Periods related problems

Article written by Dr Katya Mishanina 

Part 1

Premenstrual syndrome/tension (PMS, PMT) in an umbrella term for various symptoms that many women of childbearing age experience before periods.

It is poorly understood condition and often dismissed by the medical profession, but it can seriously affect women’s quality of life.

What are the symptoms of premenstrual syndrome? 

Emotional

Behavioral

Physical

Tension

Appetite changes and food cravings

Weight gain related to fluid retention

Anxiety

Trouble falling asleep

Breast tenderness

Low mood

Social withdrawal

Abdominal bloating

Crying spells

Poor concentration

Joint or muscle pain

Mood swings

 

Acne flare-ups

Irritability

 

Fatigue

Anger

 

Headaches

 

 

Constipation or diarrhea

What causes premenstrual syndrome?

The cause is poorly understood, but several factors may contribute:

  • Imbalance in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.
  • Chemical changes in the brain. Fluctuations and low levels of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood state and may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.

What can you do to help?

here are many things that YOU can do to promote the hormone balance:

  • Food and drink- a healthy, balanced diet is key to overall wellbeing, not just PMS.
    • Increase fiber in your diet from vegetables, fruit, nuts, seeds, beans, and whole grains. Two tablespoons of ground flax seeds a day are especially helpful in correcting constipation and balancing hormones.
    • Increase omega-3 fats by eating more wild fish like mackerel, sardines, herring, and wild salmon, as well as omega-3 eggs and walnuts.
    • Reduce trans and hydrogenated fats (mainly found in processed foods like biscuits and ready meals).
    • Reducing salt intake may reduce fluid retention.
    • Reducing refined carbohydrates, sugar and processed foods will help balance blood sugar levels and may help with mood swings.
    • Reducing caffeine (tea, coffee, cola, cocoa, chocolate etc) can help with breast tenderness. Try peppermint tea and chamomile tea instead.
    • Reducing alcohol intake may help with tiredness and sleeping difficulties.
  • Rest. Try abdominal breathing (https://www.guysandstthomas.nhs.uk/resources/patient-information/therapies/abdominal-breathing.pdf) or meditation (hyperlink https://www.bemindfulonline.com), even if it is only 10 minutes a day. Review and free up your diary to allow time to rest and relax. Prioritize yourself, work on your boundaries and learn how to say no.
  • Exercise. Women who exercise regularly say they experience fewer PMS symptoms.
    • Try doing 30 minutes of exercise every day of something (that includes walking and taking the stairs).  
    • Choose something that you enjoy, may be a dance class or a swimming lesson.
    • Consider including mind-body practices like yoga and tai chi. For long-lasting balance.
  • Sleep – getting enough (8 hours/night) sleep is essential to keep your hormones balanced. Prioritise your sleep and follow sleep hygiene rules if you are having trouble.
  • Environment- reduce hormone mimicking substances in your environment
    • Eat organic food whenever possible, especially animal products and “the dirty dozen” fruit and vegetables.
    • Switch to minimal ingredients, organic beauty products to avoid hormone-disturbing chemicals like phthalates.
    • Swap plastic bottles and food containers for glass (especially if you heat you food up in them) to reduce your exposure to BPA, another hormone mimicker.

Are there ways to cope whilst my hormones are rebalancing?

  • Observe your symptoms: The more you observe and tune into your body, the more you get to understand what is happening. This may relieve some of the anxiety and make you feel empowered.
  • Record the symptoms. It may be useful to keep a symptom diary and a period calendar. Note the days you feel irritable, low, or anxious, or experience any other PMS symptoms and the relationship to the start of the period. Once you see a pattern, you can choose take extra rest and sleep when symptoms are expected.
  • Talk about your symptoms with your family, friends or partner. It will help them to understand how you are feeling and make you feel supported. 

When will I feel the difference?

Due to the cyclical nature of PMS, it may take 2-3 cycles to assess whether any treatments/interventions had an effect. Try to stay patient and hopeful. There are many ways to help and it is a matter of finding the best treatment strategy!

The most effective approach to treating PMS naturally generally includes a combination of the above lifestyle modifications and an individual prescription of homeopathic remedies and herbal and nutritional supplements.

What are conventional medical reatment options for PMS?

  • The pill/coil. Inhibiting ovulation has been the traditional choice of treatment, however, the use of hormonal contraceptives has not been well studied. Some women benefit from them, but others find their symptoms are worsened.

  • Antidepressants (such as fluoxetine or sertraline) have been shown effective for behavioral and physical symptom amelioration1 even with intermittent dosing (just in the second half of the menstrual cycle).

What are complementary and alternative medicine treatment options?

Nutritional supplements

  • Vitamin B6 and Fish oils have been shown to help in treating PMS.3,4
  • Although it is often tempting to keep trying to find a quick fix, these are only supplements to a healthy diet
  • Also note the section below “When will I feel the difference?”

Homeopathy

The best course of action is homeopathic constitutional treatment. “Constitution” describes person’s state of health, including their temperament and any inherited and acquired characteristic. However, some local remedies are well worth trying.

Herbal remedies

Most of these herbal medicines contain plant analogues to estrogen and progesterone that help to balance these hormones in the female body. Although there are few studies published on their efficacy some women find them useful. 

Acupuncture

  • Many women find acupuncture helpful and it has positive effect in scientific studies.4

Part 2

Mood and hormones

A bit of history…

  • Few areas of women’s health elicit more interest and controversy than the relationship of women’s hormones to the mood and behaviour.
  • There have been observations for centuries that reproductive hormones cause rapid mood changes, anxiety and depression.
  • The ancient Greek believed that a women’s wandering uterus was to blame for mood and behavioural problems.
  • They coined the term “hysteria” and recommended removal of the offending organ as treatment.
  • It has now generally been accepted, both in and out of the medical community, that a woman’s menstrual cycle does affect her emotional state. (1)

Is there a difference in levels of hormones in women with PMS?

  • So far there is no evidence of differences in levels of sex hormones in women with and without PMS.
  • Levels and patterns of hormone secretion (incl. oestrodiol, progesterone, FSH, LH and ovarian and adrenal hormones) over the menstrual cycle have not been found to be disturbed in women with PMS (1).

What is the current theory of the cause of PMS?

  • The current theory is that some women have an underlying susceptibility in the interaction between the nervous system and hormones in response to normal menstrual cycle changes
  • The exact physiological cause as yet unknown due to lack of sophistication in our current technology.
  • The susceptibility may be a previous abuse or some biological conditions (1).

Does PMS cause depression or does depression cause PMS?

It is complicated…

  • There is evidence that premenstruum (a period 2 weeks before the start of the period) can worsen an already existing depression and increase the risk of onset of the new episode of depression(2).
  • 60% of women with unipolar mood disorder experience PMS and women with PMS have a 60% lifetime prevalence of major depression (3).
  • The most common symptoms that cause women to seek treatment are depression, anxiety and irritability. 

Why is PMS sometimes treated with anti-depressants?

  • It has been proposed that changes in sex hormone in the second part of the cycle (after ovulation) trigger changes in the serotonin system in the brain, resulting in decreased in levels of this chemical messenger and the symptoms of depression (4).
  • This theory is supported by the effectiveness of the antidepressants that increase levels of serotonin.

Does stress affect PMS?

Yes, there is evidence that increased stress levels play a part in PMS (5).

There is also evidence showing that traumatic events  (such as history of abuse) and per-existing anxiety are risk factors for developing PMS (6).

What psychological therapies can help with PMS?

Any strategy that reduces overall stress is likely to improve PMS and your wellbeing overall.

  • Relaxation techniques have been repeatedly shown to be very helpful for emotional and psychological well-being. Try mindfulness meditation (course/app), progressive muscle relaxation or hypnotherapy.
  • Assertiveness and time management training. Learning how to say ‘no’, learning to hold your boundaries and prioritise your needs are very valuable and effective techniques for emotional well-being. Like anything else they require practice but may have far reaching effects on one’s life.
  • Cognitive behavioural therapy (CBT) is a talking therapy, which aims to equip you with skills to find more adaptive ways of coping with premenstrual symptoms, emotions and stress overall. In one study antidepressants were compared with a course of CBT (10 sessions). Medication was associated with a more rapid response, but at 1 year follow up the CBT group had better maintenance of treatment effects. There was no additional benefit of combination treatment (7).
  • Psychotherapy is another type of talking therapy. It could be short-term or long-term and can be in individual or group sessions. In PMS context, it would be particularly useful for women with history of physical/emotional and sexual abuse.

Investigations

Diagnosis is usually made through clinical history and examination (if needed).

Sometime investigations may be needed to establish the root cause of the problem.

What therapies shall I try?

You may choose different therapies to tackle acne.

At the Natural Practice the following therapies are offered for people with acne: integrated medicine, homeopathy, nutrition, acupuncture and traditional Chinese medicine, reflexology.

Practitioners to see about this condition

Following Up

After you initial consultation, we recommend that you have regular check-ups to monitor your symptoms and response to interventions. The practitioner will advise on appropriate follow up arrangements for your individual situation.  

Multidisciplinary approach.

Depending on your needs, your care may be shared with other practitioners at the natural practice or elsewhere. Whenever you permit us, we will write to your GP to ensure they are aware of our recommendations and follow up arrangements.

 

References for Part 1:

  1. Blumenfield, M., 2006. Psychosomatic medicine. 1st ed. Philadelphia USA: Lippincott Williams &Wilkins.
  2. Kornsterin S. The evaluation and management of depression in women across the life span. J Clin Psychiatry 2001:62 (suppl 24):11-17.
  3. Gold JH, Severino SK, eds. Premenstrual Dysphoria: Myths and realities. Washington, DC: American Psychiatric Press; 1994;67-98.
  4. Spinelli MG.depression and hormone therapy. Clin Obstet Gynecol 2004;47(2):428-436
  5. Roca CA, Schmidt PJ, et al Defferential menstrual cycle regulation of hypothalamic-pituitary-adrenal axis in women with premenstrual syndrome and controls. J Clin Endocrinol Metab 2003;88(7):3057-3063
  6. Perkonigg A, Yonkers KA, et al. Risk factors for premenstrual dysphoric disorder in a community sample of young women: the role of traumatic events and posttraumatic stress disorder. J Clin Psychiatry 2004;65(10):1214-1322
  7. Wyatt KM, Dimmock PW, O’Brein PMS. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev

References for Part 2:

  1. HalBreich U, et al Efiicacy of intermittent, luteal phase sertraline treatment of premenstrual dysphoric disorder. Obstet Gynaecol 2002;100;1219-1229.
  2. Whyatt KM, Dimmock PW, O’Brein PMS. Efficacy of vitamin B-6 in treatment of premenstryal syndrome: systematic review. BMJ 1999; 318:1375-1381.
  3. Stevinson C, Ernst E. Complementary/aleternative therapies for premenstrual syndrome: a systematic review of randomised controlled trials. Am J Obstet Gynaecol 2001; 185:227-235.
  4. Lockie A 2006 Encyclopaedia of Homeopathy. London, UK: Dorling Kindersley limited.
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