Sometimes it's hard to be a woman

Between severe PMS and the menopause lies a nasty blurry bit that doctors don't really understand. Pru Irvine, a woman at the mercy of her hormones, tells a story of treatments, side effects and bloody big needles

DID YOU KNOW that HRT (hormone replacement therapy for the ignorant) makes you a better woman? And that you don't even have to be menopausal to be prescribed it? I'm probably the only woman in Britain who didn't know that. It doesn't start you voting Tory or turn you into an agony aunt. But apparently it changes you from a middle-aged, sweaty, marauding, hormone-ruled monster whose skin peels at the slightest rub, into a middle- aged angel who manages life with the minimum amount of moisturiser. Fabulous. Like the rest of the girls, I was ready. I mean who really wants a nip and tuck and all that bruising when you can achieve the same effect through inner tranquillity?

HRT comes in a little patch and this is how it went on. I never wanted to be Margaret Thatcher - God forbid. I didn't even want to be Miriam Stoppard. But I did hope that my legs might grow or that like the Hulk - remember him, that gorgeous green giant of a freak? - I might fully develop into myself. Well, things are never quite as they seem. Eighty- five per cent of all women suffer from PMS at some point, and, like death, the menopause comes to us all. Plenty is known about the latter but very little is understood about the former. What is known is that, for some women, the transition from PMS into the menopause is biologically seamless and what divides the two is a blur, not a line. Gynaecologist Dr Ailsa Gebbie says the reason for the blur is because the ovaries start to show biochemical signs of ovarian failure from as early as the mid-thirties.

That's all very well for the medics but what happens when you are that blur? I'm 41 and I've been a blur for about two years. There are thousands of women whose lives are made miserable every month by either PMT, or the menopause, or both. The only differentiating factor is hot flushes. These, says Dr. Gebbie, provide the clue: "Flushes are menopausal and we know what causes the menopause but PMS is still unexplained."

Well, sod that for an explanation. Never mind cloning sheep, let's have some more human science. After all, women make up the majority of the population. So what's available and who's going to diagnose the problem correctly? According to Dr. Gebbie, treatment is a matter of horses for courses. While GPs, especially the young ones, are getting better at both diagnosis and treatment, women also need to learn to listen to their bodies. Some women, she says, who are between the two, think they're going mad: "I've never seen anyone actually suicidal, but women in this situation need a lot of reassurance."

However, discovering the facts of the blur has not been easy. This is the story: "Doctor, doctor, every month I want to kill the children." "Hmm." "I wake up in the morning and I want a bowl of pasta with melted cheese." "That's unusual," he says. "What are you going to do about it?" I ask.

Well, naturally, he avoids the issue by sending me to THE CLINIC. It's a generic term for the place GPs use for their more difficult patients. Sometimes THE CLINIC is for the menopause and sometimes for PMS. Which clinic you attend I suspect depends on the time of day that you see your doctor rather than the thing you're afflicted by. As I've already explained, the boundaries are blurred if you're under fifty and your blood test doesn't scream menopause

Well, THE CLINIC is a great place. No plants. No fertility. Brown chairs and lots of copies of 1989 Good Housekeeping. In the waiting room we fill in forms about our hormonal patterns. We hide behind newspapers feigning disinterest in each other, while frantically trying to work out which of us is suffering from what. The lone women are menopausal, the couples are infertile and the girls with their mums are having girlie problems. Where, oh where are the mad women suffering from PMS? It's not obvious at all.

It's not clear at this point what I've got. PMS - yes. The menopause - maybe. I know I suffer from the former but I'd like the latter. It really would suit me. I mean I'm happily married, I have children and I've been sterilised. I'd like a new focus. Something big, something I could enjoy because it was so mature. And let's face it, HRT is dead sexy.

Anyway, I'm too young, they said at first. But I can have HRT because it may be just the ticket to get those hormones into line. For the past ten years or so, HRT has been prescribed for PMS because of the way oestrogen overrides the natural cycle and smooths out the peaks and troughs. It also has a mood-elevating effect, says Dr. Gebbie. It's not a miracle cure but it's great for some horses. I'll go for that, I thought. Those lovely, sticky little patches that leak new life into thick skins. I was chuffed. Excited even. On went the first one with a good slap on the buttocks. Side effects? Well, apparently everything including breast cancer. But you can get all that these days in any supermarket. So I took the plunge just in time for a family break in a log cabin in the north of Scotland.

The holiday was a little wet, a little cold and damp and the children just a little bored. I developed asthma, a chest infection, a headache and felt dizzy and sick. After 24 hours I found a doctor who, in the absence of a hospital, sent me away plugged into a breathing machine. By this time my neck was stiff and my face had sort of puffed up. I decided the holiday was over. I felt seriously unwell and I couldn't work it out. Once home, too dizzy to walk far and completely immune to paracetamol and Ventolin (for the asthma), I called the doctor. "Are you sure you can't get to the surgery? The doctor's very busy." Really, I thought. He must be visiting the sick. What a waste of a good doctor's time.

My doctor's advice was to remove the patch - instantly. So I ripped it from my bottom in one seamless swipe and flung that damned thing into the bin. And guess what? Thirty-six hours later all my symptoms had gone. I was, once again, a perfectly normal, homicidal woman just trying to get from one month to the next. It's just as well I hadn't pinned my hopes on turning into someone else because there are no miracle cures, just little alleviations. And I suspect I'm not alone in having turned the HRT myth into thereality of a Heap of Real Trouble.

So what next? Prozac, the happy drug. Very effective in treating your symptoms, they said. Really a miracle for PMS sufferers. I was happy about this. I'd always wanted an excuse to try it. And being able to admit to using it when you're not even depressed is simply icing on the cake. It didn't work at all.

After Prozac, there was Zoladex. I'll tell you just two things about it because I don't want you getting over-excited. It's very expensive. At pounds 120 per shot every month, your GP must either be very kind or you must be very bonkers. (Most women only get it for six months because of the cost). And what does it do? Well, it switches off the whole cycle - your ovaries - WITHOUT SURGERY. Okay, I'll tell you more. It was given to me "as a last resort". It's also used for shrinking fibroids and in IVF treatment. Like HRT, it's been used for PMS for about ten years and is supposed to be completely brilliant. A miracle on PMS street. Well anything's better than HRT. So, what about side effects?

"It could make your hot flushes worse." (That's the old blur factor). "What d'you mean by worse?" "Unbearable." "Oh." "But we can treat that with HRT." "Oh."

Well, I have to report that the worst side effect is actually getting it. Put simply, the needle is about 100cms long and nearly as fat as a piece of spaghetti. A kind doctor will provide a local anaesthetic. I've had two. I'm not sure. My body temperature has soared and although I live in Scotland, it feels like the Mediterranean. Dr. Gebbie says that if Zoladex doesn't work then you have to look for other psychological reasons for the problems. Great. Anyway, my husband thinks I should stop faffing about and go the whole hog. What could be nicer, he asks, than a hysterectomy and the removal of my ovaries? Lots of time in hospital, bed rest, no meals to cook, no dishwasher to empty... He may just have a point.