Pre Menstrual Syndrome or PMS – how serious is this?

In this article we will be discussing the topic of Pre Menstrual Syndrome (PMS) and hope to put a spotlight on this understated topic.

Our mental wellbeing is dependent on so many social, economic and workplace factors. If our mind is not at ease, if we are low or depressed, for whatever reason, doing any kind of work, or getting through the day or living life becomes so difficult. Imagine someone having those problems, every month, month after month. Imagine someone dealing not only with the mind issues but also bloating, joint pain, breast tenderness. I have known women who have migraine attacks every month. If having periods every month wasn’t bad enough, for some reason, god wishes to test women by making those times even more difficult for them. Well as someone rightly said, behind every woman there is a warrior. 

Unfortunately, instead of understanding that this is a genuine problem, Pre Menstrual Syndrome or PMS as it is common known, has become the subject of jokes and memes. Every time any woman is snappy, we literally attribute it to PMS. PMS jokes are not funny….Period !!!!

How common is Pre Menstrual Syndrome?

• Almost 80% of women will have some associated symptoms or problems around the time of periods at least sometime in their lives.
• Pre-Menstrual Syndrome as per the definition will probably occur in about 40%.
• In about 8% of women, these symptoms will be very severe

How do you exactly define PMS?

Pre-Menstrual Syndrome comprises of some psychological and physical symptoms that impair the normal lives of women just before their periods but resolves shortly after menstruation. We don’t exactly know why it happens but probably the wide fluctuations in the estrogen and progesterone hormones at that time may disrupt the happy hormones like serotonin and dopamine. Some other hormones regulating the water absorption from the kidneys may get faulty at this time leading to water retention and bloating. 

How to diagnose Pre Menstrual Syndrome

Correct diagnosis of PMS is important as similar symptoms can occur in women having depression, anxiety, migraine, anemia, endometriosis or hypothyroidism but in these symptoms are more likely to persist throughout the month. 

American College of OBG has defined that for a woman to be diagnosed with Pre Menstrual Syndrome , she must experience at least one psychological and one physical symptom severe enough to cause disruption in social, academic or work performance. Remember that these symptoms must be cyclical, must be relieved within 4 days of the onset of periods and must not reappear till at least the day 13 of cycle and must not be because of some medicine, or drugs or alcohol use and must occur in at least 2 consecutive months for us to make a diagnosis.

Keeping a daily record of problems helps as sometimes one tends to overestimate and exaggerate one’s symptom or from the diary one understands that the symptoms are erratic and not cyclical.

The 6 psychological symptoms one may face are:

• Angry outburst
• Anxiety
• Confusion
• Depression
• Irritability
• Social withdrawal

The 6 physical symptoms women might face are

• Abdominal bloating
• Breast tenderness or swelling
• Headache
• Joint or muscle pain
• Swelling of hands and feet
• Weight gain

Who are the women who are more likely to have the problem?

• Women in their late 20s to mid-40s
• Older teens tend to have more severe PMS than younger teens
• Women who gain weight
• Those who have had a stressful event in the past year

How do we treat this distressing problem? Reminds me of that song from Sound of Music How do you solve a problem like Maria? 😊 As did Maria in that movie, PMS too requires a lot of working upon and a lot of TLC or tender loving care.

So, here is a 10-step approach to fighting PMS

1. Try and identify the trigger factors. Sometimes PMS can be aggravated by coffee drinking, lack of sleep and chocolates. Avoid stressful situations before periods. Husbands are requested to ensure loads of tender loving care and avoid arguments at this time. This is the least we can do for the most important woman in our lives.
2. Try and improve your diet. 
   1. Do not skip meals esp. breakfast. Eat small and eat more frequently. This will keep your blood sugars stable during the entire day
   2. Eat more complex carbs so the insulin level fluctuations don’t cause intense cravings and mood swings. Cut down your sugar intake drastically
   3. Cut down on salt intake to reduce bloating and water retention
   4. Limit alcohol and caffeine intake
   5. Include whole grains, fruits and vegetables in your diet.
3. Mental health like the health of any other part of your body needs a professional to address its issues. Thus, speaking to a Psychologist sometimes works wonders in reducing the stress and unravelling the knots in the mind. Definitely something that one must try without attaching a social taboo to it.
4. Adding evening primrose oil capsules can help with the breast pain but not other symptoms. Vitamin D and Vit B6 can help though it’s not conclusively proven.
5. 1200 mg of Calcium carbonate supplementation daily has definitely shown benefits
6. Exercise is a must as this releases happy hormones and works as a super anti depressant.
7. Oral contraceptive pills esp. those containing a drug drospirenone are considered as first line of management when the above 6 steps fail to bring relief. The estrogen and progesterone being present in a fixed dose in the medication, prevents the wide fluctuations of the natural hormone in the body thereby causing relief. These have shown good benefits. The pills can be conventionally in a cyclical fashion and if that doesn’t give relief then in a continuous manner.
8. There are medicines like Spironolactone which can be used to reduce water retention and bloating.
9. There is a class of medicines which are Selective Serotonin Reuptake Inhibitors like Sertraline, Citalopram and Escitalopram which are considered as 2^nd line after oral contraceptives if they fail to act or as 1^st line in more severe cases. Found to be very effective. They can be given regularly or even during the last few days before periods though the former regime is better. You may wonder why I have been mentioning generic names of medicines to you. The idea is not to confuse you. I want this podcast to be like a ready reckoner for you when you discus options with your doctor and that’s why I have mentioned names.
10. Lastly alternative therapy like Yoga, acupuncture, herbal medicines have people who swear by it as well as people who call it useless. I guess if nothing else is working, there would be no harm in trying them out as they definitely wont harm even if they don’t do any good. 

Also read: Polycystic Ovarian Syndrome

This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.

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