Introduction
Premenstrual syndrome (PMS) is a condition that affects a woman physically and emotionally and causing changes in behaviour during certain days of the menstrual cycle, generally just before her menses. PMS is a very common condition. Its symptoms affect more than 90% of women in the reproductive age. It is important to get a proper diagnosis and treatment for physical and social well-being. Usually, PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins.
Signs & symptoms
Signs and symptoms are varied widely in PMS patients. The days affected are also different from person to person. In most cases, it starts at least one week prior to menstruation and ends with the onset of bleeding.
The symptoms of PMS are usually mild or moderate. It varies in individuals and in months.
The symptoms of PMS include:
- Bloating and belching
- Distension of abdomen
- Abdominal pain
- Soreness in breasts
- Acne
- Craving for food items, especially for sweets
- Constipation or diarrhoea
- Headache
- Nausea & vomiting
- sensitivity to light or sound
- fatigue
- irritability
- changes in sleep patterns or disturbed sleep
- anxiety
- depression
- sadness
- emotional outbursts
Causes
The cause of PMS is unknown. But a change in both sex hormones and serotonin levels at the beginning of the menstrual cycle is believed to play a role in PMS by experts.
Pathophysiology
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder are triggered by hormonal events ensuing after ovulation. The symptoms can begin in the early, mid or late luteal phase and are not associated with defined concentrations of any specific gonadal or non-gonadal hormone. Although evidence for a hormonal abnormality has not been established, the symptoms of the premenstrual disorders are related to the production of progesterone by the ovary. The two best-studied and relevant neurotransmitter systems implicated in the genesis of the symptoms are the GABArgic and the serotonergic systems. Metabolites of progesterone formed by the corpus luteum of the ovary and in the brain bind to a neurosteroid-binding site on the membrane of the gamma-aminobutyric acid (GABA) receptor, changing its configuration, rendering it resistant to further activation and finally decreasing central GABA-mediated inhibition. By a similar mechanism, the progestogens in some hormonal contraceptives are also thought to adversely affect the GABAergic system. The lowering of serotonin can give rise to PMS-like symptoms and serotonergic functioning seems to be deficient by some methods of estimating serotonergic activity in the brain; agents that augment serotonin are efficacious and are as effective even if administered only in the luteal phase. However, similar to the affective disorders, PMS is ultimately not likely to be related to the dysregulation of individual neurotransmitters. Brain imaging studies have begun to shed light on the complex brain circuitry underlying affect and behaviour and may help to explicate the intricate neurophysiological foundation of the syndrome.
Diagnosis
There are no unique physical findings or lab tests to positively diagnose premenstrual syndrome. A particular symptom to PMS if it’s part of predictable premenstrual pattern.
Treatments
For many women, lifestyle changes can help relieve PMS symptoms. But in severe cases, medications are needed. The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include:
- Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
- Diuretics like Spironolactone (Aldactone) can help ease some of the symptoms of PMS.
- Hormonal contraceptives that stop ovulation, can give relief from PMS symptoms.
Prognosis
PMS symptoms can recur, but they typically go away after the start of menstruation. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate the symptoms for most women.
Complications
Disease & Ayurveda
Ayurveda does not consider pain during menses as a single disease but explains this as a sign present in many diseases of female reproductive system. The term kashtartava defines painful menses or menstruation with discomforts.
Nidana
Unwholesome diet and regimen
Not following Ritumaticharya (advised regimen during menstruation and ovulation)
Purvaaroopa
Not mentioned
Samprapti
Bleeding during artava is the function of Apaanavayu. Also, Ayurveda explains no diseases in the female reproductive system happens without the affliction of Vaata. Kapha and sometimes Pitta come associated with Vaata to produce diseases of female reproductive system but Vaata derangement especially Apaanavaata affliction is a must. Regarding pain, Vaatadrute ruja naasti explains that Vaata is the causative dosha of Pain sensation. Here, in kashtartava the Apaanavaata gets aggravated and causes pain and discomforts during menses.
Lakshana
Pain in the abdomen during menstruation
Divisions
Not mentioned
Prognosis
Saadhyam in new & uncomplicated in young patients
Yaapya in chronic cases with other complications
Chikithsa
Ayurvedic treatment for painful menses mainly targets the balancing of Vaatadosha, the guardian of normal menstruation. As there are chances of obstruction in the channels that carry blood, cleaning of the body in the form of panchakarma therapies are advised in patients with adequate physical health.
Samana
Soolahara dravyas
Anulomanam
Pradesikaswedanam
Maatravasti
Aamapaachanam
Agnideepanam
Sodhana
Sneha-sweda
Virechana
Vamana
Asthapanavasti
Anuvasanavasti
Uttaravasti in needed cases
Commonly used medicines
Sukumaram kashayam
Kumaryasavam
Dasamoolarishtam
Shaddharanam choornam
Dhaanwantaram gulika
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
In order to help with PMS, a woman has to ecord her symptoms for a few months to identify the triggers and timing of the symptoms. This will allow her to intervene with strategies that may help to lessen them. Besides getting enough sleep and rest, things that help reduce the problems associated with PMS include:
Vitamin supplements like calcium, magnesium, vitamin E and vitamin B-6
Herbal remedies such as ginkgo, ginger, chasteberry (Vitex agnus), evening primrose oil and St. John’s wort.
Regular exercise – Physical activity, helps ease menstrual cramps for some women.
Use heat – Soaking in a hot bath or using a heating pad, hot water bottle or heat patch on lower abdomen might ease menstrual cramps.
Dietary supplements – like vitamin E, omega-3 fatty acids, vitamin B-1 (thiamin), vitamin B-6 and magnesium supplements might reduce menstrual cramps.
Reduce stress – Psychological stress might increase the risk of menstrual cramps and their severity.
Massaging the abdomen
Eating light, nutritious meals several times a day in spite of heavy meals
Relaxation techniques or yoga
Raising the legs or lying with knees bent
Reducing intake of salt, alcohol, caffeine, and sugar to prevent bloating and disturbed digestion
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
Caffeinated drinks
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil
Fresh fruits like grapes, pomegranate and dates
Eat more leafy vegetables
Use more ginger in food preparations
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from extreme climate changes.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Avoid stress and emotional hurricanes.
Yoga
Regular stretching and cardio exercises are advised in non-menstruating days. Also, specific yogacharya including naadisuddhi pranayama, vajrasana, gomukhasana, bhadrasana, bhujangaasana, pavanamuktasana is recommended.
Yoga and strenuous exercises are not advised during painful menstruation days.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Vajrasana
Gomukhasana
Bhadrasana
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://pubmed.ncbi.nlm.nih.gov/22611222/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118460/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
Whatsapp – +91 9446918019, +91 8075810816
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