medical community.
According to the IAPMD, PMDD
is a suspected genetic disorder
with symptoms worsening around
reproductive events such as
pregnancy, miscarriages and the
menopause.
Overton, of the Royal College of
Obstetricians and Gynaecologists,
says: “It is still not yet known what
causes PMDD but one line of thought
is that it may be a reaction to the
hormonal changes that happen with
each menstrual cycle. The hormone
changes can result in a serotonin
deficiency, a naturally‑occurring
chemical that narrows blood vessels
and can affect mood and produce
physical symptoms.”
Although there is growing
awareness of the condition, for
the thousands of women having to
navigate careers, relationships and
parenting alongside PMDD, each
month is an uphill battle fought
in private.T
he days when antibiotics
were doled out like
Smarties for every cough
and sniffle are long gone.
Overall, prescription
rates have dropped
dramatically in the last few years
as doctors try to combat the rising
problem of antimicrobial resistance.
Last week, researchers warned that
antibiotics may actually harm children
who take them. Scientists at the
University of Oxford and Public Health
England found that preschoolers who
take antibiotics for coughs and colds
are more likely to get ill in the future.
Their study, published in the latest
issue of the British Journal of General
Practice, looked at 250,000 children
aged one to five and found that those
who had more than two courses of
antibiotics were 30 per cent more
likely to visit a doctor or spend time in
hospital. Scientists believe the drugs
may kill beneficial bacteria in the gut.
Professor Helen Stokes‑Lampard,
chairman of the Royal College of GPs,
says: “This research drives home
how important is it for patients – and
particularly parents – to understand
antibiotics do not work for every
infection and should not be prescribed
for the most common childhood
conditions... which are usually caused
by viruses.”
Sometimes, though, antibiotics are
unavoidable. So how do you know
when you really need them, and how
can you protect your health if you’ve
no choice but to take a course?
The golden rules
“Antibiotics can be life‑saving drugs
for severe infection‑related conditions
such as sepsis,” says Professor Stokes‑
Lampard. “But instances where
children who have an infection
really do need antibiotics should be
relatively uncommon.”
Dr Fiona Cornish, a GP in
Cambridge, says antibiotics should still
be prescribed when really needed. “I
Doctors are cutting back on the use of antibiotics. Thea Jourdan
reports on how to protect yourself if you have to take them
Go with your gut
feeling if antibiotics
are the only option
with a co‑worker several years later
that prompted her to seek out help
from a gynaecologist. However,
even once she had determined that
her symptoms were linked to her
menstrual cycle, it was still an uphill
battle to convince her GP.
She says: “I had to write an A4 letter
to my GP outlining all of my symptoms
to show him that I was really serious
and that it was severe enough for him
to transfer me to the specialist Chelsea
and Westminster Hospital clinic.”
According to clinical scientist Dr
Tory Eisenlohr‑Moul, ignorance on
the part of the medical community is
part of the problem. She says: “Many
will always
do my best to
prescribe antibiotics
appropriately, for example, in the case
of someone who is suffering from a
severe urinary tract infection. We
need to be careful not to withhold
antibiotics when they are actually the
best remedy available.”
There are some groups – people
with cystic fibrosis, for example –
who have to take antibiotics daily to
keep themselves healthy, she adds.
“Women with cystitis may also need
antibiotics, particularly if the problem
is severe or they are pregnant.” OlderCollege London and author of The
Diet Myth.
“For me personally, it’s the three
Ks; kefir, kombucha and kimchi.”
Kefir is a super yogurt drink that
contains five time the diversity
of microbes as traditional yogurt,
kombucha is a Russian tea drink that
contains yeast and fungi, and kimchi
is a spicy fermented cabbage pickle
from Korea rich in “good” lactobacilli
and bifidobacteria. Sauerkraut is
the less spicy version, and another
excellent prebiotic food.
As a fizzy drink, kombucha can
seem like a treat to children, but if
they’re turning their noses up at the
three Ks, try mixing kefir in with
their favourite yogurt or ice cream.
Prof Spector also advises people
who need to take antibiotics to
protect their gut flora by avoiding
artificial sweeteners.
“Gut microbes can’t easily process
these and produce weird metabolites
which seem to have a damaging
effect. Also, stay away from highly
processed food that contains lots of
chemicals which disturb the balance
in the gut.”
Eating plenty of fibre
can help nourish the
good bacteria that
thrive in the lower
intestine, he advises.
“Plant foods high in
polyphenols, such as nuts,
berries, olive oil and red
wine, may also enhance
the growth of beneficial
bacteria.”
And mothers who are
breastfeeding a child
who is taking antibiotics
are helping to boost their
child’s good gut bacteria, he says.
“It’s how a mother passes good
bacteria on to her baby and will help
ameliorate any harmful effects of the
drugs.”Taking care: the
digestive system
can suffer because
of antibioticsASADOUR GUZELIAN; ANDREW CROWLEYpeople with urinary tract infections
do better when they are given doses
of antibiotics early on, according to
a study this year by Imperial College
London and Public Health England.
When you are given antibiotics, the
golden rule is always take the course
as directed. “Patients should take
them as directed and finish the entire
course, even if you start to feel better,”
says Professor Stokes‑Lampard.
Dr Cornish suggests checking with
your doctor that the antibiotic youare being given is the right
one – antibiotics that treat a
narrow spectrum of bacteria
are generally better than
broad spectrum antibiotics.
Depending on a person’s
symptoms, GPs will
sometimes issue a delayed
prescription for a patient to
collect if their condition (or
that of their child) doesn’t
improve, or starts to get
worse over the coming days.HEALTH
‘We must
understand
that antibiotics
do not work for
every kind of
infection’
clinicians just don’t know about
PMDD, or they think it’s just mild PMS
that will improve with a bit of self‑care.
The experimental research validating
this condition (as a hormone sensitivity
disorder) only came out in 1998, so the
research area is young, and there just
hasn’t been enough education of the
medical community yet.”
Caroline Overton, a consultant
gynaecologist and spokesman for
the Royal College of Obstetricians
and Gynaecologists (RCOG), points
out that PMDD’s similarity to other
mental health conditions can also delay
diagnosis.
“Women sadly often wait a long
time for a diagnosis due to a number
of the symptoms mimicking other
conditions, including premenstrual
syndrome, depression and bipolar
disorder,” she says.
Women who suspect that theyPMDD’s similarity to
other mental health
conditions can also
delay diagnosis
‘Ultimately, you just
go through your life
stumbling from one
month to the next’
Exhausted: Eleanor Ibi has suffered from
the condition for most of her lifeHealth newsletter
Sign up for our 365 newsletter and get
a wellbeing tip sent directly to your
inbox each day.
telegraph.co.uk/365dailyProbiotic power
Research by University College
London found that a single course
of antibiotics can change the
composition of the microbiome for at
least a year. But when you do have to
take them, there are ways to minimise
the damage to your gut microbiome,
which is made up of a complex
community of trillions of bacteria.
Glenn Gibson, professor of food
microbiology at the University of
Reading, says it’s “essential” when
taking antibiotics to take
prebiotics – which provide
nutrition for microbes –
and probiotics, which
are living microbes
that can be taken as
capsules, pills or in
food form.
“They can
certainly help
resist the
negative
effects of
antibiotics
on the gut
microbiome.
They are
routinely
given
in some
countries
when
antibiotics
are
prescribed.
That should
happen here
too.”
Prof Gibson
recommends
Bimuno for a
prebiotic and
Danone Actimel
as a probiotic. He
believes that
people should
take them
regularly for
general good health
and does so himself,
but if you’re taking
antibiotics, he advises
taking them, “as a
minimum”, during the
course and for a week
after finishing it. “They
can help with issues
such as gastroenteritis,
IBS, transit time, and
abdominal discomfort
(including gas). Current
research is also looking at brain
effects and influences on the
symptoms of obesity.”The good gut diet
“There’s a lack of really good
quality evidence but some
studies do seem to show that
eating prebiotic and probiotic
foods can reduce the impact
on the microbiome of taking
antibiotics,” says Prof Tim
Spector, professor of genetic
epidemiology at King’sin thei
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