– Dr. Rehana Khan
Pre-menstrual Syndrome (PMS) is a term used to describe a varied group of physical and psychological symptoms that occurs few days or week before the menstruation or any time after ovulation and disappear almost as soon as menstrual flow starts or shortly thereafter.
Sometimes the symptoms are so severe that they interfere with their day-to-day lives. This type of PMS is called premenstrual dysphoric disorder, or PMDD.
Premenstrual syndrome involves a combination of physical, mental, and behavioral symptoms. Premenstrual syndrome is a complex health concern. Up to 70-80% of women experience some symptoms of Premenstrual syndrome during their childbearing years.
CAUSE OF Premenstrual syndrome
Exactly what causes premenstrual syndrome is not known, but several factors may contribute to the condition. It is often linked with genetic factors because twins often suffer with it.
Current theory suggests that central nervous system neurotransmitter’s interaction with sex hormones may be responsible for Premenstrual syndrome. It is also linked with activity of serotonin. Research points to the changes that occur in hormone levels before menstruation begins; when the ovaries are working to make both estrogen and progesterone. Women who do not ovulate do not have PMS. It is believed that change in progesterone level is responsible for woman’s mood, behavior, and physical changes during the luteal phase (or second half) of the menstrual cycle.
All women have both female and male hormones within the natural balance of the body. However, increased levels of male hormones as well as increased levels of prolactin can result in a delayed ovulation and low levels of progesterone, leading to Premenstrual syndrome. Cyclic changes in hormones seem to be an important cause, because signs and symptoms of premenstrual syndrome change with hormonal fluctuations and also disappear with pregnancy and menopause.
Low levels of serotonin, an important chemical produced by the brain, may in fact be the major cause of Premenstrual syndrome responses. Serotonin helps to regulate sleep cycles and carbohydrate metabolism and influences the regulation of estrogen and progesterone. There is a theory that the common Premenstrual syndrome response of increased appetite with cravings for carbohydrates may be caused by low serotonin levels. Insufficient amounts of serotonin may contribute to other symptoms of Premenstrual syndrome, such as depression, fatigue, food cravings and sleep problems.
According to another theory Premenstrual syndrome involves inflammatory substances called prostaglandins. Prostaglandins are produced in the breast, brain, reproductive tract, kidney, and gastrointestinal tract where Premenstrual syndrome symptoms originate; which is responsible to problems such as cramping, breast tenderness, gas, diarrhea, and constipation.
Another theory explaining Premenstrual syndrome also linked to low levels of vitamins and minerals. Other possible contributors to Premenstrual syndrome include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances.
Endorphin levels drop during the luteal phase of the menstrual cycle; which may lead to nausea, jumpiness, and various types of pain in some women. Normal levels of this hormone lead to cheerful, happy moods and also make people less sensitive to pain.
However, it may be related to social, cultural, biological, and psychological factors.
SYMPTOMS OF Premenstrual syndrome:
There are a number of symptoms that comes under this heading, the exact symptoms and severity may vary in different cases and with every menstrual period. The most common symptoms include:
- Mood swings
- Anxiety and stress
- Breast tenderness and swelling
- Abdominal Bloating
- Tiredness/ fatigue
- Sex drive changes, loss of sex drive or disinterest in sex
- Lack of control or impulsivity
- Feel temporarily antisocial, avoiding friends and rejecting invitations
- Low self-esteem, tend to have negative, sad thoughts and experience a transitory lack of enthusiasm and energy
- Stiff neck
- Crying Spells
- Sadness, feelings of “fogginess”
- Difficulty concentrating
- Weight gain from Water retention
- Appetite changes and food cravings for carbohydrates and sweets
- Insomnia or difficulty in falling asleep
- Muscular and joint pain
- Unable to concentrate
- Mild fever
- Social withdrawal
- Allergic and infection problem may worse
- Irregular heart beats, palpitations
- Chest pains
- Swelling of ankles, feet, and hands
- Abdominal pain
- Recurrent cold sores
- Constipation or diarrhea
- Decreased coordination
- Less tolerance for noises and lights
- Painful menstruation
- Poor judgment
- hostility, or aggressive behavior
- Increased guilt feelings
- Slow, sluggish, lethargic movement
- Decreased self-image
- Paranoia or increased fears
- Low self-esteem
Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems.
DIAGNOSIS OF Premenstrual syndrome
There is no special test to point out Premenstrual syndrome. The following may help in making the diagnosis:
- Complete history of the patient
- Physical examination
- Psychiatric evaluation in some cases
- Mineral Analysis Test
- Blood tests to rule out other illnesses
CONVENTIONAL TREATEMENT OF Premenstrual syndrome
Line of treatment depends upon symptoms present in Premenstrual syndrome
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium can for cramps and breast discomfort. COX-2 inhibitorsare a new type of NSAID. It is longer-acting NSAID’s. Administration of COX-2 inhibitor has risk of heart attacks and strokes. COX-2 inhibitors and traditional NSAIDs have risk of serious skin reactions, stroke, deep vein thrombosis, and pulmonary embolism.
Oral contraceptives for stopping ovulation and stabilize hormonal swings; Progesterone support, Gonadotropin hormone agonists in severe Premenstrual syndrome.
Antianxiety drugs and antidepressants – may help with mood, irritability, and concentration. Anti-anxiety drugs such as Benzodiazepines or Alprazolam. Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine, paroxetine and sertraline for fatigue, food cravings and sleep problems.
Diuretics if weight gain, breast swelling, and bloating are associated with Premenstrual syndrome. Diuretics such as Metolazone and spironolactone .
Medroxyprogesterone acetate- it temporarily stops ovulation. However, Depo-Provera may cause an increase in some signs and symptoms of Premenstrual syndrome, such as increased appetite, weight gain, headache and depressed mood.
If psychological symptoms are present then tranquillizers or antidepressants are prescribed.
Supplements of Calcium, Magnesium, Vitamin B-6 and Vitamin E. Multivitamin and Mineral supplement programme may helpful in some cases.
In rare cases where Premenstrual syndrome symptoms are severe and no relief with any medications or other therapies and when pregnancy is not the objective then surgical procedure involving a partial hysterectomy can be considered.
Homeopathy Treatment & Homeopathic Remedies for Premenstrual Syndrome
Homeopathy treats the person as a whole. This means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptability) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. None of these medicines should be taken without professional advice.
[Kent] Generalities, Menses, before
[Murphy] Female, Pre-menstrual syndrome
Other useful rubrics from the repertory are:
MIND Irritability, menses, before
CHEST Pain, mammae, menses, before
CHEST Swelling, mammae, menses, before
Bovista lycoperdon, Calcarea carbonicum, Calcarea phosphoricum, Cuprum metallicum, Kali carbonicum, Lachesis, Natrum muriaticum, Veratrum album, Zincum metallicum; Hyoscyamus niger, Phosphorus, Phytolacca decandra.
Haemorrhagic diathesis. Patient having nervous temperament. Chilly patient.
Stammering. Everything falls from the hand. Enlarged sensation. Absent minded. Patient becomes sensitive. Marked languor and lassitude. Mood swing. Quarrelsome. Irritable with weak memory. Feel sad.
Diarrhea before and after menses. Cannot bear tight clothing around the waist. Palpitation. General puffiness of body. Numbness and tingling in various parts. Vertigo before menses. Stammering females who drops everything falls from hands.
Other symptoms may include traces of menses between menstruations. Soreness of pubes during menses. Palpitation and tremors.
Persons of scrofulous type, who take cold easily, with increased mucous secretions. Suited to girls who grow fat, flabby, pale and fair skin, chalky look and having leuco-phlegmatic temperament.
Rumination and worrying. Aversion to work and becomes low- spirited and depressed. Confusion, forgetfulness. Fear of misfortune. Absent minded during menses. Worried about everything. Very timid.
Great sensitiveness to cold; partial sweats. Before menses, headache, colic, chilliness and leucorrhea. Headache with cold hand and feet. Big head with large hard abdomen. Cannot bear tight clothing around the waist. Fluid retention and feeling of being overwhelmed. Burning and itching of parts before and after menstruation; in little girls. Hot swelling breasts. Breasts tender and swollen before menses.
Menses too early too profuse too long with vertigo toothache and cold, damp feet, the least excitement causes return.
Other symptoms associated with this remedy include feeling extremely fatigued and depleted, with cold limbs and difficulty climbing stairs or even walking and worsen with exposure to cold or dampness in the morning, and with exertion. PMS present with symptoms such as chills passing up and down the body, the sudden appearance of sweats especially on head, neck, and chest at night. A clammy feeling in the feet and back pain. Female complains of uterine pain and burning sensation in vagina. Worried about everything. Nightmares and disturbing sleep.
It is suitable to anaemic, dark complexioned, lean thin subjects who grow too rapidly with weak bones and curved spine. Girls slow in maturing. Anaemic females who are peevish, flabby, have cold extremities and feeble digestion.
Patient is feeble minded. Unable to sustained mental effort. Mental anxiety with all the trouble. Irritable patient. Lack of memory.
Sexual desire increased before menses. Nymphomania, all organs in erection with irresistible desire, particularly before menses with aching, pressing or weakness in uterine region. Eruption worse during menses. Leucorrhea like white of an egg.
Other symptoms with this medicine are all its symptoms are worse from any change of weather. Numbness and crawling are characteristic sensations, and tendency to perspiration and glandular enlargement. Headache, worse near the region of sutures, from change of weather, of school children about puberty. Flushes of heat and faintness, sweats easily. Menses are profuse and the patient is weak and tubercular. Menses early, scanty, every two weeks, excessive and bright red in color. If lat then first bright and then dark with violent backache. Stiffness and pain with cold, numb feelingin the limbs. Craving for bacon, ham, salted or smoked meats.
Carbo- Nitrogenoid constitution.
Nervous, uneasy, malicious and morose. Weeps violently.
Violent cramps in the abdomen, extending into chest, before, during, or after suppression of menses. Palpitations before the menses. Convulsions before menses.Puerperal convulsions with open mouth and poisthotonos. Menses too late, protracted.
It is suited to the females of soft tissues with tendency to fat that are sensitive to atmospheric changes.
Psychological changes sudden mood swings. Despondent. Very irritable. Obstinate and hypersensitive to pain, noise, touch. History of delayed menses in young girls.
Premenstrual syndrome with swollen breasts. Which come along with the presence of stitching and intense pains, water retention. Other symptoms may include weakness with soft pulse, coldness, general depression, and very characteristic stitches, which may be felt in any part of the body, or in connection with any affection. Sweating, backache, and weakness. Such patients tend to notice an increased sex drive and greater libido. Physical weakness is another symptom which is almost always seen in all patients. Also complain of sourness in the stomach, and she may suffer acidic belching. These often come along with shooting pains in the abdominal region; the patient may also be affected by cramps all over the body. Females tend to suffer from persistent constipation. Frequent need to urinate. Intense backache. Patient may complain of insomnia at night.
It is better suited to thin emaciate having haemorrhagic diathesis.
Patient is very uncomfortable with desire to go in open air and run about before menses. Delirium tremens with much trembling and confusion. Cannot bear anything tight anywhere. Sad in the morning; no desire to mix with the world. Restless and uneasy; does not wish to attend to business; wants to be off somewhere all the time.
Craving for alcohol, oysters. Climacteric troubles, palpitation, flashes of heat, hæmorrhages, vertex headache, fainting spells; worse, pressure of clothes. Persistent throbbing headache with vertigo. Patient is physical exhaustion and feels fatigue. Diarrhea. Patient often suffer from faintness, and may experience sudden flashes of heat during the day.
It is especially to the sensitive, anemic and chlorotic people.
Depressed and introverted. Irritable. Consolation aggravates the complaints. Patient wants to be alone and cry. Anxiety and fear. Alternating mental conditions.
Migraine which affects the patient and induces flashes of light in the visual field. Cardiac and muscular palpitations. Females may experiences nausea, vomiting and faintness. Physical weariness and intense and persistent trembling sensations. Muscular twitching. The condition of the patient can greatly worsen around ten in the mornings, staying in a warm room, and being exposed for long period of time to harsh sunlight can also aggravate the symptoms. The condition of the patient can improve when staying out in the open air. Craves for salt and water-thirst is a typical symptom.
Women of sanguine or nervo-sanguine temperament.
Nymphomania before the menses, unsatisfied passion in lying-in women. Other symptoms are menstrual periods with very heavy flow and cramping, with a feeling of exhaustion and icy coldness suggest a need for this remedy. Vomiting and diarrhea are often seen. Periods may start too early and go on too long. The woman feels worse at night, from exercise, and from drinking things that are warm. Cold drinks, small meals, and wrapping up in warm clothes or covers may help to bring improvement.
Aversion to work and talk. Forgetful
Female symptoms are always associated with restlessness, depression, coldness, spinal tenderness and restless feet. Dry cough before and during menses. Other symptoms may include; Period of depression in disease. Spinal affections. Twitching. Pain, as if between skin and flesh. Great relief from the complaints after menstrual flow. Very sensitive to noise. Breasts painful. Nipples sore.
Suited to nervous, irritable, excitable, sanguine people with light haired.
Confusion of mind. Mania, erotic and restless.
Before menses, hysterical or epileptic spasms. Excited sexual desire. Disturbs the nervous system profoundly. It is as if some diabolical force took possession of the brain and prevented its functions. It causes a perfect picture of mania of a quarrelsome and obscene character.
It suits to tall, slim, transparent skin, dark-haired persons, especially women who disposed to stoop shoulder.
Restless. Loss of memory. Great lowness of spirits.
Weeps before the menses. Great susceptibility to external impressions, to light, sound, odors, touch, electrical changes, thunder-storms. Suddenness of symptoms, sudden prostration, faints, sweats, shooting pains, etc. Fearfulness, as if something were creeping out of every corner. Clairvoyant state. Great tendency to start. Excitable, produces heat all over. Stitching pain in mammae.
It is suited to rheumatic or syphilitic subjects.
Great fear, she is going surly die. Loss of personal delicacy.
Aching, soreness, restlessness, prostration, is general symptoms guiding to Phytolacca. Mastitis; mammæ hard and very sensitive. Breast is hard, painful and of purple hue. Irritable breasts, before and during menses.
FEW TIPS FOR PREVENTION OF PMS:
You can manage the PMS symptoms or sometimes changes in the regular diet and lifestyle may reduce the symptoms. This plan is usually recommended first.
o Eat a well-balanced diet with increased whole grains, vegetables, fruit,
o Eat smaller, more frequent meals each day to reduce bloating and the sensation of fullness. It may help you to keep blood sugar at a steady level and reduce cravings.
o Avoid candy, sodas, and sugary foods during the week before your period which helps to decrease bloating and swelling.
o Limit salt and salty foods to reduce bloating and fluid retention.
o Limit caffeine it can make breast tenderness worse and increase headaches.
o Avoiding caffeine, sugar, nicotine, and alcohol eases irritability and improves sleep patterns.
o Take the foods high in complex carbohydrates, such as fruits, vegetables and whole grains
o Take diet rich in of vitamins and minerals
o Choose foods rich in calcium
o Keeping a consistent exercise program may also improve your well-being throughout the menstrual cycle.
o Regular daily exercise like brisk walking, cycling and swimming can help to improve overall health and alleviate symptoms such as fatigue and a depressed mood.
o Regular aerobic exercise also reduces stress and promotes regular sleep patterns. Regular aerobic exercise is beneficial and may reduce PMS responses because it increases production of endorphins (the body’s natural painkiller), which in turn may raise the serotonin level.
o Physical exercise increases sympathetic tone, a condition that lowers heart rate and reduces anxiety sensations.
o Get plenty of sleep. The body may have different sleep requirements at different times during a woman’s menstrual cycle, so it is important to get adequate rest.
o Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety and trouble sleeping or insomnia.
o Yoga may help.
Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.
A warm bath, listening to music, massage therapy may help.