Article by Gomathi Reddy.
Oh, those three days of the month!
Do you feel edgy, feel like screaming at the mildest irritant, get into panic attacks with the home phone not being picked up? Do you feel like a water-filled balloon-dragging-on-with-work? Then you are one more of us experiencing Premenstrual Syndrome (PMS) or the more severe Premenstrual Dysphoric Disorder (PMDD).
What is PMS & PMDD?
PMS is a set of symptoms linked to the menstrual cycle. PMS symptoms occur 1 to 2 weeks before your menstruation or monthly bleeding starts. The symptoms usually go away after you start bleeding. PMS can affect menstruating women of any age and the effect is different for each woman. For some people, PMS is just a monthly bother. For others, it may be so severe that it makes it hard to even get through the day. PMS goes away when your monthly periods stop, viz., when you get pregnant or go through menopause.
Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS. The main symptoms of PMDD, which can be disabling, include:
- Feelings of sadness, tension, despair, anxiety or even suicidal thoughts
- Panic attacks
- Mood swings, frequent crying or crying too much
- Irritability or anger
- Disinterest in daily activities, relationships and sex
- Trouble thinking or focusing, a feeling of not being in control
- Low energy, food cravings or binge eating
- Sleep problems, trouble getting to sleep or sleeping too much
- Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
- Aches and pains in legs, around the hip area, lower back.
Note: Your PMS/PMDD symptoms mimic symptoms caused by Clinical depression, Chronic fatigue syndrome (CFS) or Irritable bowel syndrome (IBS). Talk to your physician about ruling out these possibilities before you start treating yourself for PMS/PMDD.
PMS appears to be caused by rising and falling levels of the hormones estrogen and progesterone, which may influence brain chemicals, including serotonin, a substance that has a strong effect on mood.
In a first of its kind a study led by Susan G. Kornstein, M.D., professor of psychiatry, obstetrics and gynecology from Virginia Commonwealth’s School of Medicine, it was found that the use of low-dose antidepressant medication on women with moderatetosevere PMS was “effective and well-tolerated.”
If you have more than 3 of the above listed symptoms then it is good to see your physician who can prescribe mild antidepressants called selective serotonin reuptake inhibitors (SSRIs) These drugs change serotonin levels in the brain and can be useful to cope with the PMDD symptoms.Some physicians suggest taking minor pain killers, while others advocate drinking lots of water and rest. But all of this is just a temporary cure that must be resorted to, month-on-month.
Is PMS and PMDD imagined?
Casting aside all your irritation, it might be of interest to take a peek at the many voices about PMS.
Some researchers suggest that PMS and PMDD are just “imagined.”Historically, PMS was considered to be a woman’s way of calling for attention; women were told that it was “all in their head.” To a society where a woman is only about her physiology and her reproductive organs, it was HER duty to keep it in good health. It was pointed out that diverting her energy to other interests was the cause of her losing energy to her uterus and ovaries.
This changed as women came out to work in drones during the industrial revolution and in many cases had to work long hours,equal to men, in factories. There were miracle remedies advertised in newspapers to endure those “tortuous processes of the menstrual cycle.” Edward Clarke’s book, “Sex in Education” even declared that women, “work their brain less” than school girls and hence suffer less. His study went on to be extrapolated as women endowed with stronger bodies and a stronger reproductive “apparatus,” under normal living conditions, and hence should not leave their homes. This became a rallying point for feminists who took strong exception to such theories and went on to demonstrate how women could balance work and home, inspite of their bodily functions.
The term “premenstrual syndrome” appeared first in an article published in 1953 by Dalton &Green in the British Medical Journal. Robert T.Frank’s paper titled “Hormonal Causes of Premenstrual Tension” published in the New York Academy of Medicine was one of the firsts to link hormonal imbalances as the underlying cause of PMS. Even after that it was felt that women were legitimizing the condition as a disorder and were seeking refuge under PMS for their irrational behavior, and expressions of anxiety. Only in the 80’s PMS was getting accepted as a legitimate variable for a woman’s functioning, in a social context.
Kathryn Clancy, an assistant professor of anthropology at the University of Illinois who studies reproductive behavior, shares that “Overall, PMS is not only physiologically dependent but culturally dependent. There are studies that show women have different PMS symptoms depending on their country of origin.” She adds that some women even use the idea to subvert culturally restricting concepts about femininity and feminine behavior. She shares, “Given cultural expectations that they will behave badly, women decide to go along with it in order to behave in the ways normally inaccessible to them, [like] being bossy, irritable [or] bold.”
But whatever the definition and perspectives, PMS and PMDD are a reality for most women.
PMS & PMDD – The numbers
Studies show that up to 60 percent of women suffer from PMS, while only about 5 percent suffer from PMDD. PMS and PMDD may have genetic roots, and can also be aggravated due to hormonal imbalances.
Compared to the western woman, an average Indian woman is quite less aware of PMS much less aboutPMDD. To an extent the South Indian homes address these issues within a social construct of providing relief to the woman, albeit a few layers of superstition.
Middle-class South Indian homesoffer a break for their women “those 3 days” of the month. Those three days, gender stereotypes take a back seat, as women take time off cooking and every other chore of the house, while boys and men execute all that is needed to keep the household on track. Their tender breasts, migraines, lower back pain, abdominal cramps and mood swings are considered to be part of the package of being a healthy woman.The upside is, it’s kind of forced rest for the woman. The downside is women are not allowed to even enter their kitchen or any place of worship as their bodies are considered to be “impure.”
But that’s not the norm across communities. In most modern Indian families, the lady of the house goes through her PMS and her three days just like western women.Indian women sidestep tradition forconvenience and get things done, in their frenetic lifestyles of balancing home and work. The stress on the modern Indian woman is much, much more and so are the PMS symptoms. These modern women defy stereotypical notions about their normal biological cycle, because they believe that their economic strengths give them the freedom to delegate work to domestic help and that they can choose to get a swing at Yoga, Pranayama, medicine – both allopathic and ayurvedic- and take help from a horde of Apps that guide her on what to do, during those three days.
What can I do to keep the symptoms away?
Lifestyle changes can add another positive dimension to your body, helping you to cope with those three days with minimal disruption to your work day.
Switch to a well-balanced diet
1. Forget calorie counts – it’spassé. You can’t keepweighing every chunk of food that goes down. Switch to moderate helpings of food. Add lots more fiber and less of fried foods to your mind palate. If you are over 30, it’s good to fill your plate with more vegetables and fiber foods than carbohydrates like rice or rotis. Keep the proportion 5:1 in favour of veggies and fiber. Fiber fills you up and keeps you satiated.
2. Omega-3 fats are anti-inflammatory and are not just good for your heart, but for your whole body. If you are a vegan, grab 5-7 spoonfulls of ground flax, hemp, pumpkin or chia seeds through the day. 5-10 walnuts a day would also suffice; and if you are an omnivore, you must indulge in sardines, herring and wild salmon. On a day when you have that awful presentation taking up your time and have no time for salmons, just gulp down a couple of cod-liver oil capsules and you sure can get your requisite Omega-3.
3. Cauliflower, cabbage, kale, broccoli, turnips – the Cruciferous family – are rich in sulphur containing compounds called glucosinolates which support detoxification and indole-3-carbinol which greatly reduce the risk of breast, colon and lung cancer. They also provide lignans and phtyoestrogens, to help with estrogen metabolism. But those with thyroid issues should watch the amount of intake of cruciferous vegetables. Some studies suggest that there is a risk of hypothyroidism with increased intake of cruciferous vegetables in people with iodine deficiency. So, if you have a thyroid issue, restrict your intake to 1-2 servings of the cruciferous family, a day.
4. Replace your regular 3-full meals a day with 4-5 small meals spread through the day. Releasing small squirts of glucose into your system is a better lifestyle than releasing large packets of it thrice a day.
5. Try horse gram the wonder bean. Take a spoonful of ground horsegram every day. It adds the right amount of protein, flushes out worm infections, treats coughs and ulcers, regulates blood pressure, excessive bleeding during pregnancy period or inconsistent bleeding during menstruation, it is a good astringent, diuretic and anti-oxidant, manages your cholesterol and fights obesity. It regulates the digestive system and wards off acidity. Horse gram plant is used to treat patients suffering from weak liver, spleen enlargement and colic conditions; drinking horse gram soaked water flushes out kidney stones. Considering that most of our modern health conditions are due to weakened organs in the abdominal area, it is a good idea to take 1 -2 spoon full of soaked horse gram every day. It keeps of all your organs in your abdomen in top shape.*Do not take horse gram if you are pregnant.
6. Eliminate alcohol, smoke, caffeine and reduce dairy especially 2 weeks before the onset of menstruation.
Get your supplements right
Get enough magnesium into your system. It helps calm menstrual pains. Magnesium chelate, citrate, or glycinate are the ones that you should gulp down if you are looking at nutrient supplements. Dietary sources of magnesium include green leafy vegetables, tofu, beans, legumes, nuts, seeds and whole grains.
Calcium supplements improve mood and symptoms such as bloating and cramps. 500 mg of Calcium citrate or carbonate, twice per day should be good for most woman. To avoid possible side effects like constipation and kidney stones, drink atleast 4 litres of water a day. Dietary sources of calcium include green leafy vegetables, tofu, and sardines. Though milk is a rich source of calcium, it is advisable to avoid milk 2 weeks before the onset of menstruation.* Those who are under iron or thyroid medication, or those being treated with corticosteroids should not take calcium at the same time as their other medications.
|Ages||Suggested Daily Intake|
|9 – 18||1300|
*Talk to your physician before you plan prolonged use of calcium supplements
Get enough vitamin D. Your body also needs vitamin D to absorb calcium. You can get small amounts of vitamin D from a few foods. You can also get vitamin D from the sun, but you need to protect your skin from too much sun. Many people need to take a supplement of vitamin D.
Vitamin B6 is an important cofactor for neurotransmitter production and helps with mood and energy. Dietary sources of B6 include pineapples, leafy greens, sweet potato, legumes, sunflower seeds, bananas, avocado, poultry and meat.
400 mg of Folic acid and 400 (international units) of Vitamin E are the other wonder minerals that can add health and balance to your body.
Maintain Your Estrogen Balance
Estrogen is a female hormone responsible for reproduction and the development of sexual characteristics. It plays an important role in the health of women. One of its benefits is that it protects your bones and helps keep them strong and healthy. It keeps you active as a woman. When estrogen levels drop, many women lose bone density and develop osteoporosis. Teens and young women who often miss their periods usually have low estrogen levels. As a result, their bones may not be as strong. For midlife women, the drop in estrogen that happens with menopause can lead to rapid bone loss. Estrogen replacement is ideally started during early menopause to maximize the benefit of bone preservation.
But an increase in estrogen levels can lead to varied functional and symptomatic challenges for women. So, you must get rid of the additional estrogen in your system. Estrogen imbalance being the root cause of mood swings, it is important not to circulate the estrogen back into your system.
A good place to focus is weight management. Fat tissue creates estrogen. Too much weight gain causes estrogen, and too much estrogen causes weight gain – it’s a vicious cycle. Balance your estrogen levels by maintaining a healthy Body Mass Index(BMI) between 18.5 and 24.9.
Cut down on your sugar, add lots of fiber, beef up your exercise regimen and be consistent in your practices.
Legumes, nuts and seeds provide phytoestrogens and fiber. They help balance the estrogen.
Switch to organic foods to avoid environmental estrogens from pesticides and growth hormones, in the case of animal products.
A healthy liver balances estrogen levels in your body. On the other hand, an unhealthy or weakened liver is unable to break down estrogen in the body and hence it keeps getting circulated into the system. Sulfuric foods like onions, garlic, egg yolks and citrus fruits detoxify the liver by expelling substances that damage the liver. So make them part of your daily diet.
Fibroids, cysts on ovaries and thickened endometrial lining through menopause, all of these lead to endometrial cancer –detecting any of these is a red flag that you must lower your estrogen levels. Keep in mind that estrogen levels generally decline,post menopause. Either which way, you must get rid of the extra estrogen your body is producing, or getting added through your foods.
Keep in mind:Soy/soy supplements add more estrogen into your system. If you are diagnosed with higher levels of estrogen then you must avoid such foods completely.
Avoid constipation. Irregular bowel movements can recycle your estrogen into your system. Adding more fiber to your plate can help you avoid this situation.
Exercise Every Day
Maintaining a healthy weight is synonymous with a daily dose of exercise. The easier to implement routines are walking and light jogging.
Wake up early, and be enthusiastic about grabbing your shoes. They say the biggest demotivation to start a regular exercise routine is the distance between your bed and your shoes. Once you are strapped to them, there should be no stopping you. Improvise as you go. Add some music, dance and chutzpah to your routine; if you prefer to be in a group, get into one of those clubs for runners and there are lots of people who are training to take their first run – they can be quite an inspiration, as you watch people in all shapes, sharing the only one thing that is needed to be there – their enthusiasm. Become part of their enthusiasm and you’ll stay motivated to get those shoes on, all 30 days of the month.
Read related: 10 Ayurvedic tips to wake up early in the morning
Exercise at least 4 hours every week. Weight-bearing and muscle-strengthening exercises help keep your estrogen level rights, and your bones strong and healthy. Some examples of weight-bearing exercises are dancing, jogging, elliptical training machines, aerobics and brisk walking. Some examples of muscle- strengthening exercises are lifting weights, using elastic exercise bands, lifting your own body weight or using weight machines. If you have osteoporosis, check with your physician before beginning a new exercise program.
listen to your body. Though some women vouch that exercise can make the period manageable as the endorphins released during a workout act as natural painkillers, if your body pain and cramps scream for rest, just respect it.
The Ayurvedic Solution
According to Ayurveda, a smooth menstruation is a sign of health and wellbeing in women.
When a woman experiences distress and discomfort, there is an underlying imbalance in the integration of mind and body. Therefore, Ayurveda does not view PMS as a disease or condition but rather as an imbalance of the three doshas – Vata, Kapha and Pittha – that can be corrected. Blockages in circulation, buildup of toxins and impurities are viewed as major contributing factors to discomforting symptoms that are tagged as “PMS.”
For example, a woman with a Vata imbalance can experience anxiety, depression, insomnia, constipation, headache, or severe cramps. It is also possible that a Vata-type woman would experience rapid shifts in mood, feeling spaced out, dizziness, faiting or vertigo with ringing in the ears. A woman with Pitta imbalance may experience anger, skin rash, diarrhea and excessive thirst. A Kapha type woman may experince tiredness, heavy feeling, lack of appetite, nausea and a feeling of being emotional and sentimental.
An Ayurvedic treatment for this phase focuses on diet and herbal substances to balance the doshas. For example, it is recommended to treat Vata PMS with an anti-vata diet focused on heavier and warmer foods. Agitaiton and anger associated with Pitta imbalance can be managed by avoiding hot, spicy, oily foods as well as alcohol and caffeine. Kapha imbalance can be manged by having lighter meals, taking bitter, pungent and astringent tastes and reducing salty, sweet and sour tastes in diet.
In addition to diet, exercise routines, such as yoga postures and light aerobic activity can reduce back pain, abdominal discomfort and can stabilize emotions. Massage treatments or self-massage with warm oils, pleasant music and pacifying aromas do stimulate natural pain killers and balance moods. And finally, meditation. Make it a part of your life and see your stress levels go down and energy levels buoy up. In all, Ayurveda uses a five-sense approach to treating this discomfort, naturally.
Talk to your Ayurvedic consultant to understand your body type and what will work for you best.
Maia Szalavitz, a neuroscience journalist for TIME.com quotes a study conducted by Dr. Sarah Romans of the University of Otago in New Zealand, whichconcluded that “women don’t have a predictable pattern of low moods preceding their periods, but that doesn’t exonerate reproductive hormones from having any role in how people feel.”
Maia Szalavitz adds that men may be experiencing the same fluctuations in testosterone with similar ups and downs in mood and emotional ability. It’s possible that women’s mood swings are attributed to their reproductive hormones because their “tracking the menstrual cycle provides a noninvasive window into their fluctuations.”
In the future, technology may provide some assistance to capture data better for both men and women, and come up with customized solutions for each person based on apps that track their exercise regimen, the quality of their food, their relationships and happiness metrics, their spirituality meter and their hormones.
Until then, there’s no reason why PMS has to take over your world once a month. Set these practices in motion so that you can feel your best all month long.
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Author Bio: Gomathi Reddy is a Marketing Communication professional with specific research interest in gender studies. She writes about issues that affect women – the physical, emotional and everything in between. As an online journalist she also writes about challenges that plague the Indian society and blogs on how to make her country a better place to live. Read her blog and connect with her, here