Pre-Menstrual Syndrome
What is Pre-Menstrual Syndrome?
Interest in Premenstrual syndrome (PMS) began only after it was used as a criminal defense in Britain during the early 1980s. Until then it was considered as a purely state of mind and the patients were told “it’s all in your head”. It was considered a social problem and not a medical one.
PMS is an ailment related with the physical, psychological, and emotional symptoms during the menstrual cycle. It is also referred to as PMT or Premenstrual Tension. While about 80% of the women of child-bearing age have some mild symptoms of PMS, it is considered an ailment worthy of treatment only if it interferes with the woman’s daily life. Such symptoms are usually predictable and occur regularly during the two weeks prior to menses. Generally, symptoms may vanish before or after the start of menstrual flow.
Symptoms of Pre-Menstrual Syndrome
PMS is a group of symptoms that start one to two weeks before the woman’s period. Most women have at least some symptoms of PMS, but for some women the symptoms are severe enough to interfere with their lives. The symptoms are so varied that about 200 symptoms of PMS have been identified. Some of them are listed below:
01) Dysphoria (unhappiness for no reason)
02) Irritability
03) Abdominal bloating and cramps
04) Breast tenderness or swelling
05) Anxiety
06) Joint and muscle pain
07) Insomnia
08) Headache and fatigue
09) Acne
10) Mood swings
11) Allergic infections (eye and skin problems)
12) Food craving
13) Angry outburst
14) Confusion and social withdrawal
15) Swelling of hands and feet, etc.
Diagnosis of Pre-Menstrual Syndrome
As there are no specific laboratory tests for the diagnosis of PMS, in order to establish a pattern, a gynecologist may ask the patient to keep a record of her symptoms on a calendar for at least two menstrual cycles. This will help to establish if the symptoms are truly premenstrual and predictably recurring. If in the two cycles monitored the symptom intensity increases at least 30% in the six days before menstruation, then it is a case of PMS that needs treatment.
The Calendar of Premenstrual syndrome Experiences (COPE), the Prospective Record of the Impact and Severity of Menstruation (PRISM), and the Visual Analogue Scales (VAS) are a few standardized methods developed to describe PMS patterns.
Causes of Pre-Menstrual Syndrome
The exact causes of PMS cannot be fully defined because they differ from woman to woman. Research shows that PMS is linked to the interaction between sex hormones and the central nervous system. Serotonin, a neurotransmitter in the brain, is considered the culprit. But there are various factors that cause or aggravate the incidence of PMS:
Heredity: Researchers have come to the conclusion that heredity plays a large part in the cause of PMS because it is found more commonly in twins.
Coffee: Too much intake of caffeine aggravates the situation and causes depression.
Stress: Stress may precipitate the condition. A temporary stress or trauma like death in the family, divorce and separation, etc can also be factors for PMS.
Aging: Increasing age can cause PMS because there are a lot of hormonal changes taking place in the body of the woman at that time.
Medical history: History of depression and anxiety would precipitate some of the symptoms of PMS.
Tobacco: Smoking is another factor known to cause PMS in some women.
Family history: A person is more at risk from this disease if there is a near relation having symptoms of PMS.
Diet: A diet low in magnesium, manganese and vitamin E can cause PMS.
Types of Pre-Menstrual Syndrome
Mild PMS: If the symptoms are mild the patient does not require any specific treatment. It can be taken care of at home by the woman herself. Regular exercise, balanced diet, keeping busy and not getting into a depressive mood are sufficient and self-curative methods.
Premenstrual Dysphoric Disorder (PMDD): But if it is a case of PMDD, which is a severe case of PMS, it would have more disabling symptoms that would interfere with the woman’s daily life. Besides the usual symptoms, the woman would experience severe mood swings, crying, migraine, seizure disorders, irritable bowel movements, asthma, allergies, etc. In this case prompt treatment is essential to avoid other emotional problems.
Treatment of Pre-Menstrual Syndrome
The treatment for PMS varies from woman to woman because the symptoms are so varied. The first stage is counseling, where the medical history, family history, habits, sexual habits, medications taken, etc are gone through and the patient is advised on various modes of treatment. Some methods are:
Contraceptives: If the patient is using oral contraceptives, this could cause fluid retention and lowering levels of plasma. Hence, other methods of contraception should be used.
Diet: The patient should avoid saturated fats, refined carbohydrates, coffee, tea, tobacco, alcohol, etc at all costs. These can aggravate other problems like depression, overweight, inactivity, etc which deter treatment.
Avoid constipation: Constipation can aggravate the condition, so consumption of fruits, vegetables and meals with a lot of fiber content are advisable.
Home remedies: Cinnamon powder with a glass of warm milk helps to relieve cramps. A little psyllum husk taken early in the morning with water can help in keeping the digestive system in perfect order. This improves the health overall and aids treatment.
Hip bath/girdle: A warm water hip bath can help relieve inflammation of the uterus which cold be a cause of PMS. A wet girdle pack applied twice a day on empty stomach is very beneficial for clearing up uterine congestion and improving bowel functions. But all external treatment must be stopped during the menses.
Exercise: Brisk walks and exercises for strengthening the abdominal muscles and pelvic organs can be a great help in the treatment of PMS. This too should not be done during menses. Also, yoga (form of Indian exercises) can help in relaxing the muscles and relieve stress and anxiety.
Acupressure: Acupressure techniques applied on the middle portion of the left foot that relates to the uterus and vagina can help alleviate the symptoms of PMS to a large extent.
Herbal treatment: The stem part of the chaste tree or monk’s pepper helps in increasing the progesterone production which regulates the menstrual cycle. This is commercially available and can help relieving the symptoms of PMS. Also the yarrow plant extract can relieve inflammation.
Dietary supplements: Dietary supplements of vitamins E and B, magnesium, manganese and calcium should be consumed by the patient.
SSRIs: Serotonergic medications like selective serotonin reuptake inhibitors (SSRIs) are used if the symptoms of PMS are very severe.
Diuretics: Diuretics are used to reduce water retention.
NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen are administered to relieve pain and discomfort.
Living with Pre-Menstrual Syndrome
Symptoms like depression, migraines, angry outburst, irritability, fatigue, insomnia, sexual frustration, etc can all have a debilitating effect on the patient. If left untreated, these problems can further lead to psycho-sociological disorders, as the symptoms can restrict ones daily life. Personal and professional relationships are adversely affected. This affects women of all races, but is more prevalent in women who consume too much of alcohol and coffee and are habitual smokers.
Prevention of Pre-Menstrual Syndrome
Premenstrual syndrome (PMS), in its mild form cannot be totally prevented, but the severity of the symptoms or the chances of it becoming PMDD can be prevented.
Regular exercise: Exercises release the natural brain chemicals (endorphins) that reduce pain and improve the overall health.
Balanced diet: Diet low in carbohydrates and fats but rich in proteins, whole grains, fruits and vegetables would go a long way in naturally preventing PMS.
Calcium/Vitamin: Dietary supplements of calcium and vitamin B help to a large extent.
Alcohol/Cigarettes: Alcohol and smoking are completely taboo.
Yoga/meditation: Relaxation techniques like yoga and meditation can be a help in alleviating the symptoms of depression and anxiety.
Ironically, the World Health Organization (WHO) does not accept PMDD as a disorder. In some non-western countries PMS and PMDD are not considered as disorders but as part of a woman’s life cycle. Hence, it is difficult to standardize methods of diagnosis and treatment of these disorders across the globe. The non-western nations feel that accepting these ailments as disorders has in fact allowed unnecessary regulation and interference in women’s lives by the medical establishment. They contend that while non-Westerners generally agree that women can be affected by their menstrual cycle, treating PMS/PMDD as diseases is specific to the West and is not recognized as such in their own regions.
