Premenstrual syndrome (PMS)

Overview 

• Most well-adjusted women experience minor psychological and somatic changes for a few days preceding menstruation. [2]
• These menstrual molimina give way to a sensation of relief and well-being once menstruation is established. [2]
• This is extremely common at all ages but especially in women aged 30–45 years, the reported prevalence ranging from 5–95%. [2]
• The age incidence of PMS is said to be due to the fact that stresses are most severe in the third and fourth decades. [2]
• Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression.[4]
• Still, you don’t have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.

Epidemiology

Causes 

• The exact cause of Premenstrual syndrome (PMS) is not known. It has been postulated that it represents a syndrome which is the result of multiple biochemical abnormalities. [1]

Amongst these, the following have been implicated:

• Oestrogen excess or progesterone deficiency in the luteal phase.
• Increased carbohydrate intolerance in the luteal phase.
• Pyridoxine deficiency—this vitamin plays a role in oestrogen synthesis and also in dopamine and serotonin production.
• Increased production of vasopressin, Aldosterone, Prolactin and Systemic prostaglandins which adversely affect renal function and contribute to fluid retention and bloating.
• Fluctuations in opiate peptide concentrations affecting endorphin levels. However, biochemical estimations do not bear these out.[1]
• Hence, at present it is not yet clear whether PMS is an abnormal response to normal hormonal fluctuation or a result of hormonal abnormalities.
• A woman with hysterectomy but conservation of ovaries may also suffer from PMT suggesting that the ovarian hormones have a role in PMT.
• Low level of b-endorphins (neurotransmitters) in the brain and low level of serotonin are probably responsible for psychiatric disorders.
• Genetic predisposition is also recognized in a few cases.[1]

Types

Pathophysiology 

Sign & Symptoms 

While PMS often involves mild or moderate symptoms that don’t majorly affect daily life, symptoms can be severe enough to impact your everyday activities and overall well-being.[5]

Physical signs

• Bloated tummy
• Cramps
• Tender breasts
• Hunger
• Headache
• Muscle aches
• Joint pain
• Swollen hands and feet
• Pimples
• Weight gain
• Constipation or diarrhea

Emotional and behavioral symptoms

PMS-related changes in your mood, emotions, and behavior might include:

• Anxiety, restlessness
• Unusual anger and irritability
• Changes in appetite, including increased food cravings, especially for sweets
• Changes in sleep patterns, including fatigue and trouble sleeping
• A sad or low mood, which might involve tearfulness or sudden, uncontrollable crying
• Rapid shifts in mood and emotional outbursts
• Decreased sex drive
• Difficulty concentrating or remembering information [5]
• For some, the physical pain and emotional stress are severe enough to affect their daily lives.
• Regardless of symptom severity, the signs and symptoms generally disappear within four days after the start of the menstrual period for most women.[6]
• But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).[6]
• PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.[6]

Diagnosis

• Diagnosis depends on history and careful questioning. Temporal correlation of symptoms with the premenstrual phase of the cycle as documented in a menstrual diary helps to arrive at a rational diagnosis.
• No organic pelvic lesion is detected, and no definite test is available to confirm the diagnosis.[1]

Treatment of Premenstrual syndrome (PMS)

• For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome.
• The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include:

Antidepressants: –

• Selective serotonin reuptake inhibitors (SSRIs) which include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) have been reducing mood symptoms.
• SSRIs are the first line treatment for severe PMS or PMDD. These medications are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.[7]

Nonsteroidal anti-inflammatory drugs (NSAIDs): –

• Taken before or at the onset of your period, NSAIDs such as Ibuprofen or Naproxen sodium can ease cramping and breast discomfort.[7]

Diuretics :–

• Taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.[7]

Hormonal contraceptives­: –

• These prescription medications stop ovulation, which may bring relief from PMS symptoms.[7]

Alternative medicine :-

• Vitamin supplements:-Calcium, magnesium, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking.
• Herbal remedies:- Some women report relief of PMS symptoms with the use of herbs, such as ginkgo, ginger, chaste berry (Vitex Agnus), evening primrose oil.[7]

Acupuncture

Homeopathic Treatment of Premenstrual syndrome (PMS)

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Premenstrual syndrome (PMS):

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Bovista

• Premenstrual problems with puffiness in the extremities, fluid retention and a bloated feeling often indicate a need for this remedy.
• The woman may feel very awkward and clumsy, and may constantly be dropping things because of swollen-feeling hands.
• Diarrhea occurring around the time of the menstrual period strongly indicates this remedy.[9]

Calcarea carbonica

• PMS with fatigue, anxiety, and a feeling of being overwhelmed suggest a need for this remedy.
• The woman may have problems with water-retention and weight gain, tender breasts, digestive upsets, and headaches.
• Periods often come too early and last too long, sometimes with a flow of bright red blood.
• A general feeling of chilliness, with clammy hands and feet and cravings for sweets and eggs are other indications for Calcarea.[9]

Lachesis

• Women who need this remedy are usually intense, with a tremendous need for an outlet, both physically and mentally.
• Symptoms of PMS include congestion, headaches, flushing, surges of heat, and an intense outspoken irritability often with strong feelings of suspicion or jealousy.
• When the flow arrives, it may be heavy, but brings relief of tension. Intolerance of restrictive clothing around the waist or neck is another indication for Lachesis.[9]

Lycopodium

• PMS with a craving for sweets and a ravenous appetite suggests a need for this remedy.
• Digestive upsets with abdominal bloating and flatulence often seen, with the person feeling worst in the late afternoon and evening.
• Menstrual periods may delay, follow by a heavy flow that goes on for extra days.
• A woman who needs this remedy often wears a worried look and lacks self-confidence although she may irritable and bossy to pets and family members.
• A desire to alone, but with someone in the other room, is another indication for Lycopodium.[9]

Natrum Muriaticum

• A person who needs this remedy usually seems reserved to others, but is deeply emotional inside.
• She may feel extremely sad and lonely, but gets affronted or angry if others try to console her or sympathize.
• Depression, anger over minor things, and a need to be alone to cry are often seen when Natrum mur is needed.
• Menstrual problems can be accompanied by migraines, or a backache that feels better from lying on something either hard or pushing a solid object against the painful place.
• Lastly, A craving for salt, strong thirst, and a tendency to feel worse from being in the sun are other indications for this remedy.[9]

Pulsatilla

• Generally, This remedy can be helpful during many conditions involving hormonal changes and is often helpful to girls who have recently started having periods.
• PMS with irritability, moodiness, and weepiness is typical.
• Either Delay or suppression of the menstrual flow can be accompanied by queasy feelings, nausea, and faintness. Additionally Being too warm or in a stuffy room makes things worse, and fresh air can bring relief.
• The timing, amount, and nature of the menstrual flow are changeable as are the woman’s moods when Pulsatilla is the remedy.
• The woman usually is emotional also needy, wanting a lot of attention and comforting.[9]

Sepia

• In brief, This remedy relieves mood swings from PMS associated with irritability and poor venous circulation.[9]

Veratrum album

• Menstrual periods with very heavy flow and cramping, with a feeling of exhaustion also icy coldness suggest a need for this remedy.
• Furthermore, Vomiting and diarrhea are often seen.
• Periods may start too early and go on too long. In detail, 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.[9]

Caulophyllum

• This remedy is often helpful to women with a history of irregular periods, difficulty becoming pregnant or slow childbirth due to weak muscle tone of the uterus.
• Symptoms include discomfort during periods and a heavy flow of blood or other discharge.
• Drawing pains may feel in the pelvic region, thighs, and legs.
• Stiffness or arthritis, especially in the finger-joints, often seen when this remedy needed.[9]

Lillium tigrinum

• This remedy may helpful if a woman is inclined toward rage during PMS, makes other people "walk on eggs," and is extremely sensitive and irritable.
• Pressure in the rectum and in the pelvic region, with a sensation that the uterus is pushing out, may make her feel a frequent need to sit or cross her legs.
• Emotions and excitement aggravate the symptoms, and fresh air will often bring relief.[9]

Nux vomica

• When a woman with PMS is extremely impatient, pushy, and intolerant, this remedy may of use.
• Uncomfortable, irregular menstrual periods can experience, often with a nagging urge to move the bowels before the flow begins.
• Constipation is common, and constricting pains may extend to the rectum or tailbone region.
• Anger, mental strain, physical exertion, and overindulgence in coffee, alcohol, or food can aggravate the problems.[9]
• Woman often feels chilly and improves from warmth and rest.[9]

Kreosotum

• Headache, nausea, and a heavy flow that makes the genitals and surrounding skin feel irritated and swollen are indications for this remedy.
• Kreosotum often indicate for women with PMS who feel irritable and uncomfortable, and have a strong dislike of sexual activity.[9]

Diet & Regimen 

For Premenstrual syndrome (PMS)

• Dietary Strategies for PMS Relief:

  • Focus on Whole Foods: Emphasize a balanced diet rich in fruits, vegetables, whole grains, and lean protein.
     
  • Limit Processed Foods: Explain the negative impact of processed foods, sugary snacks, and excessive caffeine and alcohol on PMS symptoms.
  • Micronutrients Matter: Highlight the importance of specific nutrients:
    • Calcium and Vitamin D: Explain their role in mood regulation and reducing cramps. Recommend sources like dairy, leafy greens, and fortified foods.
       
    • Magnesium: Discuss its benefits in easing anxiety, irritability, and muscle cramps. Suggest incorporating magnesium-rich foods like nuts, seeds, and dark chocolate.
       
    • B Vitamins: Explain their role in mood and energy regulation. Recommend sources like whole grains, legumes, and leafy greens.   
       
    • Omega-3 Fatty Acids: Discuss their anti-inflammatory effects and potential to improve mood. Suggest sources like fatty fish, flaxseeds, and walnuts.

  Regimen 

  • Regular Exercise: Explain the mood-boosting and stress-reducing benefits of exercise. Recommend activities like yoga, walking, and swimming.  
     
  • Stress Management: Discuss the impact of stress on PMS symptoms. Suggest stress-reducing techniques like meditation, deep breathing exercises, and spending time in nature.
  • Sleep Hygiene: Emphasize the importance of quality sleep for hormonal balance and mood regulation. Offer tips for improving sleep habits.
     
  • Hydration: Explain the role of hydration in reducing bloating and water retention. Encourage adequate water intake throughout the day.

References use for Article Premenstrual syndrome (PMS)

 Textbook of Gynacology VG Padubidri (1)

 Textbook of Jeffcoate’s Principles of Gynecology (2)

 https://en.wikipedia.org/wiki/ Premenstrual_syndrome(3)

 https://www.mayoclinic.org/diseases-conditions/premenstrual-syndr(4)

 https://www.webmd.com/women/pms/what-is-pms(5)

 https://www.mayoclinic.org/diseases-conditions/premenstrual-synd(6)

 https://wwwS.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosi (7)
 https://pubmed.ncbi.nlm.nih.gov/22611222/(8)

 https://www.peacehealth.org/medical-topics/id/hn-2241003(9)

 https://www.webmd.com/women/pms/ features/diet-and-pms(10)

Bhuvaneswari K, Selvaraj K, Kumar SG, et al. Prevalence of premenstrual syndrome and its impact on quality of life among selected college students in Puducherry. NMJI. 2020;32(1).(11)

Choksi S, Shah V. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among medical students in Gujarat. Indian J Physiol Pharmacol. 2016;60(3):328-332.(12)

Jiwane R, Sachan A, Jain R, et al. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among medical students and its impact on their academic and social performance. J Midlife Health. 2018;9(2):68-72.(13)

Kaur H, Aggarwal A, Dalal PK. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: A systematic review and meta-analysis. Health Promot Perspect. 2021;11(2):129-141.(14)

The Complete Guide to PMS, 2nd Edition, Katharina Dalton, 1994,  Wellingborough: Thorsons Publishers.(15)

Fast Facts: Premenstrual Syndrome, 1st Edition, Nick Panay, 2005,  Abingdon, Oxon: Health Press.(16)

Clinical Gynecologic Endocrinology and Infertility,  8th Edition, Leon Speroff, Marc A. Fritz,  2011, Lippincott Williams & Wilkins(17).

Comprehensive Gynecology, 7th Edition, Gretchen M. Lentz, Andrea Dunaif, Elizabeth A. Stewart, et al., 2017, Elsevier.(18)

Williams Gynecology,  4th Edition,  Barbara L. Hoffman, John O. Schorge, Joseph I. Schaffer, et al., 2020,  McGraw Hill Professional.(19)

Yen & Jaffe’s Reproductive Endocrinology,  8th Edition,  Jerome F. Strauss III, Robert L. Barbieri,  2019,  Elsevier.(20)

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Our Bodies, Ourselve,  9th Edition, The Boston Women’s Health Book Collective,  2011,  Touchstone.(23)