A Complete Guide to Understand PMS (Pre-Menstrual Syndrome) in Women’s and its Effective Ayurvedic and Allopathic Treatment

Dipesh Gamare*,Sakshi Divate, Mansi Gavankar, Janvi Gangavane,

Vivek Gharat, Rupali Yevale

Konkan Gyanpeeth Rahul Dharkar College of Pharmacy and Research Institute, Karjat, 410201, India.

*Corresponding Author E-mail: dipeshgamare03@gmail.com

ABSTRACT:

Many women around the world are suffering from common physical discomfort just before their menstrual cycle. Symptoms may vary women to women which can be mild to severe such that it could affect their regular activities. Based on the diagnostic criteria, 2.5–3% of women of reproductive age have the severe form of PMS, while 40% of these women experience the moderate type. The symptoms seen were fluid retention, pain in pelvic region, mastalgia, psychological changes, behavioural changes, gastrointestinal problems, skin related problems and nervous system affecting problem. The targeting therapies to cure PMS includes allopathic as well as ayurvedic remedies. Allopathic includes mainly targeting brain SSRIs and some pharmacotherapies including administration of NSAIDs, anxiolytic agents, gonadotropin-releasing hormone (GnRH) agonists. etc. and recent studies shows combined oral contraceptives shows good effect to cure PMS prominently. And daily physical exercise can also overcome the PMS related problems wisely.

KEYWORDS: Pre-menstrual syndrome, NSAIDs, SSRIs, Pelvic pain.

INTRODUCTION:

Premenstrual syndrome (PMS) includes physical and psychological symptoms that are clinically significant during the luteal phase of the menstrual cycle and that cause severe distress and functional impairment. Within a few days following the start of menstruation, these symptoms go away.¹Girls often get their first menstrual cycle between the age of 11 and 14 years. These days, the girls feel tight or may have emotional swings, acquire water weight, and feel bloated, and experience pain in the belly, back, or legs that lasts several hours or more, therefore in the medicine it is defined as Premenstrual syndrome (PMS)².

Normal timing for the onset of symptoms is after day 13 of the menstrual cycle. PMS symptoms can appear at any moment while a woman is fertile. PMS can cause days of disruption to a woman's routine life.³ For the first time, Frank referred to PMS as "Premenstrual Tension" in a clinical setting in 1931. Greene and Dalton coined the term "Premenstrual Syndrome" in 1953 to demonstrate that it manifests in many ways than merely emotional stress.⁴ The global prevalence of women in reproductive age who experience PMS is 47.8%.⁵

About 20% of these women suffer symptoms that are severe enough to interfere with their everyday activities, with the rest women experiencing mild to moderate symptoms. Changes in appetite, weight gain, back and low back pain, headaches, breast swelling and tenderness, nausea, constipation, anxiety, irritability, rage, exhaustion, restlessness, mood swings, and crying are all signs of PMS¹.PMS has also been linked to higher risks of suicide and accidents, low employment and school attendance, poor academic performance, and psychological disorders⁶.

The more severe variant of the same condition, known as premenstrual dysphoric disorder (PMDD), as a psychiatric disease. Premenstrual symptoms are complicated; many women report symptoms ranging from mild to severe. The first step in managing PMS is to engage in daily regular activity and a diet adjustment⁷. To treat these symptoms, both pharmacological and nonpharmacological therapy options are available. The initial line of treatment for moderate symptoms is nonpharmacological, whereas pharmacological therapy – primarily selective serotonin reuptake inhibitors (SSRIs) is used to address severe symptoms.⁸

EPIDEMIOLOGY:

Based on the diagnostic criteria, 2.5–3% of women of reproductive age have the severe form of PMS, while 40% of these women experience the moderate type.^9,10,11 According to ICD-10 criteria, about 90% of women have had at least one episode of PMS¹².

Fig.1. Prevalence of PMS among university students in various nations ^13–16

CAUSES:

Premenstrual syndrome has an unknown origin. Since PMS symptoms appear at the same time as menstrual cycle hormonal variations, hormonal imbalances like excess oestrogen and low progesterone have been suggested as possible causes. Serotonin is linked with symptoms as a significant etiological factor. Three main hormones make up oestrogen: estrone, estradiol, and estriol, with estradiol being the most potent of the three. The fluctuations in oestrogen levels that occur during the luteal phase are what cause these mood swings in women. Clinical studies have demonstrated a large rise in serotonin precursors on days 7 to 11 and 17 to 19 of the menstrual cycle. This suggests that, due to the control of oestrogen and serotonin, PMS is intimately related to mood disorders. According to molecular biology studies, the hypothalamus releases norepinephrine in response to lower oestrogen levels, which causes acetylcholine, dopamine, and serotonin levels to diminish. These changes result in sleeplessness, exhaustion, and depression, which are typical symptoms of PMDD and PMS¹⁷.

A study from Egypt found a link between PMS and consuming too many foods with a sweet flavour. It also demonstrated that other elements, including consumption of fast food and caffeine, were strongly linked to PMS. It is therefore clear that lifestyle factors have a strong correlation with PMS and PMDD. In a similar study, conducted by Cheng et al. among female university students to determine the risk factors for PMS, it was discovered that dietary factors, including the consumption of fast food, sugar-sweetened beverages, and deep-fried foods, as well as lifestyle factors, including infrequent exercise and poor sleep, are significantly linked to the condition.⁸

PATHOPHYSIOLOGY:

Initially, decreased levels of progesterone in the luteal phase were thought to play a significant role in the etiology.¹⁰Because progesterone metabolites, particularly allopregnenolone, are neuroactive, acting through the gamma-aminobutyric acid (GABA) system in the brain, it can have anxiolytic properties¹⁸.

Premenstrual syndrome pathophysiology is complex, imprecise, and poorly understood. The action of progesterone on neurotransmitters such as gamma-aminobutyric acid (GABA), opioids, serotonin, and catecholamine are expected to influence PMS. This disorder is thought to be caused by a pre-existing serotonin deficiency combined with increased progesterone sensitivity.

PMS is caused by an increase in prolactin levels or an increase in its sensitivity to the effect of prolactin, changes in glucose metabolism, abnormal hypothalamic-pituitary-adrenal (HPA) axis function, insulin resistance, certain nutritional electrolyte deficiencies, and genetic factors. Stress increases sympathetic activity, which causes menstrual pain by increasing the intensity of uterine contractions¹⁹. While PMS is associated with the luteal phase, the origins of PMS are unknown, however various variables are responsible. Hormone fluctuations during the menstrual cycle appear to be a significant impact; shifting hormone levels affect some women more than others²⁰. Symptoms occur 5 to 11 days before beginning of woman's monthly menstrual cycle and stop when menstruation comes or soon after²¹.

SYMPTOMS:

Fig. 2. Symptoms of PMS²²

DIAGNOSIS:

Several clinical entities can exhibit symptoms like premenstrual syndrome. They include psychiatric conditions such as substance abuse disorders, affective disorders (e.g., depression, anxiety, dysthymia, panic), anaemia, anorexia, and bulimia, gynaecological conditions such as endometriosis, dysmenorrhea, medical conditions such as hypothyroidism, and others such as OCP use or perimenopause. As a result, it is critical to obtain an accurate history and conduct a thorough physical examination to rule out these conditions²³. PMS can also exacerbate certain health issues, such as asthma, allergies, and migraines²⁴.

Fig. 3. Investigational approaches of PMS²⁵.

PROGNOSIS:

Except for oophorectomy and menopause, most PMS symptoms recur after stopping treatment¹⁷.

COMPLICATIONS:

Untreated PMS is likely to affect sexual life, resulting in increased sexual distress, which can lead to relationship problems and additional psychological issues²⁶. There is also evidence linking PMS to an increased risk of suicidality in hormone-sensitive female¹⁷.

THERAPEUTIC TREATMENT:

For women with minor symptoms, lifestyle adjustments are sufficient to control symptoms. PMS treatment differs from woman to woman; patients are instructed on various treatment approaches such as nutrition, home remedies, contraception, exercise, herbal medicine, dietary supplements, and diuretics⁷. Pharmacotherapy has always been the front line of treatment for premenstrual syndrome, but new research suggests that combination therapy is superior. NSAIDs are non-narcotic medications that are used as a non-addictive alternative to opiates²⁷.

Reflexology is a natural healing therapy that is extremely effective in treating a wide range of health issues. Foot reflexology promotes balance and well-being with long-term effects. Reflexology benefits include reducing premenstrual syndrome, releasing stress and tension.²⁸. Acupressure is also a promising therapy to get relief from PMS²⁹.

Table. 1. Allopathic treatment of PMS

Sr. No	Therapy given	Example	References
1	NSAIDs	Naproxen, sodium (Anaprox)	15,22
2	Regular exercise and healthy diet	The consumption of complex carbohydrates raises the level of tryptophan, a serotonin precursor.	23
3	Cognitive-behavioural therapy (CBT)	CBT assists in the identification of these behaviours as well as the development of coping strategies to improve daily functioning.	25
4	combined oral contraceptives	ethinyl estradiol and drospirenone	30
5	SSRIs (selective serotonin receptor inhibitors)	Fluxetine (sarafem) Sertraline (Zoloft) Fluvoxamine (luvox)	22,26
6	gonadotropin-releasing hormone (GnRH) agonists	Leuprolide (lupron) Goserelin (zoladex) Nafarelin (synarel) Histrelin (supprelin)	22
7	Diuretics	spironolactone	22

Table. 3. Herbs use for the treatment of PMS

Herb	Uses	Dosage	Reference
Asoka (Saraca asoca)	The tree bark is a pain reliever and contains naturally occurring phytoestrogens that can help normalise menstrual flow	take two to three ml of asoka bark mixed with water, fruit juice, or even cow's milk.	32
Shatavari (Asparagus racemosus)	This plant works as an anti-inflammatory and promotes good digestion and reproductive health.	powder form combined with an Anupam, such as ghee or milk, to assist the body's processes absorb it.	32
Trikatu (Piper longum Linn, Zingiber officinale, Piper nigrum Linn)	Trikatu is primarily used to improve digestive health and as a pain reliever, making it an excellent option for PMS symptoms including cramps, an upset stomach, or bowel problems.	Powder form one teaspoon twice a day in water	32
Lodhra (Symplocos racemosa Roxb)	When taken orally, it works as a uterine tonic to help with severe bleeding and cramps.	Treatment of PMS-related hormonal acne is effective with lodhra powder.	32
Brahmi (Bacopa monnieri)	Reducing stress and getting more restful sleep are two simple and natural methods to lessen PMS symptoms.	2 teaspoon powder twice a day in water	32

ACKNOWLEDGMENTS:

Ms. Riya Kamble (Konkan Gyanpeeth Rahul Dharkar College of Pharmacy and Research Institute, Karjat, 410201, India) and Ms. Amisha Bhopatrao (Konkan Gyanpeeth Rahul Dharkar College of Pharmacy and Research Institute, Karjat, 410201, India) both have help us in literature search and to find out ayurvedic and allopathic treatments for PMS.

CONCLUSION:

PMS occurs widely across globe to nearly about 5% of women. And treating PMS is extremely difficult and cannot completely rely on their individual treatment. It is desirable the patients undergo primary medications afore mentioned and some physical exercise which may give some relief from PMS symptoms. The diagnosis of PMS is necessary to be examined because its diagnosis need to be carried out separately than other disorders including blood hormonal balance and behavioural pattern of that female and some physical changes which occur at the time of PMS. And once it is diagnosed the proper consultation of gynaecologist or general physician must be taken to confirm the clinical indications of PMS. Subsequently, she must undergo such medication along with counselling to get rid of PMS. Thus, the recommended therapy for PMS includes both allopathic and ayurvedic treatment to cure and prevent PMS²².

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Received on 01.08.2023 Modified on 24.02.2024

Asian J. Res. Pharm. Sci. 2024; 14(3):268-272.

DOI: 10.52711/2231-5659.2024.00044

Type of PMS	Ingredients	Dosage	Reference
Vata	1) Dashamoola tea, 2) Aloe vera gel with a pinch of black pepper	12 teaspoon dashamoola in a cup of hot water twice daily., 1 tablespoon three times per day before eating.	31
Pitta	1) Sukumara grutham or Dadimadya grutham, 2) Aloe-Vera gel with a pinch of cumin powder.	1) 1 teaspoon on empty stomach in the morning. 2) 1 tablespoon	31
Kapha	1) Cherries 2) Aloe vera gel with a pinch of trikatu (equal amounts of black pepper, pippali and ginger can be considered as a traditional Ayurvedic formula)	1) 10 cherries daily on an empty stomach before the expected onset of your period. 2) 1 tablespoon	31