Pre-menstrual Syndrome

By Dr Andrew Lockie MB ChB DRCOG MRCGP MFHom and Dr Nicola Geddes MB ChB MSc Nutrition MFHom

PMS is a constellation of symptoms, both physical and emotional, which affect many women in the days leading up to a period, for anything from two to 14 days. It is only relatively recently that it has been recognised and accepted as a disorder with a physical cause. The term pre-menstrual syndrome (PMS) is more comprehensive than pre-menstrual tension, and is preferred by women as it has a less sexist, accusatory ring. The symptoms are relieved almost as soon as the period starts. It is a very common complaint, affecting three out of four women aged 30-40.

The social implications of PMS are considerable. There is an increased incidence of anti-social behaviour, accidents, illness and psychiatric crises in pre-menstrual women. Examples of this include poor standards of school work, with fewer passes and distinctions; schoolgirls receive more than the expected number of punishments, and are more forgetful and unpunctual. A three to five per cent increase in absenteeism from work occurs around the period time. Symptoms may be severe enough to cause a fear of crossing the road or driving, so the sufferer becomes isolated, preferring to stay close to home.

Behaviour of the sufferer that is different from the norm influences the lives of partners, children, neighbours, and friends. Aggressive behaviour towards the partner may lead to counter-violence.

Children are very sensitive to their mother’s emotional state, and may respond to inexplicable mood swings by psychosomatic symptoms such as a cough, runny nose, crying and vomiting. Thus, in addition to the unpleasant symptoms and feeling of not being in control that the sufferer experiences, she may also feel guilty about the effect she is having on those closest to her. This may account for the significant number of attempted suicides in the pre-menstrual phase.

Causes and symptoms
The causes of PMS are many and varied. They include hereditary predisposition, emotional causes and dietary errors. Metabolically it is possible to recognise four main sub-types of PMS, depending on the symptoms experienced. 

Type 1 PMS A:  Symptoms are nervous tension, mood swings, anxiety and irritability. This is the most common type, affecting 65 to 75 per cent of PMS sufferers. 
Type 2 PMS B:  Symptoms are of fluid retention, weight gain, breast heaviness and swelling and abdominal bloating. This affects 65 to 75 per cent of sufferers with PMS and appears to be due to excess aldosterone production, which produces salt and water retention. 
Type 3 PMS C:  Symptoms are sweet craving, increased appetite, dizziness and fainting. This affects 24 to 35 per cent of pre-menstrual women, and is due to decreased carbohydrate tolerance.
Type 4 PMS D:  Symptoms are depression, crying, confusion, forgetfulness and insomnia. This affects 25 to 35 per cent of women, and is more commonly found combined with PMS A, which occurs first and is followed by PMS D symptoms a few days before the onset of a period. It is characterised by high progesterone and low oestrogen.

Additional Symptoms
1. Skin disorders, increased tendency to acne. Skin becomes blotchy and dull with blemishes and whiteheads, and there may be a tendency to bruise. The skin is often more greasy.
2. Aches and pains due to (a) increased pressure within the tissues as retained fluid starts to collect, pressing on the nerve endings; (b) increased state of tension of the muscle fibres, possibly due to actual pre-menstrual effect on the muscle fibre, though it may also be due to mental tension; (c) painful periods caused by congestion of blood vessels in the pelvis and the genital regions – giving rise to a dull persistent pain in contrast to spasmodic period pains; (d) clumsiness.

Other more unusual symptoms are as follows: apathy, agoraphobia, panic attacks, fright, phobias, aversion to company, suspicion, feeling of detachment, suicidal tendencies, swelling of upper eyelids, hair loss, sinusitis, sore throat, numbness of the throat, backache, swelling of the hip and lower back, cutting pain in the legs, itching irritation and burning in the vagina, vaginal discharge which may be yellow and offensive, aversion to intercourse, pain on intercourse, burning pain in bladder, increase in wind and alternate constipation and diarrhoea, hot feet and a general feeling of being worse between 3 and 5pm.

Homeopathic treatment
The best course of action is homeopathic constitutional treatment, although the remedies listed below are well worth trying.

Specific remedies to be taken every 12 hours for up to three days, starting 24 hours before pre-menstrual symptoms are due. All remedies to be taken in 30c potency.

Sepia
Irritability – worse for stress; depression; indifference; agoraphobia; weepiness; difficulty in concentrating; wanting to get away from everyone; emotionally flat; suicidal; fits of screaming; possible violence; anger; hair falling out; headaches in general; pressure on top of the head; chronic sinusitis; greasy facial skin; hot flushes on face; sore throat with numbness; desire for sweets and salty things; tenderness, dragging, bearing down pains in lower abdomen; anal fissure; burning pain in vagina; yellow, burning, offensive vaginal discharge; itching of vagina caused by discharge; discharge after intercourse with tendency to thrush – worse after childbirth; aversion to sexual intercourse or just reduced sex drive; prolapse of the womb; may have endometriosis; pain in vagina on intercourse, symptoms worse at menopause; sore nipples; palpitations.

Generalities: muscular tension – worse between 3 and 5pm; trembling weakness and weariness in morning. Symptoms worse after periods.

Calcarea
Depression; indifference; agoraphobia; weepiness; irritability; panic attacks; suicidal; apprehension; fearful, especially in public places; dizziness; headache before periods; general tendency to headaches; pains in back of head; greasy facial skin; sore throat; desire for sweets, sugar, salt and eggs; yellow, burning vaginal discharge causes itching; tendency to thrush; PMS worse since pregnancy; prolapse of womb; pain in womb during periods; swelling and tenderness of breasts before periods; backache; clumsiness; swollen ankles; swelling of hands; cutting pains in thigh; sleeplessness.

Generalities: painful joints; tiredness and lack of energy; weakness with cold sweats; tendency to put on weight.

Lycopodium
Irritability – worse for stress; depression; lack of self confidence; weepiness; difficulty in concentrating; wanting to be left alone; suspicious; mistrustful; feeling of being detached; violent behaviour; fearful in a crowd of people; weepy after periods; anger; hair falling out; headaches before periods; greasy facial skin; hot flushes on face; sore throat; nausea; desire for sweet things; desire for sugar; bloated abdomen; dull aching pains; bearing down pains in lower abdomen; irritable bowel syndrome; yellow vaginal discharge; aversion to sexual intercourse; may have endometriosis; tender nipples and breasts; backache; swelling of back; swollen fingers, hands, feet and ankles.

Generalities: joint pains; general weakness; trembling; weakness in morning; weakness with sweating; tendency to put on weight.

Pulsatilla
Irritability – worse for stress; depression; indifference; lack of self-confidence; weepiness; burst into tears for no reason; desire to be alone; suspicious; mistrusting; feeling of detachment; suicidal; indecisiveness; anxious about the future; fearful in public places; fearful in a crowd; dizziness; headaches before periods; swelling of upper eyelids; bloated abdomen; dull aching pain and bearing down pains in lower abdomen; cramping pains -better for heat; irritable bowel syndrome; urgent need to pass water; burning pain; burning pains in vagina; burning yellow vaginal discharge, with tendency to thrush; PMS worse since pregnancy; prolapse of the womb; pain in womb during periods; periods irregular and may be scanty; symptoms worse at menopause; tender breasts; backache; hot feet; swollen fingers, ankles and feet.

Generalities: joint pains; weakness; muscular tension; tendency to weight gain.

Sulphur
Weepiness; irritability; desire to be left alone; mistrustful; anxiety; violent; angry and apprehensive; hair falling out; headache before periods; drawing pains in head; swelling of upper eyelids; chronic sinusitis; greasy facial skin; hot flushes on face; sore throat; marked desire or sweets, sugar and salt; dragging bearing down pain in lower abdomen; constipation; anal fissure; irritable bowel syndrome; urgent need to pass water; burning pains in vagina; yellow, burning offensive vaginal discharge which causes itching; aversion to intercourse or reduced sex drive; pain in vagina on intercourse, worse at menopause; painful nipples; clumsiness, hot feet; swelling of fingers and hands.

Generalities: joint pains; PMS worse during convalescence from illness; tendency to put on weight.

Lachesis
Irritability; difficulty in concentrating; aversion to company; suspicious and mistrustful; detached feeling; suicidal; violent; indecisive; symptoms worse for stress; dizziness; hair falling out; headache before periods; sore throat worse on left side; bloated abdomen; tenderness in abdomen; constipation; anal fissure; irritable bowel syndrome; menopause; burning, vaginal discharge; PMS worse since pregnancy; tender nipples; palpitations; backache; clumsiness; swollen ankles; aching pains in hips; swollen hands; sleeplessness.

Generalities: symptoms better at beginning of period; weakness and heaviness in morning – worse after periods are over.

Natrum mur
Depression; indifference; lack of self-confidence; weepiness; definite aversion to company; detached feeling; anxiety; suicidal; violent; fearful in a crowed; symptoms worse for stress; hair falling out; headaches before periods; pressure on top of head; greasy facial skin; nausea; desires salty and sweet things; anal fissure; irritable bowel syndrome; burning pain in vagina; itching from vaginal discharge; tendency to thrush; aversion to intercourse or reduced sex drive; pain in vagina on intercourse; swollen tender breasts; palpitations.

Generalities: weakness; muscular tension; trembling; weariness in morning; fluid retention.

Nux vom
Indifference; lack of self-confidence; agoraphobia; irritability; difficulty in concentrating; aversion to company; mistrustful; anxiety; suicidal; violent; fearful in public places; fearful in a crowd; anger, symptoms worse for stress; dizziness; drawing pains in head; chronic catarrh; acne on face; sore throat; nausea; desire for fatty foods, rich foods, alcohol; bearing down pain in lower abdomen; constipation; anal fissure; irritable bowel syndrome; frequent need to pass water; yellow, offensive vaginal discharge with tendency to thrush; PMS worse since pregnancy; pain in womb during periods; worse at menopause; tenderness of breasts; backache; clumsiness.

Generalities: joint pains; muscular tension; weariness in the morning; generally worse after periods as well as before, chilliness.

Phosphorus
Worse for stress; indifference; panic attacks; difficult concentration; feeling of detachment; violent; apprehensive; weepiness after periods; anger; dizziness; hair falling out; greasy facial skin; acne on face; nausea, desire for sweets, sugar, salt and salty things; dragging down pain in abdomen; anal fissure; irritable bowel syndrome; urgent need to pass water; menopause; burning vaginal discharge; aversion to intercourse; clumsiness; swollen fingers, ankles, feet and hands; cramps in calves.

Generalities: joint pains; weakness; PMS worse during convalescence from and acute illness; muscle tension; tendency to put on weight.

Graphites
Weepiness; irritability; difficulty in concentrating; anxiety; indecision; hair falling out; swollen face; hot flushes on face; constipation; anal fissure; burning pain in vagina; yellow vaginal discharge, with tendency to thrush; reduced sex drive; symptoms worse at menopause; tenderness in breasts and nipples; clumsiness; cutting pains in thigh; swelling of fingers, ankles and feet.

Generalities: weakness; generally worse after periods; tendency to put on weight.

Kali carb
Irritability; panic attacks; angry; tense; hair falling out; swollen upper eyelids, like a little bag or pouch; chronic sinusitis; swollen face; desires sweets, sugar; dull aching pain; gnawing pain in abdomen; constipation; irritable bowel syndrome; urgent need to pass water; reduced sex drive; pain in vagina on intercourse; symptoms worse at menopause; swollen, tender breasts; backaches; sleeplessness.

Generalities: joint pains; trembling; tendency to weight gain; exhaustion; symptoms worse around 3am.

Silicea
Lack of self-confidence; difficulty in concentrating; hair falling out; pressure on top of head; greasy facial skin; acne on face; sore throat; cramping pains – better for warmth; constipation; anal fissure; offensive vaginal discharge; tender nipples; clumsiness; swollen feet.

Generalities: joint pains; symptoms worse during convalescence from acute illness; muscle tension.

Belladonna
Worse for stress; irritability; aversion to company; mistrustful; suicidal; violent; headache before periods; feeling of pressure on top of head; sore throat; dragging pains; burning in vagina; tendency to thrush; PMS worse since pregnancy; pain in womb during periods, symptoms worse at menopause; clumsiness; cutting pains in thigh; swollen hands; sleeplessness.

Generalities: joint pains; weakness; weariness; tendency to gain weight.

Causticum
Depression; weepiness; irritability; difficulty in concentrating; suspicious and mistrustful; pessimistic; over-sensitive; greasy facial skin; acne on face; sore throat; frequent urge to urinate or signs of cystitis; anal fissure; itching from vaginal discharge; PMS symptoms worse since pregnancy; aversion to sexual intercourse or reduced sex drive; tender nipples; backache; clumsiness; swollen feet.

Generalities: joint pains; weakness.

This article is taken from The Women’s Guide to Homeopathy by Dr Andrew Lockie MB ChB DRCOG MRCGP MFHom and Dr Nicola Geddes MB ChB MSc Nutrition MFHom published by Penguin Books, price £14 (paperback only).