| INTRODUCTION:
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. PMS is a complex health concern. Up to
70-80% of women experience some symptoms of PMS during their childbearing
years.
ETIOLOGY OF PMS:
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 PMS. 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 PMS. 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 PMS 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 PMS 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 PMS, such
as depression, fatigue, food cravings and sleep problems.
According to another theory PMS involves inflammatory substances
called prostaglandins. Prostaglandins are produced in the breast,
brain, reproductive tract, kidney, and gastrointestinal tract where
PMS symptoms originate; which is responsible to problems such as
cramping, breast tenderness, gas, diarrhea, and constipation.
Another theory explaining PMS also linked to low levels of
vitamins and minerals. Other possible contributors to PMS 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 PMS:
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
- Irritability
- Dizziness
- Breast tenderness and swelling
- Acne
- 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
- Headaches/migraines
- Depression
- Crying Spells
- Sadness, feelings of "fogginess"
- Difficulty concentrating
- Indecisiveness
- Forgetfulness
- 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
- Backache
- Abdominal pain
- Recurrent cold sores
- Nausea
- Constipation or diarrhea
- Decreased coordination
- Less tolerance for noises and lights
- Painful menstruation
- Confusion
- 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 PMS:
There is no special test to point out PMS. 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 PMS:
Line of treatment depends upon symptoms present in PMS
Anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen or naproxen sodium can for cramps and breast discomfort.
COX-2 inhibitors are 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.
Hormonal therapy
Oral contraceptives for stopping ovulation and stabilize
hormonal swings; Progesterone support, Gonadotropin hormone agonists
in severe PMS.
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 PMS. 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 PMS, 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 PMS 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.
Homeopathic Treatment
of 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.
Reportorial rubrics
[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
Homeopathic Remedies
Bovista lycoperdon, Calcarea carbonicum, Calcarea phosphoricum,
Cuprum metallicum, Kali carbonicum, Lachesis, Natrum muriaticum,
Veratrum album, Zincum metallicum; Hyoscyamus niger,
Phosphorus, Phytolacca decandra.
Materia medica
Bovista lycoperdon
Constitution
Haemorrhagic diathesis. Patient having nervous temperament. Chilly
patient.
Mind
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.
Symptoms
Diarrhoea 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.
Calcarea carbonica
Constitution
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.
Mind
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.
Symptoms
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.
Calcarea phosphorica
Constitution
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.
Mind
Patient is feeble minded. Unable to sustained mental effort. Mental
anxiety with all the trouble. Irritable patient. Lack of memory.
Symptoms
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 feeling in the limbs. Craving for bacon, ham, salted or
smoked meats.
Cuprum metallicum
Constitution
Carbo- Nitrogenoid constitution.
Mind
Nervous, uneasy, malicious and morose. Weeps violently.
Symptoms
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.
Kali carbonicum
Constitution
It is suited to the females of soft tissues with tendency to fat
that are sensitive to atmospheric changes.
Mind
Psychological changes sudden mood swings. Despondent. Very
irritable. Obstinate and hypersensitive to pain,
noise, touch. History of delayed menses in young girls.
Symptoms
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.
Lachesis
Constitution
It is better suited to thin emaciate having haemorrhagic diathesis.
Mind
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.
Symptoms
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.
Natrum muriaticum
Constitution
It is especially to the sensitive, anemic and chlorotic people.
Mind
Depressed and introverted. Irritable. Consolation aggravates the
complaints. Patient wants to be alone and cry. Anxiety and fear.
Alternating mental conditions.
Symptoms
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.
Veratrum album
Constitution
Women of sanguine or nervo-sanguine temperament.
Symptoms
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.
Zincum metallicum
Constitution
Nervous constitution.
Mind
Aversion to work and talk. Forgetful
Symptoms
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.
Hyoscyamus niger
Constitution
Suited to nervous, irritable, excitable, sanguine people with light
haired.
Mind
Confusion of mind. Mania, erotic and restless.
Symptoms
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.
Phosphorus
Constitution
It suits to tall, slim, transparent skin, dark-haired persons, especially
women who disposed to stoop shoulder.
Mind
Restless. Loss of memory. Great lowness of spirits.
Symptoms
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.
Phytolacca decandra
Constitution
It is suited to rheumatic or syphilitic subjects.
Mind
Great fear, she is going surly die. Loss of personal delicacy.
Symptoms
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.
DIET
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
EXERCISE
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.
REDUCE STRESS
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.
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