Dr-Rupali Mahadik
Amrutwel Women's Clinic
Kharaghar
Navi Mumbai
# PMS # Hormionalimbalance # Menstrualproblems # moodswing
Pre- Menstrual Syndrome (PMS)
PMS is cyclic appearance of one or more Physical, Emotional or Behavioural symptoms during luteal phase of menstrual cycle followed by amelioration of symptoms with the onset of menstrual flow such that the symptoms affect work,efficiency, relationship and social life of the woman. wedding party bridesmaid collections in dusty rose
PMS affects 30-40 % of women, of these about 5% suffer from severe PMS.
Theories
Different theories have been put forward to explain PMS eg -
1. Hormone- low progesterone level, raised aldosterone levels, hypeeprolactinaemia etc.
2. Vitamins- deficiency of vit E, C,B6,B8, Biotin
3. Deficiency of essential fatty acids
4. Subclinical Hypoglycemia
5. Decreased levels of Central dopamine and serotonin
6. Deficiency of prostaglandin E
etc
* Essential Fatty Acids are an integral part of every cell membrane and are responsible for production of prostaglandin E1.
Deficiency of EFA makes the cells abnormally sensitive to normal circulating levels of Ovarian hormones.
Diagnosis-
The American Psychiatric Association(APS) has laid down guidelines for the diagnosis of PMS.
A. Timing of Symptoms- these begins in last week of luteal phase and remit after onset of menses
B. Atleast 5 symptoms should b present and one of them must be from first 4 symptoms enumerated-
1. Sudden onset of being sad ,tearful, irritable or angry
2. Persistent and marked anger and irritability.
3. Marked anxiety or tension.
4. Markedly depression mood, feeling of hopelessness.
5. Decreased interest in sexual activities.
6. Easy fatiguability or marked lack of energy.
7. Sense of difficulty in concentrating.
8. Marked change in appetite, overeating or food craving.
9. Hypersomnia or insomnia.
10. Physical symptoms such as breast tenderness, headache, edema feet, joint pain or muscle pain, weight gain.
C. The symptoms interfere with work or usual activities or interpersonal relationships.
D. The symptoms are not an exacerbation of a baseline psychiatric illness.
These are 4 pre-requisites for diagnosis of PMS.
Treatment-
Medical-
A. Pharmacological -
1. Symptomatic-eg mefenamic acid for headache,Bromocriptine for breast tenderness.
2.Minerals- eg Zinc , Magnesium, Calcium.
3. Vitamins- eg Vit B6 , Vit E, C ,B8 , Biotin
4.Evening Primerose oil
5. Serotonergic antidepressant-fluoxetine.
6. Hormones-Progesterone, Danazol etc.
* Both EFA and PGE1 stabilise cells and smoothen out the actions of rapidly changing hormonal levels in the luteal phase, and thus prevent premenstrual symptoms.
* Pyridoxine and evening primrose oil are effective in 80% of cases of PMS
B. Non Pharmacological-
1. Diet-
Limit consumption of tea coffee colas chocolate.
Limit intake of dairy products , saturated fats, refined sugar,salt.
Add Whole grains and cereals.
Increase intake of green leafy vegetables, legumes.
2. Exercise- Yoga .
3. Stress reduction- Counseling, Meditation and Relaxation techniques.
