Pre-menstrual syndrome (PMS) covers a wide variety of symptoms, the most common of which are irritability, breast swelling and tenderness, bloating, backaches, headaches, anxiety or depression, weight gain, food cravings, fatigue and abdominal bloating. Usually only a few of these symptoms occur in any one woman. Obviously, all of these symptoms can occur for other reasons, but in PMS the common factor is that the symptoms come and go in relation to the menstrual cycle, typically starting in the second half of the cycle and reducing or ceasing as or shortly after the period begins. In mild cases, the symptoms are only present for a couple of days before the period, but in severe cases the symptoms can occur through at least half and sometimes three quarters of the cycle.
Why does PMS occur? There are many theories, most of which revolve around imbalances of the female hormones. Note that word ‘imbalance’; there isn’t an absolute amount of each hormone that needs to lx’ present, but a relative balance between them. The honest answer is that we don’t yet know precisely why PMS occurs.
Orthodox treatment
One of the most potent ways to help sufferers of PMS is to make sure that both the patient and her family realise that they are dealing with a physical illness. The trouble with PMS is that sufferers feel that they’re going mad. for women to recognise the fact that it’s PMS, and to understand that her partner and her family also know that it’s PMS, is a great relief.
Water retention is a common symptom of PMS. Certainly, giving a mild diuretic (a drug that encourages the kidney to excrete more fluid) often gels rid of PMS symptoms, especially bloating, weight gain and breast tenderness. Vitamin B6 is also used in PMS, taken in doses of about 50mg-100mg per day. There is as yet no completely objective evidence that it works, though many doctors use it. Vitamin B6 is thought to exert its action on the brain, possibly by affecting the way in which the pituitary gland releases the hormones which control the female cycle. However, Vitamin B6 can cause inflammation of the nerves if given for long periods and especially if used in high doses, Evening Primrose Oil may help in some cases. Its active constituent, gamolenic acid, is now available on prescription.
As far as hormone treatment of PMS is concerned, one of the most helpful methods is to take extra progesterone in the week before the menstrual bleed starts. Progesterone is normally released from the ovary during the second half of a cycle, and the extra progesterone in tablet form boosts its effects. In severe cases it may help to add progesterone for two or even three weeks leading up to the period. Extra oestrogens, which must be used with extra progesterone (see below) can sometimes improve pre-menstrual symptoms. Oestrogen and progesterone together make up the combined contraception pill, so putting the patient on the contraceptive pill could help. Sometimes the preparations used in hormone replacement therapy (HRT) can also be used to boost the levels of oestrogen and progesterone in PMS.
Bromocriptine can reduce pre-menstrual breast pain, but it’s not appropriate if you’re planning a family.
Some types of painkillers such as mefenamic acid help reduce PMS symptoms, and relieve the pain of any headache directly. The drugs in this group are of a type often used to reduce inflammation in rheumatism and other musculo-skeletal problems. Anti-depressants may also be of use in some cases of PMS, especially where there are psychological symptoms such as anxiety or depression.
Self-help
Acknowledging that you are a PMS sufferer is a great ‘step forward. It doesn’t mean that you’re hiding behind a convenient syndrome.
Diet can sometimes help. Follow the rules of low-fat, high-fibre, low-sugar diet, with lots of fruit and vegetables. Cut down on caffeine and alcohol, which will encourage mood swings. Keeping your sugar level as constant as possible may help; in some cases changing to a three-hourly starch diet, which includes lots of unrefined carbohydrates, will also make a difference. However, you’ll have to make sure that your total daily intake doesn’t rise and cause you to gain weight.
Complementary treatment
If you suffer from pre-menstrual craving for sweet things, a chromium supplement might help – this is because chromium is linked to our insulin levels, and this in turn controls the amount of sugar in our bloodstream.
Sometimes reducing fluid and/or salt intake before the period may lessen the sensation of bloating.
Relaxation and exercise, which both reduce tension, will help alleviate symptoms.
A supplement of Vitamin B6 can be helpful, starting two days before your symptoms normally begin and stopping just after your menstrual cycle has started. Evening Primrose Oil works for some women, taking it alongside Vitamin B6. Note that Evening Primrose Oil can cause fits in those suffering from temporal lobe epilepsy, so beware.
Acupuncture can help with many symptoms, including bloating (by helping the body eliminate excess fluid), cravings (by suppressing your appetite), mood swings (by calming your nervous system), painful breasts and headaches (through various methods of pain relief and reduction). Obviously, when the other symptoms of PMS are relieved, a great deal of pressure may be lifted from the sufferer. Simply controlling mood swings can provide relief from headaches by making the patient feel she is back in control of her own body – and that’s a good starting point for banishing emotionally linked stress.
Aromatherapy has much to offer PMS sufferers. Geranium and rosemary are said to help prevent water retention. A head, neck and shoulder massage with lavender, sandalwood, camomile or geranium helps to relieve tension and relax the muscles, in the case of headache. Geranium, bergamot, rosemary and lavender (singly or in a Mend) may act as stimulants to overcome lethargy and tiredness. Cold lavender compresses can relieve painful breasts. Where muscle tension is a feature, any of the manipulative therapies are likely to help.
Homoeopathy will work, best if remedies are prescribed according to your specific symptoms – or group of symptoms. In general, however, lachesis and nat mur are used to relieve water retention; mood swings can be treated with kreasote, lycopodium and causticum; sore breasts may be relieved by Pulsatilla.
The clinical intuitionalist might suggest some of the following. Vitamin B6 acts as a mild and natural diuretic, as does Fenugreek lea or dandelion root coffee. A low-fat, low-sugar, low-salt diet (as above) should he implemented, especially the week before, and the week of, your worst symptoms. Supplements of Brewer’s yeast and adrenal glandulars can help with cravings and mood swings (included anxiety and depression). A calcium, supplement, taken along with evening primrose, is said to reduce headaches by restoring the hormone balance between oestrogen and progesterone.
In terms of medical herbalism, you might try coughgrass and cleavers, drunk as a tea, which acts as a diuretic. Gentian can control blood-sugar levels; skullcap or oats can control mood swings; camomile, peppermint or feverfew can reduce headaches by improving circulation and relieving tension; and chaste tree or white deadnettle are said to improve the circulation, reducing congestion and pressure.
Royal jelly is also said to be helpful. Reflexology and biofeedback are also often recommended.
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