Premenstrual Syndrome (PMS) is a psychosomatic disorder of unknown etiology, often recurring just prior to menstruation.
Etiopathogenesis
- Unknown / Idiopathic
- Alteration in estrogen and
progesterone levels
- Neuroendocrine factors
- Serotonin – Reduced levels
- Endorphins – Reduced levels
- Gamma-Aminobutyric Acid (GABA) dysfunction
- Psychological factors
- Hormonal involvement
- Thyrotropin-Releasing Hormone (TRH)
- Prolactin, Renin, Aldosterone
- Prostaglandins
Clinical Features
1.
Physical Symptoms
- Abdominal bloating
- Breast tenderness
2.
Hormonal Symptoms
- Swelling of extremities
- Weight gain
3.
Psychological Symptoms
- Irritability
- Insomnia
- Anxiety
- Headache
- Loss of concentration
Treatment & Management
1. General
Measures
- Reassurance & Counseling
- Lifestyle modifications
- Avoidance of stimulants
(Caffeine, Nicotine, Alcohol)
2.
Pharmacological Management
- Tranquilizers
(Anti-depressants & Anxiolytics)
- Alprazolam – For anxiety
and depression
- Combined Oral Contraceptive
Pills (COCs)
- Bromocriptine – 2.5 mg (For suppression of ovarian cycle)
- Danazol & GnRH analogues
Keynote Symptoms of Premenstrual Syndrome (PMS)
- Irritability, mood swings,
depression, and anxiety before menstruation
- Bloating, breast tenderness, and
weight gain
- Headache, fatigue, and difficulty
concentrating
- Food cravings, especially for
sweets or salty foods
- Lower abdominal pain, cramps, or
backache before periods
1. Sepia
Indications:
- Extreme irritability,
indifference to family, and mood swings before menses
- Dragging-down sensation in
the pelvis with fatigue
Keynote Symptoms:
- Feels emotionally detached and
exhausted.
- Bearing-down sensation in the uterus.
- Craves sour foods like pickles and
vinegar.
- Worse from cold air and better with
vigorous exercise.
- Vaginal dryness and low libido.
2. Pulsatilla
Indications:
- Mild, gentle women who feel
weepy and crave attention during PMS
- Delayed, scanty, or
irregular menstrual flow
Keynote Symptoms:
- Easily tearful and seeks comfort.
- Symptoms constantly change.
- Worse in warm rooms, better in open
air.
- Craves fatty foods but dislikes warm
drinks.
- Menses are dark,
thick, and delayed.
3. Natrum Muriaticum
Indications:
- Severe headaches, water
retention, and emotional suppression before menses
- Craving for salty foods and
aversion to consolation
Keynote Symptoms:
- Deeply emotional but avoids expressing
feelings.
- Intense headaches before periods.
- Craves salt and drinks little water.
- Dry lips and excessive thirst.
- Worse in the sun and from emotional stress.
4. Lachesis
Indications:
- Hot flashes, intense anger,
and excessive talkativeness before menstruation
- Profuse and dark menstrual
flow, worsened by tight clothing
Keynote Symptoms:
- Cannot tolerate anything tight around
the neck or abdomen.
- Loquacious (talks excessively) and
suspicious.
- Symptoms worsen after sleep.
- Menses start with intense congestion
and headache.
- Menstrual flow is profuse, dark, and
clotted.
5. Nux Vomica
Indications:
- Highly irritable, impatient,
and oversensitive women during PMS
- Cramping pain in the lower
abdomen, worse in the morning
Keynote Symptoms:
- Easily angered and intolerant of noise
and light.
- Strong craving for stimulants like
coffee, alcohol, and spicy foods.
- Constipation with an ineffectual urge
to pass stool.
- Sensitive to cold and prefers warmth.
- Sleep is disturbed, often waking up
between 3–4 AM.