What is PMS?
Premenstrual Syndrome or PMS, as it is commonly known, is a disorder in which certain symptoms occur in the days just before a period. These symptoms may be physical, like backache, headache, pain or swelling of the breasts, a sensation of bloating or weight gain before the menstrual period. The patients may have emotional symptoms, like anxiety, irritability, exhaustion, lethargy, mood swings, depressions, loss of appetite or craving for certain foods, or else the patient may have changes in behaviour e.g. violence, clumsiness or loss of concentration.
How common is PMS?
This problem is so common that about 95% of the woman have one or more symptoms. In 70% of the cases there are emotional symptoms along with bloatedness. However, the symptoms are severe enough in only 11% cases so as to require medical help.
What causes PMS?
Looking at how frequent PMS is suggests that in their milder form they are a part of the normal menstrual period. The more severe cases, however, may have an underlying cause, which is not really known so far. Although the scientific possibilities are many, one of the probable reasons for PMS could be some hormonal trigger, which occurs before the period. One theory is that there may be some nutritional deficiency too because relief is often seen by giving certain nutritional supplements to the patient.
How is PMS diagnosed?
There is no laboratory test as such to diagnose PMS. Most of the times the doctor will ask you to keep a record of the coming 3 months and note whether the symptoms actually start within 12 days of the start of the period or were present throughout the month but became more just before the period. This difference is important because in 30% of the women there may be some underlying psychiatric or medical disorder, which causes some symptoms throughout the month, which get worse just before the period. These disorders include psychiatric depressive syndromes, personality disorders, psychosocial stress, convulsive disorders, irritable bowel syndrome, hypothyroidism and some cases of oral contraceptive users. PMS characteristically begins after Day 12 of the menstrual cycle and relief occurs within 4 days of the period. That means that after the period is over, for about 10-12 days the patient is completely all right before the symptoms begin again.
How can one handle PMS?
One of the best ways to manage PMS is by what is called the ‘Self-Help Therapy’. As the first line of management, it is excellent and relieves the symptoms in about 50-75% cases. There are three parts to this very important treatment. The first is to alter your diet. The rationale behind this is self-explanatory e.g. reducing salt intake decreases retention of fluid, bloatedness and weight gain; decreasing alcohol intake decreases depressive pre-menstrual symptoms, frequent meals keeps sugar levels normal, and weight reduction in obese women helps to decrease PMS. One should also avoid ‘junk’ foods, limit caffeine intake and intake of animal fats. The second important part is to modify your lifestyle. Aerobic physical exercise like brisk walking for 30 – 40 minutes in the second half of the menstrual cycle helps by a ‘mood elevating effect’ and by taking the woman away from the often-stressful home environment. Many patients relish this form of ‘self help’. Other stress busters and relaxation techniques like yoga, hypnosis, music, poetry, meditation and acupuncture work very well for some women. The third part of the Self-Help Therapy is the addition of certain vitamins like vitamin E and B6, which help, in low doses.
What should one do if Self-Help does not help?
The next step is, of course, to visit your gynaecologist who will first confirm the diagnosis and rule out any psychiatric or medical problem. Very often, the supportive attitude and reassurance by the doctor is known to bring relief in the symptoms. The treatment is individualized according to the patient and the most prominent symptom is treated first. Medicines are available which help in reducing the premenstrual weight gain; painful breasts, emotional symptoms, headache and backache, but their side effects prevent their use for long durations of time. Each new treatment should be given at least 3 months before trying another.
One very important finding in daily practice is that mothers of women with PMS have suffered from PMS themselves. They, in fact, transfer their agonies and stresses to their daughters. If women view some discomfort during periods as a very natural event, their own daughters are less likely to suffer.
The final message for mothers of girls who suffer from PMS is to teach their daughters to flow with all changes in life in a relaxed way and for those who suffer from PMS is ‘ Don’t give up hope ‘.