Pre-menstrual syndrome

Dr Julie Geraghty
talks about how wild yam helped a patient suffering from severe PMT

‘It must be the time of the month’, is quite often the response when a woman snaps at her partner, friends or colleagues. Premenstrual syndrome (PMS), the name given to the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman’s monthly period, is generally regarded and accepted as part and parcel of being a woman’s life despite the accompanying mood swings, fluid retention and abdominal pain. However, a small number of women find that their symptoms are severe enough to stop them living their normal lives, including Y a 29-year-old woman who was referred to the Homeopathic Hospital with menstrual migraine associated with symptoms in the right arm, and episodes of severe abdominal pain.

Patient symptoms
I asked the patient to describe her symptoms to me. Y told me: “I get migraines once a month with the start of my periods. I’ve also had two small bowel blockages since I asked my GP for the referral. The migraine starts with a pain between my neck and shoulders, then my head starts pounding and my whole right arm goes numb, like a dead weight. There’s a feeling as if something is pulling on my shoulder, it’s better if I put my arm above my head (she puts her right arm up over her head). I can’t hear properly in my right ear, my ear feels bunged up. And there’s a dot in the middle of the vision of my right eye. My head is pounding, I need to put pressure on my head to suppress the pounding.”

Further probing
I asked her which symptom as the worst. Her response was: “My arm is the worst, I can never get comfortable. I also get it at the mid-cycle, along with a slight headache, but it’s much worse with the migraines at the start of my period. It’s as if there’s a block of concrete in my arm, the whole arm is tingling, and the fingers go numb. There’s tremendous pressure on the joint by my neck, a pulling feeling in my joints between my shoulder and my head, as if someone is yanking on my arm. It’s better if I prop my arm up with pillows. I try to stretch it; I put it above my head. The migraine comes once a month but it affects me mid month too, so you don’t have much release from it. I can’t plan anything. It’s there in the mornings; it gets worse as the day goes on. It lasts two days and I feel a spaced out and nauseous.”

I then went on to ask the patient to describe the actual pain of the migraine. She said: “There’s tremendous pressure in my head as if my head is going to explode. I push against it with my pillow…pressure is the only thing that releases the feeling, as if all the blood vessels in there are wanting to burst. It’s a constant pain, excruciating, always worse on the right side at the back of my head. It’s so intense in a small area, as if all the blood is rushing to this part of your head, and there’s nowhere for it to go. Something needs to burst to relieve the pressure. I feel my arm is pulling me down, like I have an arm made of concrete. The arm feels so solid, the end of my fingers feel numb. I have to stretch my arm up above my head to get any relief.”

Bowel blockage
The patient had also mentioned two recent small bowel blockages so I asked her to tell me more about them. “It’s excruciating pain, you curl up into a ball. It eases if I stop eating and drinking, but they had to put me on a drip for two days until it unwinds itself,” she said. “I can’t stretch out, it’s knotted in a ball. I’m curled up rocking, I feel everything is in a big knot. It’s all entangled together, there’s no movement at all. worse, it gets solid; everything is stuck as if there’s a solid block there. There’s nothing you can do to relieve it …it feels as if one big bowel movement would empty it, but it’s one big blocked area, no softness anywhere. Now the skin of my tummy is flexible, but when I have the obstruction, I can’t grab the skin because it’s so stretched, so bloated. It doesn’t feel like gas, it feels like I’ve eaten boiled potatoes, which have formed one big solid thing with no movement to it, it feels it wants to come out but there are no small bits. It’s a whole big block that would have to come out to relieve the pressure. My whole body tenses up as I’m trying to go to the toilet. I feel pressure on my rectum, excruciating pain in my bottom as if all the weight is pushed onto it, but it can’t get out, as if it’s trying to get out of a hole that’s that big, but the block is twenty times bigger, a whole block is pushing on the tiny area. When you’re not trying to make a bowel movement, the pain is spread out, when you push, it centralises the pain to one small area. It’s very draining, you get so frustrated, something so simple is causing so much pain, no matter how much you try there’s nothing you can do. You can’t even pass wind; you can only go into hospital.

Stomach ulcer
The patient added that doctors thought that the pain was due to scar tissue from a burst stomach ulcer when she was 21. “I woke up with a fever, I was throwing up blood, I was taken to hospital and eventually they found out it was a small stomach ulcer that had burst, and I was given a blood transfusion,” she said. “They think that taking Nurofen for wisdom tooth pain had caused the ulcer. It happened again last year. I felt sick, the pain got worse and worse, I was taken to casualty, they did an x-ray and I had another burst ulcer. I was in hospital for 10 days and they did emergency surgery. I lost a lot of weight. The first time I felt as if I was dying when I was vomiting blood. The second time I had so much pain breathing I also felt like I was dying. They don’t know what caused it, I was told to stay on antacids forever. The first time when I was 21, I was drinking more, and I did take Nurofen for my wisdom tooth. Now I’m much healthier but I’m still completely at a loss as to why it happened last year because I hadn’t been taking any anti-inflammatories. When an ulcer bursts, it’s like a hole, things can go where they shouldn’t go, they cause your insides to flare up, everything gets red and full of pus, which causes pain. I’ve had two lots of bowel blockages which they say are caused by the bowel twisting around the scar tissue from the burst ulcers. The first was last year and the second was six weeks ago. With my bowel, there’s no way of knowing when the obstruction is going to come back again, so I’m always on tenterhooks. To me it feels as if my bowel got in a knot, all tangled up, screwed up in a ball. If you don’t eat, it slowly relaxes, untangles, it feels as if it’s squashed in a space where there’s not enough room, it’s all tangled. It relaxes it can move around, unravel, like when you wake up all curled up in a ball, you slowly relax, you stretch yourself out. When I wake up screwed up in a ball on my side, I stretch my legs out, any tension slowly goes down my body as I stretch, (she stretches her legs and arms out straight), and it’s like a complete release.”

Homeopathic diagnosis
This young woman has very severe symptoms that are interfering with her life. What’s interesting from a homeopathic point of view is the way that she describes these symptoms. In fact, I’d never heard anyone describing migraines and arm pains like she was experiencing. That’s the beauty of a homeopathy, when you go into it, even if patients have the same diagnosis like ‘migraine’, the individual experience of the migraine will be very different for each person. She also has two completely different sets of symptoms, migraines with arm pains, and burst ulcers causing blockages due to scar tissue, but we are looking for a homeopathic medicine that covers both. As a homeopathic doctor we are trying to understand what is similar in the way that her body experiences these two different groups of symptoms. In this case, I found it fascinating that she described both the pain in her head and the pain in her bottom as a feeling of great pressure on a small area. She describes both the feeling in her arm and the feeling in her tummy as being completely ‘solid’. The thing that most relieves the arm pain and the tummy pains is stretching out, and ‘unwinding’ the solid knot.

Wild yam
This led me to a very interesting homeopathic medicine called Dioscorea Villosa. It’s made from wild yam, and has long been known as a remedy for unbearably sharp, twisting, colicky pains. These pains can occur pretty much anywhere in the body, but are particularly common in the tummy. The characteristic ‘keynote’ about these pains is that they’re better for stretching out, or bending backwards, and worse for doubling up. I decided to give Dioscorea Villosa 30c, one dose with the mid-cycle pains, and three doses 12 hours apart with the migraine pains.

Partial improvement
Two months later the patient returned for a follow up appointment. She said: “Last month, the medicine worked brilliantly with the mid-cycle headaches, it’s the best relief I’ve had. With the menstrual headaches, it only helped the arm symptoms, not the head pain. Now I only have very slight tingling in my arm, but no pulling pain or numbness. But I’m still getting the bad headaches when my period starts. I feel drained and nauseous, but I’m never actually sick.”

As she’d had a promising improvement in some symptoms, I decided to increase the strength of Dioscorea Villosa to 200c with pre-menstrual migraines, and continue 30c mid-cycle.

World of difference
Four months on the patient came back and reported: “The tablets are helping a lot; I’m feeling much better. The lower strength helps the arm symptoms a lot but sometimes it takes 40 minutes to kick in. The higher strength has definitely helped the migraines; I’m taking much fewer painkillers. I take the medicine three times a day for two days, but I think four times would be better. I’m amazed how quickly it works; within 15 minutes my headache is improving. I’ve been dreading my periods; they seem to come around again so quickly. The medicine has made the world of difference, the high strength is definitely much more effective. I haven’t had any tummy pains.”

I advised her to take the higher potency, 200c, up to four times daily, as it was clearly more effective than the 30c.

Effective remedy
Four months later the patient reported a marked improvement in her symptoms. She told me: “The medicine has made a huge difference, the four doses on the first two days of my period are very effective. They work very quickly and last for four hours. I only take one dose at the mid-cycle for the arm pain that helps hugely. I’ve also tried the remedy when I’ve had tummy pain, because of gas making me bloated, I’ve taken two doses on three different occasions and the pain has cleared up very quickly. Before it would take hours and I’d be afraid it would go into the knot. I feel so much better. I feel I can live again.”

Julie Geraghty MBChB MFHom DCH works at the Bristol Homeopathic Hospital and also has a private practice.