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Pre-Menstrual Syndrome (PMS)

by Dr. Eva Bell
(Bangalore, India)

The pre-menstrual period which is about 7-10 days before the onset of menses, is a difficult time for some women. Though most women experience mild symptoms which need no medication, about 7-10% suffer from severe physical and emotional symptoms. In a very small group the symptoms are so intense that it disrupts their normal routine completely. This goes by the name premenstrual dysphoric disorder (PMDD.)

The complaint is usually of a bloated feeling, with abdominal discomfort, pelvic pain, swelling of breasts, migraine, irritability, insomnia and reduced sex drive. Some have an abnormal craving for food and alcohol. Suicidal tendencies, anti-social behaviour, violence towards loved ones are also known to occur. Because these symptoms affect judgement, there is a likelihood of accidents on the road or at work. All these symptoms disappear with the onset of menses. Most women who suffer from PMS are above thirty years of age. The same symptoms may occur every month or they may vary.

The cause of most of these symptoms has been attributed to retention of salt and water in the body during the pre-menstrual phase. A woman may gain up to one kilogram in weight. Her ankles may be swollen. This is due to fluctuation in hormonal levels during the menstrual cycle.

In a normal menstrual cycle oestrogen peaks up till mid-cycle when ovulation takes place. In the second half of the cycle, progesterone is secreted along with oestrogen. But both hormones fall rapidly about a week before periods and continue to do so until menstruation. A woman’s self esteem is said to be directly proportionate to her oestrogen levels. When it peaks at ovulation, a woman is full of self confidence and is in a good mood. But when it falls pre-menstrually, she becomes tense, moody and irritable. Fall in progesterone brings about salt and water retention in the body. Simultaneously there is a rise in anti-diuretic
hormone secreted by the posterior pituitary glad. PMS is rarely seen in women who are on oral contraceptives. But those with pre-existing psychological problems are more prone to PMS.

Obese women with a Body Mass Index above 30 show a higher incidence of PMS. Women working in stress-related jobs are more likely to experience PMS. Young people who consume too many caffeinated drinks or eat fast foods or fried foods or alcohol are at risk as these foods influence moods and energy levels.

Management of PMS

• Watch what you eat. There should be a decrease of sugar, salt, caffeinated drinks and alcohol. Fats should also be cut down. Instead, the diet should contain plenty of fruit and vegetables, whole wheat bread, brown rice and cereals.

• Exercise is strongly recommended. Relaxation exercises to de-stress are helpful.

• Psychological support and therapy. A trained therapist will teach ways to manage the impact of symptoms on daily life.

• Medication. Anti-depressants help if used for 15 days prior to periods. It should be taken only under a doctor’s advice. Hormones (a combination of oestrogen and progesterone) in second half of cycle are also prescribed. Evening Primrose Oil taken for ten days before periods reduces breast tenderness. Vitamin B6, Calcium, Magnesium supplements may also be taken.

• Women should understand the working of their bodies and the impact hormones have on their moods. Mood swings are hormonally induced and are not permanent.

• Husbands need to play a very supportive role. They should understand why women behave as they do pre-menstrually, and treat them with affection and tenderness. Financial and other important decisions should not be discussed with their wives during this stressful period. A husband’s reassurance and support will go a long way in helping a woman endure the symptoms of PMS.


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