That uninvited friend: premenstrual syndrome
Most women know (or remember) the uninvited friend who visits just before their period every month: the moodiness, bloating, insomnia, headaches, breast tenderness and other annoying symptoms. While as many as 75% of women experience disruptive symptoms related to premenstrual syndrome (PMS), only a small proportion, around 5-8%, are considered to have symptoms that are “clinically significant”[i]. A comparable proportion, 3-8%, experience the most severe symptoms of Premenstrual Dysphoric Disorder (PMDD), which are mostly behavioral and addressed as a psychiatric disorder[ii].
Are my symptoms serious?
Since most menstruating girls and women experience PMS to some degree, it’s important to assess whether your symptoms should be cause for concern or action. The experience of discomfort is completely subjective and individual, so what may be intolerable for one woman may not be for another.
But at the same time, there remains a general reluctance among women to report even severe symptoms associated with menstruation or PMS to their doctor. Why is this? It could be that women and girls are taught to just accept these symptoms as part of the burden of being female, or we don’t expect our symptoms to be taken seriously (women’s symptoms often aren’t), or maybe we are too embarrassed to talk about them.
If you feel your PMS symptoms are indeed serious, the first step might be to see if there could be other explanations. There are a few, such as certain forms of epilepsy, clinical depression, thyroid problems or chronic fatigue syndrome. However, a key indicator of PMS or PMDD is that the symptoms occur only in the second half of the menstrual cycle leading up to your period. If your symptoms don’t follow a cyclical pattern that corresponds to your monthly cycle, you could suspect something other than PMS and should report this to your doctor.
If the main symptom is severe pain, this should also be reported to your doctor since it might be a sign of endometriosis, fibroids or another condition.
So what makes PMS symptoms clinically significant? Conventional medicine divides PMS symptoms into five different categories and doctors typically ask patients to rank each on a scale of 1 (mild) to 3 (severe):
PMS-A (anxiety):
Difficulty sleeping
Tense feelings
Irritability
Clumsiness
Mood swings
PMS-C (craving):
Headache
Cravings for sweet foods
Cravings for salty foods
Cravings for other types of food
PMS-D (depression):
Depression
Angry feelings for no reason
Feelings that are easily upset
Poor concentration or memory
Feelings of low self-worth
Violent feelings
PMS-H (hydration):
Weight gain
Abdominal bloating
Breast tenderness
Swelling of extremities
PMS-O (other):
Menstrual pain
Change in bowel habits
Frequent urination
Hot flashes or cold sweats
General aches or pains
Nausea
Acne
Allergic reactions
Upper respiratory tract infections
The most severe form of PMS is PMDD, a behavioral disorder, which is seen most often in women in their 30s and 40s. But it can also afflict adolescent girls, with a risk that parents might view the symptoms as part of typical PMS and therefore don’t see a need to take action.
Doctors look for the following as indicators of PMDD:
· Depressed mood, feelings of hopelessness
· Anxiety, tension, feelings of being “keyed up” or “on edge”
· Mood swings
· Persistent anger or irritability
· Decreased interest in usual activities (eg, work, school, friends, and hobbies)
· Difficulty concentrating
· Lack of energy, fatigue
· Changes in appetite
· Insomnia or excess sleepiness
· Sense of being overwhelmed or out of control
While bloodwork or other diagnostic tests may be pursued to rule out other conditions, it is mostly patient reports that are used to diagnose PMS; “depression inventories” (questionnaires) are frequently used to diagnose PMDD.
How is PMS or PMDD treated by conventional medicine?
PMS is considered difficult to treat[iii], so non-medical approaches are often recommended. For example, eliminating foods such as dairy, refined sugar and salty foods, has been found to be associated with relief of PMS symptoms. Calcium or magnesium supplements might also be recommended. Your doctor may encourage regular exercise, including yoga, which has shown some promise in alleviating PMS symptoms. Finally, you might be asked to keep a diary of your symptoms in order to track improvement (or worsening).
Surgical removal of the ovaries is occasionally recommended, but this obviously results in the inability to have children and is therefore not advisable for younger women and girls.
A range of drugs might be prescribed by doctors, including: GnRH agonists, which suppress ovarian function; steroids that lower production of estrogen and other reproductive hormones; NSAID painkillers; COX-2 inhibitors, an alternative to NSAIDs; diuretics to treat bloating; and antidepressants and anti-anxiety medication for depression or anxiety. Oral contraceptives may also be prescribed, though they have not shown clear benefit in relieving PMS symptoms.
If there is a diagnosis of PMDD, in addition to approaches used for PMS the most frequent drug therapies specifically address behavioral symptoms associated with this condition: antidepressants, anti-anxiety medication, and occasionally, anti-convulsants.
What can you do to help your PMS symptoms?
One important thing you can do is to ensure that you eat healthy, which means mostly whole foods, ideally organic, free-range and grass-fed. As mentioned previously, regular exercise is also known to improve symptoms.
There are other things you can do that might provide some relief for your PMS symptoms:
· Relaxation, deep breathing and meditation (there are several phone apps for this)
· Biofeedback and guided imagery (this requires a trained practitioner with appropriate equipment)
· Acupuncture (also requires a trained practitioner)
· Cognitive behavioral therapy (requires a trained clinician, at least to begin with)
· Light therapy (home devices are available)
· Massage
· Chiropractic therapy
A range of dietary supplements claiming to address PMS symptoms are advertised and sold, but there is not yet clear evidence these are effective in providing relief.
Homeopathy for PMS and PMDD
A study from 2001, also reported in Medscape[iv] (a general reference for physicians), showed that 90% of women under homeopathic care for a period of two years showed an improvement of at least 30% in PMS symptoms for those receiving homeopathic treatment, as compared with only 37.5% of women receiving placebo[v].
Homeopathic medicines, which are federally recognized in the US, therefore offer a viable alternative for a condition considered difficult to treat by conventional medicine.
One advantage of homeopathic care is that the remedies work with the body’s own ability to heal itself. This means that, unlike prescription drugs or supplements, they are taken until resolution is reached, not for the rest of your life.
We will first have a long conversation that includes a detailed analysis of all your symptoms: emotional, cognitive and physical; some may be common, others may not.
PMS can be addressed using a range of homeopathic remedies that are individualized to your unique set of symptoms. Some medicines address the whole collection of symptoms, others are chosen because they target specific body systems or organs, such as the endocrine (or hormonal) system. We would probably start with the symptoms that are of greatest concern to you, working through them until you are feeling significant relief.
[i] Yonkers, K, R Casper (2022) “Epidemiology and pathogenesis of premenstrual syndrome and premenstrual dysphoric disorder” https://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder#H255917
[ii] Ghao, G, G Donmei H Sun X Cheng L An M Qiao (2021) “Trends in Research Related to Premenstrual Syndrome and Premenstrual Dysphoric Disorder From 1945 to 2018: A Bibliometric Analysis” Frontiers in Public Health https://doi.org/10.3389/fpubh.2021.596128
[iii] https://emedicine.medscape.com/article/953696-treatment
[iv] https://emedicine.medscape.com/article/953696-treatment
[v] Yakir, M, S Kreitler A Brzezinski G Vithoulkas M Oberbaum Z Bentwich (2001) “Effects of homeopathic treatment in women with premenstrual syndrome: a pilot study” British Homoeopathic Journal 2001, 90 (3): 148-53 https://read.qxmd.com/read/11479782/effects-of-homeopathic-treatment-in-women-with-premenstrual-syndrome-a-pilot-study