In an ideal world, going to the surgery would be no different from going to a shoe shop. You could request treatment for your cyclical bloating or headache just as easily as you could ask to try on that pair of suede ankle boots in a size 5.
Alas, visiting the doctor is not such a simple transaction because, whether they realise it or not, each party brings preconceived ideas to the consultation. Your doctor's views on premenstrual syndrome (PMS) will inevitably be coloured by the teaching he or she has had and the patients already seen with it. If your doctor is a woman, it may also be influenced by whether or not she is a sufferer herself - but, unless you know her fairly well already, you won't know this.
Incidentally, it's easy to assume that a woman doctor is more interested in helping PMS patients, but that's not necessarily so. Women doctors don't always know more about PMS, and it may well be a male doctor in the practice who's had more experience of it, especially if someone in his family is a sufferer.
When should you see the doctor? You go when you can, obviously, but the best time may depend on the type of symptoms you get - if it's breast tenderness, go when it's at its worst because there'll be more to show for it. However, if you get tearful or aggressive, it may be better to see the doctor while you're fairly free of symptoms, lest he/she conclude that your complaint is in the mind.
Be yourself, of course, and be honest - but up to a point. There has to be a meeting of minds during the consultation. Perhaps unfairly, doctors tend to be better disposed towards physical symptoms. Concentrating on these, if you can, means you're less likely to exit the surgery with a possibly inappropriate prescription for antidepressants.
Try not to rely on a written list of symptoms, but if you must, keep it short and mention your most severe symptoms. Doctors tend to believe that no one woman can possibly have all the symptoms of PMS at the same time. This may or may not be true. However, it's almost inevitable that the more symptoms you complain of simultaneously, the less impact each one will make on the doctor.
Building up to a crescendo is best left to musicians. Mention your most worryng or most troublesome symptoms first, and don't leave the most dramatic ones till last. By the time you've got your hand on the door-knob, the doctor may well have switched off.
In some severe cases PMS sufferers may feel so desperate they are suicidal. If you feel this wretched, it's important for your doctor to know. But if your symptoms are not nearly this extreme try to avoid the words 'terrible' and 'unbearable' which may, I'm afraid, give the wrong impression. To be fair to my fellow GPs, doctors often have a different perspective to non-medical people because of the range of illnesses they have to deal with. Sure, your symptoms aren't competing with those of others for a place in the pop charts, but, for the doctor, spill-over from other consultations does occur. If your GP has just given the previous patient news of a terminal illness, or has tried to comfort a parent following a cot death, your breast pain, anxiety or cyclic mood swings, no matter how unpleasant, are unlikely to make your doctor weep in sympathy with you.
As you know, there's no one treatment for all PMS sufferers. Make it easy on both of you by actually saying what you expect from this consultation. This could be 'Can you suggest something for the bloating?' or perhaps 'Is there a specialist with an interest in my kind of problem?' If you already know the name of a consultant you want to see, say so.
Similarly, if you've already tried remedies for PMS, mention them. Don't be embarrassed to admit you've given some weird and wonderful therapies a go. These days, complementary therapies are much more a part of mainstream medicine. Besides, some herbal medicines are actually very potent drugs and your GP is better off knowing about them.
By definition, PMS occurs in the build-up to a period and disappears completely from the heaviest days of the period for at least seven days (though some PMS patients dispute this). Bringing a calendar of your symptoms to the surgery, such as a menstrual chart, will save valuable time - yours as much as the doctor's. At an intitial consultation for PMS, many GPs will only tell the patient to return when she has kept a symptom diary for three months. You may as well have done this first. At its simplest, you can make a three-month symptom diary from a single sheet of ruled paper (most A4 pages have 32 or so lines on them). Write the dates down one side, say in the left-hand margin and then divide the rest of the sheet into three vertical columns - one for each month. Place a red cross against days you are actually menstruating and maybe an extra red cross for the heaviest days of the cycle. Then, jot down your symptoms against the days you experience them. You'll need to be reasonably concise. 'Wanted to kill grandpa with Kitchen Devil bread-knife' is of course very graphic, but there's a limit to what you can fit onto a third of a line ...
While on the subject of assassination, try not to be too confrontational if you and your GP don't see eye to eye. If you can't communicate with each other, or treatment fails to live up to expectations, consider whether you should part company. It's your body, your health, your life. It's easy to change GPand it's your right to do so, as often as you need to. (Bear in mind, though, that while doing the rounds of all the surgeries in the area may be your privilege, it does not usually endear a patient to the local medical community.
Actually, these days you may not have to change your doctor at all - in a group practice you may be able to get the help and support you need from the practice nurse. Many patients (not all of them women) find it easier to talk to a nurse than to a doctor.
Should you take your partner with you?
Sometimes a relative or partner can provide valuable moral support, or corroborate how bad your symptoms are. You can of course take whoever you like. However, my personal feeling is that you should be at ease enough with your GP to talk about your PMS without the help of a third party. If necessary, take someone with you until you feel you have established a good relationship. By then you should feel confident enough to go it alone. If not, think about whether this is the right doctor for you.
What about the kids?
You may have little option but to take the family along to the surgery - as the mother of three lively boys, I know it's hard to find someone to look after young kids, but try not to drag them along if you can avoid it. Their presence may provide a graphic illustation of how ratty you can get, but they are also a distraction. How can you concentrate on doing your symptoms justice when you're stopping your toddler from playing with the blood pressure machine or sticking his hand in the sharps disposal bin (containing potentially dangerous bacteria and viruses)? If you're stuck, maybe a receptionist can mind them in the waiting room for you.
Dr Carol Cooper, GP and writer, www.drcarolcooper.com