Pre-Menstrual Syndrome and Homeopathy

Introduction: The term pre menstrual syndrome (PMS) is used to describe a combination of physical, emotional and behavioral symptoms occurring 2 weeks prior to menses with relief soon after the onset of menstruation.

Approximately 75 percent of women experience PMS to some degree, with 20 to 50 percent finding that symptoms disrupt their daily activities, and 3 to 5 percent becoming incapacitated. Approximately 30% of women who seek treatment for PMS have a chronic psychiatric disorder. It should fulfill the following criteria:

·         Not related to any organic lesion.

·         Regularly occurs during the luteal phase (15-28^th day) of each ovulatory menstrual cycle.

·         Symptoms must be severe enough to disturb the life style of the woman or she requires medical help.

·         Symptom free-period during the rest of the cycle.

Historical View:

The first recorded cases of PMS (or PMT- pre menstrual tension, as it was then known) were in 1931, when Dr. Robert T. Frank, an American physician working in New York reported 15 cases of PMT. He attributed excess oestrogen as its cause.

In 1938, Dr. Israel, another American doctor presented his theory that not all women had high levels of oestrogen but they did have low levels of progesterone.

In 1943, Dr. Biskind published a study which supported the theory that many pre menstrual symptoms reported were similar to vitamin B deficiency symptoms.

In 1953, Dr. Katharina Dalton, a British doctor, began publishing her work. She and Dr. Raymond Greene renamed the condition "Pre-menstrual syndrome". Dr.Dalton is considered as a pioneer in this field. She supports the theory that pre-menstrually low levels of hormone progesterone are present.

During the last years, inspite of repeated attempts no consistent pattern has emerged regarding the cause of symptoms during PMS.

Aetiology

The etiology of PMS is not well understood. Numerous theories have been proposed but none have been proven. A temporal relationship to the luteal phase of menstrual cycle is clear and currently many experiments suggests that progesterone or metabolites of progesterone interact with neurotransmitters and ion channels in the brain. Anovulatory cycles whether spontaneous or induced by GNRH analogues or danazol have been reported to abolish the cyclical mood change. Another hypothesis is that there could be imbalance of neurotransmitters of brain (excitatory and inhibitory amines) acting on specific brain receptors whose sensitivity is modulated by ovarian hormone changes. The symptoms of PMS are probably due to the complex interaction of ovarian hormones, central and autonomic neurotransmitters.

Possible causes of PMS

1. Hormonal

·         Oestrogen deficiency/excess.

·         Progesterone deficiency.

·         High oestrogen/Progesterone ratio.

·         Prolactin excess.

·         Cortisol excess.

·         Hypoglycemia.

·         Insulin resistance.

·         Thyroid problems.

·         Adrenal insufficiency.

2. Prostaglandins

·         Prostaglandin excess/deficiency.

·         Essential fatty acid deficiency.

3. Neurotransmitters

·         Serotonin deficiency.

·         Dopamine deficiency.

·         Calcium excess or deficiency.

·         Potassium deficiency.

4. Vitamins and Minerals

·         Vitamin B6 deficiency.

·         Vitamin A deficiency.

·         Vitamin C deficiency.

·         Magnesium deficiency.

5. Other factors

·         Disturbed interpersonal relations.

·         Work related stress.

·         Financial difficulties.

·         Worry and friction at work/home.

·         Inadequate or diet poor in nutrients.

·         Environmental pollutants.

·         Oral contraceptive pills.

·         Increasing age, especially 30-40 yrs.

·         After child birth.

·         Lack of exercise.

·         Operations and other illnesses.

Symptomatology, Diagnostic Criteria and Self Assessment of PMS:

Since the inception of this entity more than 150 symptoms have been described. Of these many occur in noncyclical manner in female population and are non specific. A few of the multiple symptoms of PMS:

1.     Psychologic: tension, depression, irritability, aggression, lethargy, mood swings, uncontrolled crying, change in libido, panic attacks, anxiety.

2.     Metabolic: breast tenderness, water retention, oedema.

3.     Gastrointestinal: abdominal bloating, increased flatulence, constipation, diarrhea.

4.     Neurologic: migranes and other headaches, syncope, vertigo.

5.     Urinary: oliguria, urethritis, cystitis, enuresis, urinary retention.

6.     Dermatologic: acne, urticaria.

7.     Orthopaedic/rheumatologic: pain and swelling of the joints.

8.     Opthalmologic and laryngologic: redness of the eyes, sinusitis, rhinitis, sore throat, hoarseness.

9.     Cardiovascular: palpitations, ectopic beats, paroxysmal tachycardia.

10. Chronic medical problems: such as diabetes and asthma may worsen pre-menstrually, a condition termed as pre-menstrual magnification.

Dr. Guy Abraham, former professor of Obstetrics and Gynecology at the University of Los Angeles, has divided the symptoms of PMS into four groups, as detailed below:

PMS-A (Anxiety): Most common sub-group(80%). Symptoms are: Nervous tension, Mood swings, Irritability, Anxiety.

PMS-H (Hydration): Symptoms occur in 60% of sufferers. Symptoms are: Weight gain, Swelling of extremities, Breast tenderness, Abdominal bloating.

PMS-C (Craving): Symptoms occur in 40% of sufferers. Symptoms are: Headache, Craving for sweets, Increased appetite, Heart pounding, Fatigue, Dizziness or fainting.

PMS-D (Depression): Least commonly found. Symptoms are: Depression, Forgetfulness, Crying, Confusion, Insomnia.

PMDD- Premenstrual dysphoric disorder: When in PMS, emotional symptoms are more serious with significant impairment, it is known as PMDD. The American Psychiatric Association describes PMDD as having at least five of the following symptoms: sadness, anxiety, mood swings, persistent irritability, withdrawal, difficulty in concentrating, fatigue, marked changes in appetite and sleep patterns, a feeling of being overwhelmed, and physical symptoms such as weight gain/bloating, headache, and joint/muscle pain.

Diagnostic evaluation is possible by a proper history and self assessment.

PMS is a polysymptomatic disorder and the syndrome may last anywhere from 3 to 21 days. Symptoms begin week to few days before menstruation begins, and then diminish as the period begins. The severity of complaints is greater during the luteal phase of cycle. Symptoms do not begin on the same day, nor will women have the symptoms throughout their lives. Patient is instructed to chart her symptoms on a menstrual calendar for at least 3 cycles and each symptom is rated daily on a scale of 0-3. Zero indicates symptoms not observed, 1 indicates symptoms noticeable but work not impaired, 2 indicates work interfered and 3 indicates incapacitation or requiring medical therapy. A follicular phase score can be tabulated rapidly by summing up the total points on days 3-9 and a luteal phase by summing in last 7 days. The diagnosis is made on following criteria:

1.     Luteal phase score is at least 42.

2.      Luteal phase score is at least twice that of the follicular phase.

3.     The Follicular phase score is less than 40.

Stress and Homeopathy:

The hypothalamus-pituitary-ovarian cycle controls the hormonal cycle which in turn is responsible for normal menstrual cycle. Now the hypothalamus is influenced by levels of stress and emotion. So if excessive physical or mental stress is continued for a long duration, it may cause the pituitary to 'switch off" the ovaries and thus periods cease.

Management:

General measures:

a)     Education: A woman should have knowledge of the menstrual cycle and effect of different hormones on the body. This helps her in better understanding of the symptoms and also helps her to cope up.

b)     Exercise: Regular light exercise three or four times weekly throughout the month, especially during the premenstrual time helps her to reduce stress. An increase in exercise decreases breast tenderness, fluid retention, depression and anxiety.

c)      Stress management: Relaxation and visualization exercises should be practiced. Supportive psychotherapy is useful.

d)     Diet and Nutrition: Frequent smaller meals, with increased complex carbohydrates, green leafy vegetables, legumes, and whole grains should be taken.

·         Caffeine is implicated in benign breast disease, which can cause breast tenderness and should be avoided.

·         Reduce intake of sugar and junk foods (they cause water retention and block the uptake of essential minerals.

·         Reduce intake of salt (causes fluid retention).

·         Reduce intake of tea.

·         Include green vegetables or salad daily.

·         Limit intake of dairy products (they interfere with magnesium absorption, which is often deficient in PMS sufferers).

·         Include plenty of whole foods and use good vegetable oils.

·         Chromium (250 mcg one to two times per day) to reduce sugar cravings in case of diabetes.

·         PMS-A: VitaminB6 (100 to 200 mg a day) and magnesium diets (400 mg a day) are advised.

·         PMS-H: Vitamin B6, Vitamin E (400 to 600 IU a day), magnesium and chromium diets.

·         PMS-C: Vitamin B6, magnesium and chromium diets.

·         PMS-D: Vitamin B6, magnesium and Vitamin C diets.

Homeopathic View on PMS:

On the Basis of Etiology: - The occurrence of PMS is related to excess or deficiency of hormones/neurotransmitters. This shows the Psoric nature of the syndrome.

On the Basis of Symptoms:- The symptoms of PMS-A; PMS-C are predominantly Psoric while the symptoms of PMS-H; PMS-D are predominantly Sycotic.

Miasms and menstrual disturbances

          Psora: all functional disturbances of uterus and ovaries. Psychopathic sexual perversions. Flow scanty, too short duration. Dysmenorrhoea. Premenstrual magnification of migraine and asthma. Craves sweets and candies. Anxiety. PMS-A and PMS-C. e.g. Sulphur.

          Pseudo-psora: Patient feels badly a week before menses. Hysteria, irritability, nervousness and depression. Flow pale or bright red, seldom clotted, long lasting and exhausting. Loss of appetite, nausea, vomiting, vertigo and neuralgias. PMS-A, PMS-H, PMS-D. e.g. Calcarea carb and Kali carb.

          Sycosis: Intermenstrually, rheumatic and myalgic pains. Dark clotted, excoriating with musty odor. Urological concomitants with menstrual disturbances. Tenderness of breasts. PMS-D. e.g. Sepia, Lachesis.

Thus different miasms have different presentations in premenstrual syndrome. It is the responsibility of the homoeopathic physician to identify the case miasmatically and prescribe accordingly. Unless the miasmatic hurdle is removed complete cure cannot be established. Homeopathic medicines not only relieve the patient of his complaints but also help in preservation of his health.

Homeopathic Therapeutics:

PMS-A (Anxiety): Ars., Nux vom, Chamo, Calc, Graph., Hepar, Kali c, Ign, Nat mur, Nitric acid, Platina, Lyco, Mag mur, Kreos, Puls, Sepia, Laches, Silicea.

PMS-H (Hydration): Conium, Calc., Lac can, Kali c, Kali mur, Phyto, Lyco, Sulph, Puls, Spongia, Nat mur, Kreos, Bry, Sepia, Zincum, Thuja, Arg nit, Carbo veg, China.

PMS-C (Craving): Cuprum, Cactus, Nat mur, Spong, Laches, Cimic, Ignatia, Lauro, Lith carb, Mag carb, Lyco, Gels, Calc phos, Sulph, Verat, Bryon, Tarent, Merc, Caps, Phos, Ipecac, Mag mur, Petr.

PMS-D (Depression): Lach, Puls, Nat mur, Calc, Cimic, Ign, Iris, Murex, Sepia, Mag mur, Kali phos, Psor, Sulph, Conium, Hyos, Tarent, Croc, Phos acid, Platina, Kali phos.

Indications of some leading medicines:

Bovista: Premenstrual problems with puffiness in the extremities, fluid retention, and a bloated feeling often indicate a need for this remedy. The woman may feel very awkward and clumsy, and may constantly be dropping things because of swollen-feeling hands. Diarrhea occurring around the time of the menstrual period strongly indicates this remedy.

Calcarea carbonica: PMS with fatigue, anxiety, and a feeling of being overwhelmed suggest a need for this remedy. The woman may have problems with water-retention and weight gain, tender breasts, digestive upsets, and headaches. Periods often come too early and last too long, sometimes with a flow of bright red blood. A general feeling of chilliness, with clammy hands and feet, and cravings for sweets and eggs are other indications for Calcarea.

Caulophyllum: This remedy is often helpful to women with a history of irregular periods, difficulty becoming pregnant, or slow childbirth due to weak muscle tone of the uterus. Symptoms include discomfort during periods and a heavy flow of blood or other discharge. Drawing pains may be felt in the pelvic region, thighs, and legs. Stiffness or arthritis, especially in the finger-joints, often is seen when this remedy is needed.

Chamomilla: A woman likely to respond to this remedy is angry, irritable, and hypersensitive to pain. Cramping may come on, or be intensified, because of emotional upset. Flow can be very heavy, and the blood may look dark or clotted. Problems are often worse at night. Heating pads or exposure to wind may aggravate the symptoms, and motion (such as rocking or brisk walking) may help to reduce the tension and discomfort.

Cimicifuga (also called Actaea Racemosa): This remedy can be helpful for irregular and painful periods, with shooting pains that go down the hips and thighs, or cramps similar to labor-pains that are felt in the pelvic area. Headache with pain and stiffness in the neck and back will often occur with PMS. The woman is likely to be intense and talkative, becoming agitated, fearful, and depressed before a menstrual period.

Folliculinum: Premenstrual tension in women with abaundant periods, breasts feel full, hot, heavy, tense or painful, with weight gain and nervousness before the period.

Kreosotum: Headache, nausea, and a heavy flow that makes the genitals and surrounding skin feel irritated and swollen are indications for this remedy. Kreosotum is often indicated for women with PMS who feel irritable and uncomfortable, and have a strong dislike of sexual activity.

Lachesis: Women who need this remedy are usually intense, with a tremendous need for an outlet, both physically and mentally. Symptoms of PMS include congestion, headaches, flushing, surges of heat, and an intense outspoken irritability-often with strong feelings of suspicion or jealousy. When the flow arrives, it may be heavy, but brings relief of tension. Intolerance of restrictive clothing around the waist or neck is another indication for Lachesis.

Lilium tigrinum: This remedy may be helpful if a woman is inclined toward rage during PMS, makes other people "walk on eggs," and is extremely sensitive and irritable. Pressure in the rectum and in the pelvic region, with a sensation that the uterus is pushing out, may make her feel a frequent need to sit or cross her legs. Emotions and excitement aggravate the symptoms, and fresh air will often bring relief.

Lycopodium: PMS with a craving for sweets and a ravenous appetite (sometimes a bulimic tendency) suggests a need for this remedy. Digestive upsets with abdominal bloating and flatulence are often seen, with the person feeling worst in the late afternoon and evening. Menstrual periods may be delayed, followed by a heavy flow that goes on for extra days. A woman who needs this remedy often wears a worried look and lacks self-confidence-although she may be irritable and bossy to pets and family members. A desire to be alone, but with someone in the other room, is another indication for Lycopodium.

Natrum muriaticum: A person who needs this remedy usually seems reserved to others, but is deeply emotional inside. She may feel extremely sad and lonely, but gets affronted or angry if others try to console her or sympathize. Depression, anger over minor things, and a need to be alone to cry are often seen when Natrum mur is needed. Menstrual problems can be accompanied by migraines, or a backache that feels better from lying on something hard or pushing a solid object against the painful place. A craving for salt, strong thirst, and a tendency to feel worse from being in the sun are other indications for this remedy.

Nux vomica: When a woman with PMS is extremely impatient, pushy, and intolerant, this remedy may be of use. Uncomfortable, irregular menstrual periods can be experienced, often with a nagging urge to move the bowels before the flow begins. Constipation is common, and constricting pains may extend to the rectum or tailbone region. Anger, mental strain, physical exertion, and overindulgence in coffee, alcohol, or food can aggravate the problems. The woman often feels chilly and improves from warmth and rest.

Pulsatilla: This remedy can be helpful during many conditions involving hormonal changes and is often helpful to girls who have recently started having periods. PMS with irritability, moodiness, and weepiness is typical. Delay or suppression of the menstrual flow can be accompanied by queasy feelings, nausea, and faintness. Being too warm or in a stuffy room makes things worse, and fresh air can bring relief. The timing, amount, and nature of the menstrual flow are changeable-as are the woman's moods-when Pulsatilla is the remedy. The woman usually is emotional and needy, wanting a lot of attention and comforting.

Sepia: A woman who needs this remedy with PMS feels weary and dragged-out, wanting others (especially family members) to keep their distance. She often feels taken for granted and overworked, becoming irritable or sarcastic if demands are made. Late periods or scanty flow with a feeling that the pelvic floor is weak, or as if the uterus is sagging, often indicates a need for Sepia. Tender breasts, fatigue. Irritability, sensitivity to odors, loss of sex drive and bearing down sensations with the flow Dampness and perspiring may aggravate the symptoms. Warmth and exercise, especially dancing, often restore some energy and brighten up the her mood.

Veratrum album: Menstrual periods with very heavy flow and cramping, with a feeling of exhaustion and icy coldness suggest a need for this remedy. Vomiting and diarrhea are often seen. Periods may start too early and go on too long. The woman feels worse at night, from exercise, and from drinking things that are warm. Cold drinks, small meals, and wrapping up in warm clothes or covers may help to bring improvement.