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Pre-Menstrual Syndrome

What is PMS

is Premenstrual syndrome (PMS) is cyclic constellation of symptoms appearing during the late luteal phase of the menstrual cycle ( approximately  the 2 weeks before the start of your periods) and disappearing by the end of full flow of menses.

The pathophysiology of PMS is now understood to be a complex interaction between fluctuations in ovarian steroids and central neurotransmitters as well as peripheral effects of these hormones. Highly effective treatments for the disorder have been developed that include agents that alter central neurotransmitters and circulating ovarian steroid levels.

Although some 150 symptoms have been listed as premenstrual, the most common symptoms are as follows

• Decreased energy PMS Symptoms
• Tension
• Irritability
• Anger
• Food cravings
• Depression
• Headache
• Altered sex drive
• Breast pain
• Muscle aches
• Abdominal bloating
• Oedema of the fingers and ankles

PMS is estimated to affect between 30% and 40% of menstruating women; 80% of women experience premenstrual emotional or physical changes but do not have much difficulty. Peak occurrence is among women in their 30s and 40s, but as any teenager nows, it is also very common in the adolescent years.

In most cases symptoms are relatively mild; however, in about 3% to 8% of women, symptoms can be severe enough to have a negative impact on their lives, putting home life and work in jeopardy. Severe PMS with depression, irritability, and severe mood swings is referred to as premenstrual dysphoric disorder (PMDD)

Dr. Guy Abraham developed a system for categorising premenstrual syndrome into four distinct subgroups. They can be summarised as follows:

1. PMS-A (anxiety) is believed to be related to high levels of estrogen and deficiency of progesterone. Women experience irritability, anxiety, and emotional lability.
2. PMS-C (carbohydrate craving) is of unclear aetiology but may be caused by enhanced intracellular binding of insulin. Women with this subtype experience increased appetite, sugar and carbohydrate craving, headache, and heart palpitations
3. PMS-D (depression) is possibly caused by low levels of estrogen, which leads to excessive breakdown of neurotransmitters. Low estrogen levels may be caused by enhanced adrenal androgen or progesterone secretion.
4. PMS-H (hyperhydration) is the result of increased water retention secondary to elevations of aldosterone. Elevations of aldosterone in the premenstrual period may be the result of excess estrogen, excessive salt intake, stress, or magnesium deficiency. Women with this subtype report weight gain, breast tenderness and fullness, swelling of the hands and feet, and abdominal bloating.

Although used by many traditional and alternative practitioners, these categories should be considered only guidelines, because the basis for their separation has not been adequately confirmed by current research and most women do not neatly fit into just one of the groups.

So what can you do to help yourself

Do

  • take regular exercise
    • Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week.
    • Regular daily exercise can help improve your overall health and alleviate certain symptoms, such as fatigue and a depressed mood.
  • eat a healthy, balanced die
    • Eat smaller, more-frequent meals to reduce bloating and the sensation of fullness.
    • Limit salt and salty foods to reduce bloating and fluid retention.
    • Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.
    • Choose foods rich in calcium. If you can’t tolerate dairy products or aren’t getting adequate calcium in your diet, a daily calcium supplement may help
    • Avoid caffeine and alcohol.
  • get plenty of sleep
    • 7 to 8 hours is recommended
  • Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia).
    • try reducing your stress by doing yoga or meditation
  • take painkillers such as ibuprofen or paracetamol to ease the pai
  •  keep a diary of your symptoms for at least 2 to 3 menstrual cycles

Don’t

  • do not smoke
  • do not drink too much alcohol
  • do not consume large quantities of high glycaemic sugars

What other help can be offered

Psychological support

  • cognitive behavioural therapy – a talking therapy

Supplements

  • 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
      • evening primrose oil
      • ginkgo
      • ginger
      • chasteberry (Vitex agnus)
      • St. John’s wort.
    • However, few scientific studies have found that any herbs are effective for relief of PMS symptoms
    • Herbal remedies also aren’t regulated by the Food and Drug Administration, so there’s no record of product safety or effectiveness.
    • Talk with your doctor before taking any herbal products, as they may have side effects or interact with other medications you’re taking. St. John’s wort, for example, reduces the effectiveness of birth control pills.

Acupuncture.

A practitioner of acupuncture inserts sterilised stainless steel needles into the skin at specific points on the body. Some women experience symptom relief after acupuncture treatment.

Medical Approach

  • 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.
  • Hormonal Medicines
    • Natural Micronized progesterone taken for 10 days prior to menstruation.
      • maybe useful for those predominantly with water retention and anxiety
    • Transdermal Estradiol, again taken 10 days prior to menstruation
      • may sometimes be used to alleviate menstrual migraines
    • others such as the combined contraceptive pill
    • Antidepressants
      • Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in 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.
    • Diuretics
      • When exercise and limiting salt intake aren’t enough to reduce the weight gain, swelling and bloating of PMS, 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.

If you still get symptoms after trying these treatments, you may be referred to a specialist.

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