Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) describes a collection of symptoms - both physical and emotional - that afflict many women in the days leading up to a menstrual period. The condition may affect as many as three out of four women aged between 30 and 40, and can last from two days to two weeks. Most women carry on with life, despite aches and pains and feeling low, but as many as ten per cent are seriously debilitated. The symptoms tend to disappear almost as soon as bleeding starts.

For a long time disregarded as a disorder in its own right, and also rather disparagingly referred to as premenstrual tension, PMS is now understood to have physical causes. Its widespread occurrence has been attributed by some to the unnatural lifestyles led by many women in the industrialized world, although one study revealed that premenstrual baboons in Kenya withdrew from the group and spent more time feeding in the trees.

The Impact of Premenstrual Syndrome

The implications of women suffering from PMS are considerable. The condition increases the incidence of antisocial behaviour, accidents, illness and emotional crisis in women. Among schoolgirls, standards of work drop, exam results may prove disappointing, more punishments are given out and punctuality declines. Female students also become more forgetful. In the workplace, there is a 3-5 per cent increase in absenteeism. If her symptoms are severe enough, a woman may feel reluctant to drive a car or even cross a road, and she will become reclusive at home.

All this has as impact on a woman's family, friends and work colleagues. Children are highly sensitive to their mothers' heightened emotions and may well respond with mood swings of their own. They may develop psychosomatic symptoms such as coughing, vomiting, a runny nose or a headache. Aggressive behaviour towards her partner may put a woman at risk of counter-aggression, and if she has a predisposition to aggression she is more likely to commit a violent crime when she is premenstrual.

So, in addition to the physical discomforts and emotional disturbances of the condition itself, a woman may be racked with guilt because of the effects of her PMS on those closest to her. This may contribute to the significant number of attempted suicides among premenstrual women.

What are the Causes of PMS?

The causes of premenstrual syndrome include hereditary predisposition, emotional factors and dietary irregularities. It has been found, for example, that women suffering from PMS eat 62 per cent more refined carbohydrates, 275 per cent more sugar, 79 per cent more dairy products, 78 per cent more sodium, 53 per cent less iron, 77 per cent less manganese and 52 per cent less zinc than women who exhibit no symptoms of PMS. The condition is exacerbated by stress and overwork.

Different types of PMS

There are four kinds of PMS that can be defined metabolically, depending on the symptoms.

• PMS A
  This, the most common type, affects between 65 and 75 per cent of PMS patients and the main symptoms are nervous tension, anxiety, irritability and mood swings. PMS A is believed to be caused by high oestrogen levels, possibly the result of vitamin B deficiency, which reduces the liver's ability to break down oestrogen ready for excretion. If a patient is also constipated, the oestrogen is reabsorbed in an active form.
  
  High levels of oestrogen affect mood and behaviour in a number of ways. An imbalance in the chemicals in the brain results in excessive amounts of adrenaline and serotonin which cause anxiety and irritability, while too little dopamine reduces any calming potential. Excessive oestrogen also blocks vitamin B metabolism which is required for the synthesis of dopamine. This can be remedied with a 500mg supplement of B₆ per day, but only under the instruction of a nutritionally trained physician or a dietician because of the risk of side-effects.
  
  Oestrogen or progesterone imbalances may increase a person's B₆ requirements with the consequence that a women may show normal B₆ levels in her blood but in fact be deficient in her requirements. This vitamin is also needed by the body for facilitating the efficient use of essential fatty acids by body tissues. High dietary intakes of saturated fats diminish the metabolism of essential fatty acids which necessitates adequate supplies of magnesium, zinc, chromium and vitamins B₃ and C as well as B₆.
  
  Reduced amounts of fatty acid may make women abnormally sensitive to normal levels of prolactin in the blood. Prolactin is a pituitary hormone controlling oestrogen and progesterone production during the menstrual cycle. Excessive prolactin can cause swollen, tender breasts, but few PMS patients have high prolactin levels as such.
  
  A third consequence of high oestrogen levels is imbalance in the regulation of blood sugar levels, causing recurrent hypoglycaemia, with its associated mood swings.
  
  
• PMS H
  This type of premenstrual syndrome affects only slightly fewer women than PMS A and is believed to be linked to excessive production of aldosterone, causing salt and water retention. Weight gain is therefore a symptom, as well as swelling and heaviness of the breasts and abdominal bloating. A high salt intake alone causes fluid retention and weight gain may be in the order of 1-2kg (2-4lb). This may be accompanied by swelling of the face, hands and ankles. As with PMS A, oestrogen levels may be high, leading to excessive amounts of serotonin, which in turn increases aldosterone production. There is also dopamine deficiency. This chemical normally suppresses the release of aldosterone.
  
  
• PMS C
  This type affects 25 to 35 per cent of premenstrual women and is characterized by a craving for sweet things, a bigger appetite, headache, dizziness, palpitations, fainting and tiredness. It is caused by decreased tolerance of carbohydrates. It is believed to be the result of hypoglycaemia although the mechanism is not fully understood. There may be an increased sensitivity to insulin in premenstrual women. High intakes of sugar and refined carbohydrates will make regulation of blood sugar levels more difficult and bring about mood changes. This will also adversely affect magnesium intakes. The mineral is important for the production of progesterone, the control of blood sugar levels and the metabolism of fatty acids. Large amounts of sugar also cause water retention and bloating.
  
  High consumption of tea and coffee hinders the absorption of dietary nutrients and is linked to mood swings, irritability and sleep disturbance. Alcohol may upset vitamin and mineral balances and adversely affect the clearance of oestrogen from the liver as well as reducing control of blood sugar. In the absence of these substances - and sugar - the body compensates for hypoglycaemia by producing adrenalin, which increases blood sugar levels by releasing glucose from stores in the liver. This, however, also causes anxiety, sweating, palpitations and trembling.
  
  
• PMS D
  This type of PMS affects between 25 and 35 per cent of women and is very often found combined with PMS A, which occurs first and then is followed by PMS D symptoms a few days before the start of bleeding. The symptoms include crying, confusion, depression and insomnia. Women with this type of PMS tend to have high levels of progesterone and low levels of oestrogen, the latter of which may bring about an increased rate of breakdown of neurotransmitters in the body. It has been suggested that lead poisoning from vehicle exhausts and factory outlets may block the action of oestrogen but not that of progesterone. If this is the case, then adequate intakes of vitamin B₁, magnesium, zinc and iron are essential to reduce the absorption and deposition of lead and to increase its excretion.

Other Symptoms of PMS

Many women suffering from premenstrual syndrome may also experience the following complaints.

• Skin Disorders
  There may be an increased tendency to develop acne or general blotchiness and dullness with blemishes and whiteheads (milia). The skin may be more greasy than usual and may bruise more easily.
  
  
• Aches and Pains
  These may be linked to fluid retention. As fluid collects within tissues, it exerts pressure on nerve endings. Pain resulting from increased muscle tension may be due to premenstrual effects on the muscle fibres themselves or it may be the result of mental tension. In addition to spasmodic, cramping pains experienced by many women, period pains may take the form of a dull, persistent pain felt in the pelvic region or genital area. This is caused by the congestion of blood vessels. Finally, pain may be felt directly as a result of accidents caused by clumsiness.
  
  
• More Unusual Physical Symptoms Include
  swollen eyelids; hair loss; sore or numb throat; sinusitis; backache; swelling of the hips and lower back; irritation or burning of the vagina; vaginal discharge; aversion to sexual intercourse; painful intercourse; burning pain in the bladder; increased flatulence; alternate constipation and diarrhoea; cutting pains in the legs; and hot feet. Many women find that their symptoms feel worse generally between about 3 and 5 pm.
  
  
• Emotional Symptoms Include
  apathy; panic attacks; general fear; phobias, especially agoraphobia; feelings of detachment; suspiciousness; aversion to being in company; and even a suicidal tendency.

Other Causes of PMS

It used to be thought that PMS was a result of progesterone deficiency. This is the case, however, in only a relatively small number of patients. A large majority of women do not benefit from progesterone therapy. In addition, there is 5-10 per cent risk of side effects such as tiredness, lethargy, inertia, depression and hypoglycaemia.

Preventing Premenstrual Syndrome

From studying the causes and symptoms of PMS, it would appear that the most obvious preventative measures are to:

• correct nutritional deficiencies;
• regulate blood sugar levels; 
• reduce salt intake; 
• treat hormone imbalances promptly.

Since hormones are produced (and destroyed) by the liver, it is advisable to optimise liver function. Poor liver function is not always easy to detect, since the standard blood test will not show as abnormal until there is high level of liver dysfunction. Symptoms include digestive disturbances, tiredness, general malaise, allergies and constipation, as well as PMS. Poor liver function may be the result of reduced bile secretion. This is caused by:

• Gallstones;
• consumption of alcohol;
• poor diet;
• Stress;
• the use of steroids, including the contraceptive pill and oestrogens;
• the use of other drugs and the effects of chemicals, including environmental pollutants;
• pregnancy;
• hereditary disorders, such as Gilbert's syndrome;
• auto-intoxication from the bowel, which means waste products leak through the bowel wall and reach the liver via the circulatory system.

Boosting Liver Function

There are some easy measures to take to protect the liver by:

• Reducing consumption of alcohol and saturated fats. This will lessen the risk of damage to the liver and help to prevent a reduction in bile secretion. Increasing the amount of fibre in the diet will actively promote bile secretion. 
• Increasing dietary intakes of antioxidants such as vitamins C and E, zinc and selenium to protect against damage from free radicals. These are highly reactive molecules that can destroy the structure of cells if they are allowed to. 
• Following a special Liver Diet. This avoids foods that the liver finds difficult to process, including meat, fowl, eggs, refined cereals, sugary foods, dairy products, nuts, fried foods, chocolate, coffee, citrus fruits, tomatoes, bananas and avocados.
• Taking dietary supplements to cleanse the colon. These include alfalfa tablets, acidophilus capsules and psyllium husks.

General Self-Help Measures

Following certain dietary guidelines may help to relieve PMS symptoms:

• avoid foods that are high in salt (and do not cheat by adding it at the table);
• avoid junk food, fatty foods and tea and coffee;
• limit intakes of dairy products and refined carbohydrates, especially sugary foods;
• eat several small, protein-rich snacks rather than one or two large meals;
• get protein from vegetarian sources, such as pulses, nuts and whole grains;
• eat raw vegetables;
• stop smoking;
• lose excess weight;
• take dietary supplements such as
  - vitamin B₆: 50-200 mg a day
  (more than this may cause nerve damage)
  - vitamin E: 150-300 units a day
  - Evening Primrose oil
  - multivitamins and minerals: a good one for PMS is Optivite (take two tablets three times a day), which is available from most chemists and health shops.

It is advisable to take dietary supplements daily for the first month, then during the two weeks before a period or starting just before you would expect the onset of PMS symptoms (unless you have been advised otherwise by a nutritionally trained doctor).

Treating Premenstrual Syndrome

A doctor may prescribe vitamin B₆, Evening Primrose oil or progesterone. Other conventional drugs given for PMS include bromocriptine to relieve breast tenderness, diuretics to prevent fluid retention or Danazol, which inhibits the release of pituitary hormones that stimulate the ovary. Psychotherapy may be recommended for dealing with associated emotional problems.

Homeopathic Treatment

Constitutional homeopathic treatment is the best course of action in dealing with PMS. The following remedies can be tried in the meantime. Take specific remedies in the 30c potency every 12 hours for up to three days, beginning 24 hours before you would expect symptoms to start.

• Sepia
  For irritability that is worse for stress; depression; indifference; agoraphobia; tearfulness; difficulty in concentrating; desire to get away from everyone, including loved ones; emotionally flat feelings, suicidal tendency; screaming fits; possible violent behaviour; anger; hair loss; headaches; pressure on the top of the head; chronic sinusitis; greasy facial skin; acne; hot flushes on the face; sore throat with numbness; nausea; desire for sweets and salty foods; tenderness and dragging, bearing down pains in the lower abdomen; anal fissure; burning pain in the bladder; burning pains in the vagina; yellow, burning, offensive-smelling vaginal discharge that causes itching; discharge after sexual intercourse with a tendency to thrush - worse after childbirth; aversion to sexual intercourse or reduced sex drive; prolapse of the uterus; possible endometriosis; vaginal pain on intercourse - worse at the menopause; sore nipples; palpitations.
  
  Generalities: muscular tension that is worse between 3 and 5 pm; trembling; weakness and weariness in the morning; symptoms worse after a period.
  
  
• Calcarea
  For depression; indifference; agoraphobia; tearfulness; irritability; panic attacks; suicidal tendency; apprehension; fearfulness, especially in public places; dizziness; headache before a period; general tendency to headaches; pains in the back of the head; greasy facial skin; sore throat; desire for sweets, sugar, salt and eggs; yellow, burning vaginal discharge that causes itching; tendency to thrush; PMS worse since pregnancy; prolapse of the uterus; pain in the uterus during a period; tender, swollen breasts before a period; backache; clumsiness; swollen ankles; swollen hands; cutting pains in the thighs, insomnia.
  
  Generalities: painful joints; tiredness and lack of energy; weakness with cold sweats; tendency to put on weight.
  
  
• Lycopodium
  For irritability that is worse for stress; depression; lack of self-confidence; tearfulness; difficulty in concentrating; desire to be left alone; suspiciousness; mistrustfulness; feeling of detachment; violent behaviour; fearfulness in a crowd; tearfulness after a period; anger; hair loss; headaches before a period; greasy facial skin; hot flushes on the face; sore throat; nausea; desire for sweet foods and sugar; bloated abdomen; dull aching pains; bearing down pains in the lower abdomen; irritable bowel syndrome; yellow vaginal discharge; aversion to sexual intercourse; possible endometriosis; tender nipples and breasts; swollen, aching back; swollen fingers, hands, feet and ankles.
  
  Generalities: joint pain; general weakness; trembling; weakness in the morning; weakness with sweating; tendency to put on weight.
  
  
• Pulsatilla
  For irritability that is worse for stress; depression; indifference; lack of self-confidence; tearfulness; sudden tearfulness for no apparent reason; desire to be alone; suspiciousness; mistrustfulness; feeling of detachment; suicidal tendency; indecisiveness; anxiety about the future; fearfulness in public places; dizziness; headaches before a period; swollen upper eyelids; swollen face; nausea; desire for sweets; bloated abdomen; dull aching pain and bearing down pains in the lower abdomen; cramping pains that are better for heat; irritable bowel syndrome; urgent need to pass water; burning pain; burning pains in the vagina; yellow, burning vaginal discharge with a tendency to thrush; PMS worse since pregnancy; prolapse of the uterus; pain in the uterus during a period; periods irregular and possibly scanty - worse at the menopause; tender breasts; backache; hot feet; swollen fingers, ankles and feet.
  
  Generalities: joint pain; weakness; muscular tension; tendency to put on weight.
  
  
• Sulphur
  For tearfulness; irritability; desire to be left alone; mistrustfulness; anxiety; violent behaviour; anger and apprehension; hair loss; headache before a period; drawing pains in the head; swollen upper eyelids; chronic sinusitis; greasy facial skin; hot flushes on the face; sore throat; marked desire for sweets, sugar and salt; dragging, bearing down pain in the lower abdomen; constipation; anal fissure; irritable bowel syndrome; urgent need to pass water; burning pains in the vagina; yellow, offensive-smelling, burning vaginal discharge that causes itching; aversion to sexual intercourse or reduced sex drive; vaginal pain on intercourse - worse at the menopause; painful nipples; clumsiness; hot feet; swollen fingers and hands.
  
  Generalities: joint pain; PMS worse during convalescence from illness; tendency to put on weight.
  
  
• Lachesis
  For irritability; difficulty in concentrating; aversion to company; suspiciousness and mistrustfulness; feeling of detachment; suicidal tendency; violent behaviour; indecisiveness; symptoms worse for stress; dizziness; hair loss; headache before a period; sore throat that is worse on the left side; bloated abdomen; tenderness in the abdomen; constipation; anal fissure; irritable bowel syndrome; menopause; burning vaginal discharge; PMS worse since pregnancy; tender nipples; palpitations; backache; clumsiness; swollen ankles; aching pains in the hips; swollen hands; insomnia.
  
  Generalities: symptoms better at the beginning of a period; weakness and weariness in the morning - worse after a period.
  
  
• Natrum mur.
  For depression; indifference; lack of self-confidence; tearfulness; definite aversion to company; feeling of detachment; anxiety; suicidal tendency; violent behaviour; fearfulness in a crowd; symptoms worse for stress; hair loss; headaches before a period; pressure on top of the head; greasy facial skin; nausea; desire for salty and sweet foods; anal fissure; irritable bowel syndrome; burning pain in the vagina; itching from vaginal discharge; tendency to thrush; aversion to sexual intercourse or reduced sex drive; vaginal pain on intercourse; swollen, tender breasts; palpitations.
  
  Generalities: weakness; muscular tension; trembling; weariness in the morning; fluid retention.
  
  
• Nux
  For indifference; lack of self-confidence; agoraphobia; irritability; difficulty in concentrating; aversion to company; mistrustfulness; anxiety; suicidal tendency; violent behaviour; fearfulness in public places; fearfulness in a crowd; symptoms worse for stress; dizziness; drawing pains in the head; pressure on top of the head; chronic catarrh; acne on the face; sore throat; nausea; desire for fatty foods, rich foods and alcohol; bearing down pain in the lower abdomen; constipation; anal fissure; irritable bowel syndrome; frequent urge to pass water; yellow, offensive-smelling vaginal discharge with a tendency to thrush; PMS worse since pregnancy; pain in the uterus during a period - worse at the menopause; tender breasts; backache; clumsiness.
  
  Generalities: joint pain; muscular tension; weariness in the morning; generally worse before and after a period; chilliness.
  
  
• Phosphorus
  Worse for stress. For indifference; panic attacks; difficulty in concentrating; feeling of detachment; violent behaviour; apprehension; tearfulness after a period; anger; dizziness; hair loss; greasy facial skin; acne on the face; nausea; desire for sweets, sugar, salt and salty foods; dragging pain in the abdomen; anal fissure; irritable bowel syndrome; urgent need to pass water; menopause; burning vaginal discharge; aversion to sexual intercourse; clumsiness; swollen fingers, hands, ankles and feet; cramps in the calves.
  
  Generalities: joint pain; weakness; PMS worse during convalescence from an acute illness; muscle tension; tendency to put on weight.
  
  
• Graphites
  For tearfulness; irritability; difficulty in concentrating; anxiety; indecisiveness; hair loss, swollen face; hot flushes on the face; constipation; anal fissure; burning pain in the vagina; yellow, vaginal discharge with a tendency to thrush; reduced sex drive - worse at the menopause; tender breasts and nipples; clumsiness; cutting pains in the thighs; swollen fingers, ankles and feet.
  
  Generalities: weakness; generally worse after a period; tendency to put on weight.
  
  
• Kali carb.
  For irritability; panic attacks; anger; tension; hair loss; swollen upper eyelids that resemble little bags or pouches; chronic sinusitis; swollen face; desire for sweets and sugar; dull, aching pain; gnawing pain in the abdomen; constipation; irritable bowel syndrome; urgent need to pass water; reduced sex drive; vaginal pain on sexual intercourse; symptoms worse at the menopause; swollen, tender breasts; backache; insomnia.
  
  Generalities: joint pain; trembling; tendency to put on weight; exhaustion; symptoms worse about 3 am.
  
  
• Silicea
  For lack of self-confidence; difficulty in concentrating; hair loss; pressure on top of the head; greasy facial skin; acne on the face; sore throat; cramping pains that are better for warmth; constipation; anal fissure; offensive-smelling vaginal discharge; tender nipples; clumsiness; swollen feet.
  
  Generalities: joint pain; PMS symptoms worse during convalescence from acute illness; muscle tension.
  
  
• Belladonna
  Worse for stress. For irritability; aversion to company; mistrustfulness; suicidal tendency; violent behaviour; headache before a period; feeling of pressure on top of the head; sore throat; dragging pains; burning in the vagina; tendency to thrush; PMS worse since pregnancy; pain in the uterus during a period - worse at the menopause; clumsiness; cutting pains in the thighs; swollen hands; insomnia.
  
  Generalities: joint pain; weakness; weariness; tendency to put on weight.
  
  
• Causticum
  For depression; tearfulness; irritability; difficulty in concentrating; suspiciousness and mistrustfulness; pessimism; oversensitivity; greasy facial skin; acne on the face; sore throat; frequent urge to pass water or signs of cystitis; anal fissure; itching from vaginal discharge; PMS symptoms worse since pregnancy; aversion to sexual intercourse or reduced sex drive; tender nipples; backache; clumsiness; swollen feet.
  
  Generalities: joint pain; weakness.

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