Understanding Premenstrual Syndrome (PMS)

While women have known about PMS since the first menstruation ever, the term was only spoken about first in 1913 by American gynecologist Robert Frank & German psychoanalyst Karen Horney. PMS is thought to be caused by hormonal changes during the menstrual cycle and is a catch-all name for a myriad of physical and psychological symptoms.

Most women of reproductive age have one or more emotional or physical symptom in the premenstrual phase (2 weeks before menses). Mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, are the most distressing, but somatic complaints, such as breast tenderness, bloating, and joint and muscle pain can also be problematic[1].

When does PMS begin and end?

The length of premenstrual symptoms expression varies between a few days and 2 weeks[1]. It may start at the time of ovulation when serum progesterone and estradiol increases, but continue to increase after these hormonal levels are beginning to decline. Symptoms often worsen substantially during the last five premenstrual days i.e. 6 days before, and peak at about 2 days before menses start[1].

If PMS symptoms are severe and cause problems with work or personal relationships, you may have Primary dysmenorrhea (PDM) or Premenstrual dysphoric disorder (PMDD).

1. PMS typically starts during second half of the menstrual cycle, is at peak on the initial days and ends after 2-4 days after menstrual bleeding starts.
2. 90% menstruating women and 62% Indian women suffer from PMS during their childbearing years.
3. 5% of all women who suffer from PMS are temporarily disabled by it due to the severity of symptoms; this severe condition of PMS is referred to as Primary dysmenorrhea (PDM) or Premenstrual dysphoric disorder (PMDD).
4. Changes in sex hormone levels and brain hormone levels (neurotransmitters) have been major factors for experiencing PMS.
5. Women, who experience PMS, have low serotonin level in brain, prior to their periods. This low level of serotonin, can affect mood and sensitivity to pain.
6. Women without PMS experience 3-4 synchronous and rhythmical contraction at 10 mins interval, while women with PMS experience more than 4-5 non-rhythmic & uncoordinated uterine contractions.

What happens inside your body in PMS?

On average, women have a menstrual period every 28 days with bleeding (menstruation) lasting approximately four to seven days. PMS happens in the days after ovulation because estrogen and progesterone levels begin falling dramatically if you are not pregnant.

During this time, the level of hormone-like substances called prostaglandins, which are produced by the uterus increases, resulting in uterus muscle contraction. The levels of prostaglandins increase prior to menstruation, and peak at the start of the menses.

In PMS the uterus is induced to contract frequently and dysrhythmically, with increased basal tone and increased active pressure. Uterine hypercontractility, reduced uterine blood flow, and increased peripheral nerve hypersensitivity induce pain.

These changes play a major role in physical, behavioural and psychological symptoms of PMS. As a result of these changes, women experience pain, discomfort, and other symptoms during the menses.

Common PMS Symptoms

Diagnosis of PMS

The diagnosis of PMS can be difficult because many medical and psychological conditions can mimic or worsen symptoms of PMS. There are no blood or laboratory tests to determine if a woman has PMS.

However, a diagnosis can be made through tracking monthly symptoms to find patterns and discussing them with a doctor. Keeping a menstrual diary helps the health-care professional to make the diagnosis and also helps the patient better understand her own body and moods.

Experiencing mild bearable pain for which taking pain killers is not required, is normal. But if symptoms begin to interfere with your normal activities, personal or social relationships or work, if you can't concentrate/focus, if you have to stay home and lie down, then that is abnormal and indicates PMS.

What are the treatments for PMS? How do they help improve PMS?

Medical treatments fall into groups of NSAID’s, hormonal treatments, oral contraceptive, selective serotonin receptor inhibitors (or SSRIs), anti depressants, diuretics.

Often these medications have a negative impact on the body. The most common side-effects include headache, nausea, insomnia, fatigue or lethargy, decreased concentration, dizziness, gastrointestinal symptoms, central nervous system symptoms, nephrotoxic and hepatotoxic effects and decreased libido or delayed orgasm.

Also it should be noted that these medicines have a specific actions and one drug alone will not be enough for complete relief from PMS. If any healthy regularly menstruating woman is to considering these as a constant for every monthly cycle, she is more likely to experience a side effect of these drugs.

Periods are natural and they are not meant to be uncomfortable and if unfortunately they are one should only resort to nature for treatment.

Unived's PMS Management Supplement

Unived’s PMS Management supplement is a complete menstrual support that helps relieve physical symptoms by restoring the vitamins and mineral levels and providing phytonutrients that help block prostaglandins, lower stress hormones, prevent excitation of neurons and maintain the happy hormone levels without disturbing or interfering with the body’s normal reproductive health, hormones or functions.

It is made up of KSM-66® Organic Ashwagandha Extract, L-theanine, Curcumin and provides 2000% RDA of vitamin B6, 100% RDA of vitamin D3, 80.6% RDA of Magnesium and 30% RDA of Iron for women. All these ingredients work together to block pain, relax muscles, prevent nausea, improve blood flow and oxygen transport within the body and maintain cortisol, serotonin and dopamine levels.

PMS & Athletes

Many reports have documented that the premenstrual phase is associated with decreased athletic performance[2]. The athletic performance of 54.5% of athletes was found to suffer in competition or in practice due to premenstrual symptoms[2].

It is researched that women could make greater strength gains and produce more force when they strength trained during their low-hormone phase compared to training in the high hormone phase. This is affected when there are Premenstrual symptoms causing reduced reaction time, neuromuscular coordination, and manual dexterity during premenstrual and menstrual phase.

Also blood sugar levels, breathing rate and thermoregulations are negatively impacted during this time which decreases aerobic capacity. It’s a bit harder and more important to do everything you can to keep your head in the game.

And so Unived’s PMS Management supplement will help you relax and eliminate any symptoms that are holding you back during that time of the month.

Advice – As estrogen and progesterone levels are higher at the time of onset of PMS it becomes important to consider that your body is well supplied with carbohydrate and protein as higher progesterone has a catabolic effect on the muscle tissues and estrogen reduces the growing capacity of muscles. You need to put in more CHO’s into your system especially for long bouts of intense training and can pair it up with Unived’s PMS Management for a complete support.

Tips to Manage PMS[3] 

• Try low-impact exercise: Be active throughout the month. Aerobic activity can lessen depression, fatigue and other symptoms. Explore low-impact exercises like walking, swimming and cycling.
• Focus on food: Eat healthy every day especially before and during periods. Make a point to avoid caffeine, salt and sugar, two weeks before your period. Include nutrient rich foods like whole grains, protein, and a variety of fruits and vegetables rich in calcium & magnesium.
• Hydration: remember to drink plenty of water as and when you need to. It is important to remain well hydrated and keep that blood flowing during this time.
• Focus on sleep: Get plenty of sleep. Teens need eight to 10 hours of sleep, or more.
• Don’t smoke or vape: One study found that smokers were twice as likely to have moderate or severe PMS.
• Keep track: Write down when you have your period and what you’re feeling, so you can notice patterns of what’s normal for you.
• Not everything is PMS: That headache might really be a migraine, fatigue can be a thyroid issue, and moodiness can be anxiety or depression which should be treated.
• Having one menstrual bleeding every month (28-35 days) is normal if you don’t experience menstrual flow regularly every month it is recommended to see a doctor.

References:

[1] Kimberly Ann Yonkers et. al., “Premenstrual syndrome”, Lancet. Author manuscript; available in PMC 2011 June 20, NIH Public Access Author Manuscript

[2] Takashi Takeda et. al., “Premenstrual symptoms interference and equol production status in Japanese collegiate athletes: A cross-sectional study”, J. Obstet. Gynaecol. Res. Vol. 44, No. 3: 488–494, March 2018

[3] Johnson Memorial Health, “What Should I Do If My PMS Is Getting Worse?”, Mar 8, 2018 http://blog.johnsonmemorial.org/what-should-i-do-if-my-pms-is-getting-worse