PREMENSTRUAL SYNDROME (PMS)

• Premenstrual syndrome (PMS) is a psychoneuroendocrine disorder of unknown aetiology, often noticed just before menstruation
• The cyclic appearance of a large number of symptoms during the last 7-10 days of the menstrual cycle
• When these symptoms disrupt daily functioning they are grouped under the name premenstrual dysphoric disorder (PMDD)
• PMS is more common in women aged 30-45

The exact cause is not known, but the following hypothesis is postulated

• Alteration in the level of oestrogen and progesterone starting from the mid-luteal phase
• Neuroendocrine factors – Serotonin, Endomorphins, GABA
• Psychological and psychosocial factors may be involved to produce behavioural changes

Others

• Related to thyrotropin-releasing hormone (TRH), prolactin, renin, aldosterone, prostaglandins, etc.
• It may be related to childbirth or a disturbing event

Related to water retention

• Abdominal bloating
• Breast tenderness
• Swelling of the extremities
• Weight gain

 Neuropsychiatric symptoms

• Irritability
• Tearfulness
• Depression
• Anxiety and tension
• Mood swings
• Forgetfulness
• Confusion
• Restlessness, anger
• Headache
• Increased appetite

Behavioural symptoms

• Fatigue
• Tiredness
• Dyspareunia
• Insomnia

• No objective test can confirm PMS
• Daily diary, assessment charts, other ancillary methods are helpful aids to clinical diagnosis
• The time and timing of the symptoms are more important than the severity of symptoms
• Baseline values – CBC, Chem-20 at morning
• Cervical swab for wet mount

• Lifestyle modification and cognitive behaviour therapy 

Non-pharmacological

• Assurance, Yoga, Stress management, Diet manipulation
• Avoidance of salt, caffeine, and alcohol especially in the second half of the cycle improves the symptoms

Non-hormonal

• Tranquilizers or antidepressant drugs
• Selective serotonin reuptake inhibitors and nor-adrenaline reuptake inhibitors

 Hormones

• Oral contraceptive pills
• Progesterone

 Suppression of ovarian cycle

• Danazol 200 mg daily
• GnRH analogues

Oopherectomy

Ayurvedic Treatment

Internal Medicines

• Sukumaram Kashaya
• Kalyanaka kashaya
• Abhayarishta
• Asokaarishta
• Dhanwanthara Gutika
• Manasamithra Vataka
• Panchajeeraka Guda
• Sukumara Gritha 

Procedures

• Thala – Ksheerabala taila + Kachooradi
• Virechana – Sukumara Eranda