PMS: more than once a month mood swing

For many women, PMS is a nightmare come true. For the uninitiated, Pre-menstrual syndrome (PMS) is a disorder that affects many women around one to two weeks before menstruation begins. During that period a woman feels grouchy, bloated, goes on eating binges, craves for chocolates and suffers a constant irritation with the world in general. This adversely affects the life of women suffering from it and those around her – spouse, children, co-workers, and friends. In fact, severe PMS responses are known to challenge health, change normal routine and impact lifestyle.

While such mood changes have been described at the time of the ancient Greeks, it was Katharina Dalton, a physician and women’s health pioneer, who first identified this disruptive cyclic phenomenon. Her classic book, Once A Month, set the standard for the many books and PMS studies.

Dr Arti Luthra, Gynaecologist and private practitioner says, “PMS is a very common disorder among women in the age group of 30 to 40 years. Unfortunately, there is little awareness about the problem or its causes and effects. While I have patients from the upper strata of society, there is little awareness among the lower economic groups. With an increase in awareness, more women should come to the doctors to find a solution instead of suffering silently. Besides, her family would also treat her with more consideration.”

Symptoms of PMS can include any or all of these:

• Abdominal bloating
• Acne
• Anxiety
• Backache
• Breast swelling and tenderness
• Cramps
• Depression
• Food cravings
• Fainting spells
• Headaches
• Insomnia
• Joint pains
• Nervousness
• Skin eruptions
• Water retention

Why PMS?

The physical responses to PMS can also be caused by a problem known as endometriosis, a condition most likely caused by a hormone imbalance in which tissue that looks and acts like the lining of the uterus is found outside of the uterus in the pelvis. At menstruation, this tissue bleeds lightly. The blood irritates nearby tissue and causes pain.

Most experts agree that PMS has something to do with the imbalance of estrogen and progesterone in the latter part of the menstrual cycle, the adrenal hormones that control water retention, and also mood influencing chemical substances in the brain.

There is new evidence showing that low levels of serotonin, an important chemical produced by the brain, may in fact be the major cause of PMS responses. Serotonin helps regulate sleep cycles and carbohydrate metabolism and influences the regulation of estrogen and progesterone. Women with PMS tend to have low and varying levels of serotonin – a condition that can cause early or delayed ovulation and trigger an imbalance of estrogen and progesterone.

The bottom line is that low serotonin affects ovulation, and a “less than perfect ovulation” lowers levels of serotonin in the brain, leading to the vicious cycle known as PMS.

An article in the New England Journal of Medicine found that women who suffer from PMS were also often found to have a subtle low thyroid condition. This condition can be uncovered by specialized testing, and management of a low thyroid condition can alleviate PMS responses

Taking Control of PMS

The first step involves keeping a menstrual diary and recording their physical discomfort and emotional upheavals as and when they occur by ranking them on a scale of 01 to 10, Keeping a record continuously for 3 months would help track your PMS.

Lifestyle Modifications:

• Eating right – Instead of the traditional “three square meals a day”, women prone to PMS should try eating 3 small meals and 3 snacks daily. They should eat fresh fruits and vegetables, whole grains cereals and breads, beans, peas, lentils, nuts and seeds, and broiled chicken and fish and consume high protein snacks between meals.
• Exercise – Regular exercise can be very helpful. Exercise increases oxygen level in the blood, which helps in nutrient absorption and efficient elimination of toxins from the body. It also helps to keep hormone levels more stable.
• Water – They should drink plenty of water a week prior and a week later to the menstrual cycle.
• See a physician – To rule out an underlying medical condition that may be causing symptoms, such as abnormal thyroid function, endometriosis, or a genuine psychological problem such as clinical depression.

Avoid:

• Smoking.
• Caffeine: Caffeine stimulates central nervous system that can make you anxious and jittery. It is responsible for tender breasts also acts as a diuretic that can deplete many important nutrients.
• Alcohol, and snacks high in salt and sugar – Do not consume alcohol or sugar in any form, like, white bread, jam, cookies, chocolates, especially during the week before you expect symptoms. These foods cause loss of magnesium in urine.
• Dairy products – because they block the absorption of magnesium and increase its urinary excretion

Managing PMS

While Dr Arti Luthra has found Pyrodoxine and Evening Primrose oil helpful while treating her patients, many Vitamins and supplements are effective in alleviating PMS symptoms.

• Vitamin E – This vitamin has been shown to be helpful for the breast symptoms associated with PMS and also the mood swings and irritability.
• Magnesium – Magnesium is classified as ‘nature’s tranquilliser’. It is vital in treating those aspects of the pre-menstrual symptoms that relate to anxiety. When taken with Vitamin B6 it becomes more effective in treating PMS symptoms.
• GLA Omega 6 essential fatty acids (linoleic acid) are converted to gamma linolenic acid (GLA) that is found in plants such as evening primrose, borage and starflower. A number of studies have shown that evening primrose oil (EPO) is effective in reducing the symptoms of PMS and especially helpful to women whose main pre-menstrual symptom is breast tenderness.

Treating PMS

For many females with PMS, prescription medications are very effective in the management of individual responses.

• Spironolactone, a medication that blocks the hormone responsible for bloating and swelling, can relieve PMS responses and reduce excess water weight. 
• Blood pressure medications known as beta-blockers work to oppose the flow of adrenaline within the body and have proven to be effective in controlling anxiety attacks associated with PMS.
• In certain cases, birth control therapy – in the form of oral contraceptives -is used to suppress and regulate ovulation and lessen PMS responses overall. Since synthetic progesterone used in certain birth control pills has actually been shown to cause PMS, great care and experience are necessary in managing this therapy. 
• Other management involves antidepressants such as Prozac, Paxil, Sarafem (which is the same as Prozac) and Zoloft, which raise levels of serotonin. These medications have proven to be very effective in managing PMS responses because they block the break down of serotonin in the brain and increase the amount of serotonin present.
• In rare situations where PMS responses are severe, conditions are not sufficiently improved by any medications or other therapies and when pregnancy is not the objective, a surgical procedure involving a partial hysterectomy can be considered. In certain well-qualified cases, this surgery has enabled women to lead PMS-free lives.

PMS is something that a woman and her family will have to live with. There will always be good, better and best days, but by taking control of PMS and learning how to live life out from under the black cloud of PMS, it is very possible to learn how to feel better all month long.

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