Q:What is your opinion as to the effectiveness of progesterone therapy for symptoms of premenstrual syndrome and also the safety aspect? What would be your "natural recommendations" for this syndrome? Dr. M. G., Uckfield, East Sussex.

A:Our main problem with progesterone for PMT is that a patient could be subjected to a load of side effects unnecessarily.The most common preparation used is Cyclogest, which is given either as a pessary or suppository or even by injection.

According to a study published in the Journal of the American Medical Association (August l990), progesterone (the hormone which controls a woman's cycle from the time an egg is released until she gets her period), has no value in treating PMT. This latest is the seventh study to show such a result, according to The Women's Nutritional Advisory Service (WNAS).

In addition, you must weigh the potentially serious side effects of progesterones. But in the States, every manufacturer of progesterone or progestins (as synthentic progesterone is called there) has had to place warnings in bold type in the Physician's Desk Reference noting that there is an increased risk of birth defects in children of mothers who take this drug. According to one study, says drug company Parke Davis in its entry on Norlutate, babies born to women who had taken sex hormones during the first three months of pregnancy were 4 to 5 times more likely to have abnormalities of the arms or legs than if their mothers hadn't taken them. "Some of these women had taken these drugs for only a few days," says the drug company. So if you inadvertently get pregnant while taking progesterone (and they seem to interfere with barrier forms of contraception), it may already be too late.

According to the Health Research Group, progestins have been associated with stroke, blood clots and blindness in women. In experiments with laboratory mammals, they've also caused breast and uterine cancers, and their potential as a human carcinogen is now being examined.

The other myriad side effects listed by manufacters in the PDR include: rises in blood pressure, headache, nervousness, dizziness, fatigue, depression, cystitis like symptoms and even PMT in other words the drug causes the very symptoms you are trying to cure!

The other problem with the drug based approach is that it doesn't treat the woman as an individual. Premenstrual Syndrome is really an umbrella term for a host of very variable symptoms, ranging from irritability, weepiness, depression, weight gain or even fainting. WNAS believes that women with PMT fall into one of four categories which they term A (Anxiety), H (hydration, or water retention), C (craving for sweets) or D (depression) . The only common aspect of PMT is that it occurs some time before a period (and that time can vary tremendously) and it causes misery in every sufferer.

In addition to its many manifestations, PMT can have a host of causes: wheat allergy; low levels of vitamins B6 and magnesium; too much dairy produce; excess sugar in the diet.

The most sensible regime appears to be one in which a practitioner takes a very detailed medical history, including information about diet and lifestyle (it's been shown, for instance, that the Pill, lack of exercise, and even financial difficulties all cause PMT). WNAS makes use of a detailed questionnaire to create a specific regime that will help the sufferer.

Broadly speaking, they recommend that sufferers reduce their intake of sugar, junk foods and salt, tea and coffee, dairy products, tobacco and alcohol.

They should then follow a healthy diet composed of daily portions of green vegetables and salads, good quality vegetable oils (such as cold pressed sunflower or safflower seed oil) for cooking and in margarine,and whole foods (ie, those that have not been processed). By this they mean wholemeal bread and cereals (rye, oats, millet and barley), nuts, seeds and beans, one portion of lean red meat and several portions of fish and poultry per week. Fatty fish is known to contain essential fatty acids which are thought to help breast tenderness.

It's also important to take regular exercise, which can simply mean one brisk half hour walk four times a week.

Finally, WNAS recommends that sufferers take regular vitamin supplements; they feel most confident recommending Optivite (from Lambert Dietary Products in Tunbridge Wells) because it has been specifically formulated for women and contains high levels of B6 and magnesium, two nutrients often low in PMT sufferers.

If your PMT is severe and/or you think you'd benefit from personal advice, you can write or phone WNAS (P.O. Box 268, Hove, East Sussex BN3 lRW; Tel: 0273 77l366 make sure to send an SAE). They have either a postal service, through which you can fill out questionnaires and speak to them on the phone, or clinics in Hove or London, where trained nurses will see you.

Do note that their fees are a bit pricey. The four month postal service, which includes a diagnosis following a questionnaire, monthly follow up calls and a phone service which you can avail yourself of any time, costs £86. Otherwise, the clinic in London is £50 for a first appointment and £25 for each follow up; and £45 in Hove for an initial appointment with £20 for each follow up.

A cheaper alternative may be to have a look at their excellent handbook, Beat PMT Through Diet (Ebury Press, £5.99) which contains the full self help regime.