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Nimisha Achari and Dr. Gudly Nanda
20/3/2024
Menstruation is normal, healthy, and often a tricky part of life for most women and, in fact, many men. Today, approximately 26% of people worldwide constitute women of reproductive age group, who form the bulk of menstruating people 1. Even though much progress has been made on the subject, sadly, it remains stigmatized in most parts of the world. Awareness regarding processes that happen during your cycle can not only destigmatize the taboo around it, but it can also help menstruating people manage their symptoms better.
If you are someone who menstruates, you most probably are familiar with PMS. Struggling with PMS can be very hard and might even feel alienating for some people. In a world where there are so many different pressures on a woman's body, PMS combined with other issues makes it doubly hard. In this blog, we will try to demystify the medical reasons behind PMS and cover some tips on dealing with it.
Premenstrual syndrome (PMS) is a collective result of physical, psychological, and behavioural changes that usually presents 5 days preceding your periods, ending within 4 days of menses and for at least three menstrual cycles. 2
While in most women, it manifests as mood changes, in a few others, physical changes can also be attributed to PMS.
In some cases, the physical pain and emotional stress are severe enough to affect day-to-day living. A more disabling form of PMS is PMDD (Pre-Menstrual Dysphoric Disorder), affecting around 5% of women in the reproductive age group, requiring serious medical attention.
Graphics- Bodempudi Siri
Though the precise explanation for PMS is uncertain, it was earlier proposed to be due to hormonal changes that cluster around and after ovulation, especially during the second half of the menstrual cycle, i.e., the luteal phase.
Ovulation happens about halfway through the menstrual cycle. At this point, your body releases an egg, causing the remaining follicle to form what is called the Corpus Luteum. Failure of fertilization of the egg will result in regression of the Corpus Luteum in the later part of the luteal phase causing a feedback decrease in levels of estrogen and progesterone. According to older theories, a shift in this balance results in PMS.
However, evidence now supports newer theories.
● PMS is currently postulated to be due to a deficiency in neurotransmitter, Serotonin. Any imbalance in levels of Serotonin can cause mood swings, depression, anxiety, irritability, and fatigue. Neuroimaging reveals altered serotonin activity in PMDD patients.
● Nutritional causes include a deficiency of Magnesium and Calcium 3
Six basic categories to describe symptoms of PMS- 3
- PMS A – anxiety, irritability, mood swings
- PMS C – Craving for sweet or salty foods
- PMS D - Depression, Anger, poor concentration, insomnia
- PMS H – Hydration, weight gain, bloating, breast tenderness(mastalgia), edema of extremities
- PMS O – other symptoms like general body aches, acne, nausea, and a change in bowel habits
- PMS T – total overall symptoms
PMS can vary from person to person, so do the external factors that precipitate it. Subsequently, it is imperative to understand the stressors that lead to mood swings in your case to prevent and manage them better.
The myriad of external stressors that take a toll on your mental health could be as varied, from shifting to a new place to switching your job. From just a lousy day to losing your job. From a toxic friend to the ups and downs in your relationship. From the lack of sleep to past emotional trauma. From alcohol and drugs to family disputes. From recovering through a divorce to single parenting. It could very well be said that anything happening in and around you could act as a trigger. These external stressors, coupled with the hormonal changes your body goes through every month, are the factors that eventually lead to simple or sometimes drastic mood changes.
Mood swings and emotional disturbances, including depression and anxiety, affect a considerable number of women, due to which emotional support, behavioural counseling, and stress management are the cornerstones for improving symptoms of PMS.
● Eat more healthy foods
It is essential to keep your diet in check because what you eat will directly impact the severity of PMS. Have a diet rich in complex carbohydrates and avoid simple carbohydrates. Small and frequent diet to reduce craving. Go low on dairy products, avoid too much salt or refined sugars. A calcium-rich diet like low-fat milk, green leafy vegetables, fish or calcium, and magnesium supplements can help ease symptoms. 2
● Avoid caffeine
Caffeinated drinks are a big NO during PMS as they can increase anxiety, nervousness, and insomnia.
● Avoid alcohol and smoking
Alcohol may act as a depressant during PMS, and it is prudent to avoid alcoholic beverages to prevent mood changes. Smoking is associated with an increased incidence of PMS.
● Regular exercise
Sticking to a regular aerobic exercise regime is a good idea during PMS. Brisk walking for 30 mins for most days in a week not only helps with PMS but also is good for your heart and lungs, preventing hypertension in the long run. 2
● Stress management
It is advisable to engage in activities that help you relax and stay away from stressors.
Several relaxation techniques like yoga, meditation, massage, chiropractic therapy, deep breathing exercises are recommended to dissolve stress.
Graphics- Bodempudi Siri
● Support and education
Support from family and friends is essential while going through this phase. Emotional support has proven to be beneficial on most occasions, deferring the need for pharmacological treatments
● Get good sleep
A healthy mind reflects a healthy body. So, getting enough sleep is always an excellent way to ensure that your body and mind are well-rested.
● Cognitive therapy
This is proving to be an effective method to combat depression, anxiety, and other mental health problems associated with PMS and PMDD. It helps understand how hormonal changes during the menstrual cycle can affect thinking, mood, and social behaviour. 4
● Consult your doctor
Chart your symptoms in a diary for at least two to three cycles to give your doctor a clearer idea about your symptoms and their timings.
In the end, your doctor may prescribe you medications that help increase Serotonin, a deficiency of which is now claimed to be the primary cause for PMS. 2
Diuretics can help reduce bloating and breast tenderness. 5
Similarly, you may require Anti-inflammatory medications to reduce general body aches and pain after proper scrutiny by your doctor.
The use and benefit of Hormonal contraceptives in PMS are conflicting. 5
● Herbal remedies
Unproven benefits. Kindly consult your doctor before starting any.
It is essential to rule out other medical conditions before diagnosing PMS. Several other mental health conditions can mimic the symptoms of PMS and should not be dismissed lightly.
As of now, there is no single treatment strategy that’s completely effective in tackling PMS.
IN THE END
PMS can be frustrating. When you are happy one minute, sad the next, and God forbid, if someone mentions "it's that time of the month," and you really want to throw something at them, but you know your resting bitch face is going to take care of it. When you experience torrential crying spells, shitty cramps, and sore boobs all in one go, this rollercoaster ride is overwhelming.
Graphics- Bodempudi Siri
Check out Pinkishe Foundation's social handle on Facebook & Instagram and keep yourselves updated on content related to Women Well-Being and Menstrual Education.
To have someone take care of you, listen to you vent and be empathetic about what you’re going through is nothing less than blissful heaven. All in all, it’s love that you need.
Even though PMS affects nearly 90% of reproductive women worldwide, it still remains a condition that warrants more research.
It's 2022, and our hope this year lies in Science, researching more, relating to women's issues more, and giving women the safe space to speak up. Because sometimes, the best results are gained from just lending an ear.
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