PMS or Premenstrual Syndrome has for centuries been marred with prejudice, scorn and lack of recognition or understanding in the Western culture. The medical community up until the late 1980’s refused to acknowledge PMS as actually being a disorder and generally characterized and discounted it as a discomfort. Most feminists attributed this to the fact that the medical community at that time consisted mainly of men who subjugated women, telling them to take as doctrine the ideologies and diagnoses that men themselves could feel no empathy or sympathy for - simply because they could not take the measures to understand it. Until recently, women were told that their symptoms were those of a hypochondriac or of a psychiatric nature or, worst, that there was no physiological evidence to support their existence. Of course, many men would offer refusal, rather than research. Research would offer a solution to this myth, as well as the diffusion of innuendoes. It would also shake the already frail ego of endurance. Most women deal with discomfort of some sort at least two weeks out of the month, every month, and yet most women brave it with stiff upper lips.
Many different cultures celebrate the menstrual cycle in many original ways, all depending on the religion, values and ethics of that culture. Here are a few cultures and their views on PMS:
India
In the South of India and in Ceylon, the Brahmin community performs a traditional ritual to celebrate the beginning of menstruation called Samati Sadang. The hope is that the girl will lead a fertile life. The girl sits on a bed of banana leaves while she eats raw eggs flavored with ginger oil. Afterward, she is given a ceremonial bath in milk. When the ritual is over, the whole family comes together to feast and celebrate her becoming a mature female.
When a Nayar girl of India begins her period, she may be secluded from men and visited by neighboring women dressed in new clothes. This is the first time she will begin wearing a sari, a traditional woman’s dress of her culture. Later, her friends give her a ceremonial bath and then go to a feast of food, celebratory music and cheers.
Japan
While I was stationed in Okinawa for three years, I noticed that tampons come with little finger coverings – plastic finger protectors – so that women do not have to touch themselves “down there” when they insert them.
Native American Tribes
The Hopi, like many other cultures, have several myths about the magical powers of menstrual blood. “The Bloody Maiden Who Looks After Animals” is a mythological woman, who, legend has it, was angry with some Hopi hunters. She killed them and then appeared before all the people covered with blood. She then grabbed a nearby antelope with one hand and wiped her other hand over her vulva. With the hand coated with her menstruation blood, she wiped the antelope’s nose while twisting it and then let it free. She then told the people that from then on it would be very hard to hunt the antelope.
Ivory Coast
An elder (an older, respected member of the community) of the Beng people of Africa’s Ivory Coast explains menstruation as such:
“Menstrual blood is special because it carries in it a living being. It works like a tree. Before bearing fruit, a tree must first bear flowers. Menstrual blood is like the flower; it must emerge before the fruit – the baby – can be born. Childbirth is like a tree finally bearing its fruit, which the woman then gathers.
Various cultures have very different beliefs about a woman’s cycle, but few discuss the effect prior to discharge, based on a lack of understanding. To begin to understand PMS, we must first define Premenstrual Syndrome. PSM is a syndrome, syndrome meaning a collective of over 150-plus associated symptoms, both mental and physical. PMS appears between puberty and menopause but generally occurs in women between the ages of 25-45 and is exclusive to the female gender. The first sign of PMS is an irregular menstrual cycle. The menstrual cycle is the process that prepares the uterus to accommodate a pregnancy.
When conception does not occur (an egg is not fertilized), the failure to conceive results in the menstrual flow, the process by which the body dispenses unfertilized egg and its supportive hormones, vitamins and fluids. This process usually begins in females at the age of 12 and is called “The Menarche,” which cycles monthly until about the age of 50 when she starts another process called “Menopause.”
Women generally have a regular cycle of periods. The length of a normal menstrual cycle varies anywhere from three to five weeks, with menstruation lasting between three to seven days. The "average" menstrual cycle is estimated at 28 days and the first day of bleeding is arbitrarily called "Day One" of the cycle.
Menstruation is controlled by a series of hormonal interactions between the brain and the ovaries. During the early part of the cycle, Follicle Stimulating Hormone (FSH) is released by the pituitary gland. FSH triggers the growth of follicles in the ovary where the egg is stored. As the follicle grows, it secretes estrogen in increasing amounts. This is called the proliferatory phase of the menstrual cycle. The estrogen causes the lining of the uterus (endometrium) to grow, or proliferate. When the egg approaches maturity inside the follicle, the follicle releases a burst of progesterone and estrogen.
The pituitary secretes FSH and also Luteinizing Hormone (LH). The peak of FSH-LH signals the release of the egg from the follicle -- ovulation. Under the influence of LH, the follicle changes its function and begins to secrete less estrogen and more progesterone. The progesterone causes further changes in the estrogen-primed uterine lining to prepare for the implantation of a fertilized egg. This is called the secretory phase of the cycle (wash out). After ovulation, the LH and FSH levels return to baseline. If fertilization does not occur, the follicle no longer makes hormones, resulting in menstrual flow.
Considering the complex hormonal interplay involved in the menses, it is understandable that some women will have abnormal or irregular patterns.
Some women will have heavy bleeding with frequent periods or midcycle spotting (dysfunctional uterine bleeding), while others have light, unpredictable periods or may skip months altogether (amenorrhea). Both types of periods may result from the same problem -- a failure to ovulate or release eggs (anovulation). Women usually cease to ovulate at the beginning or the end of their reproductive lives. In the younger female, the pituitary hormone levels may be too low to trigger ovulation; in older women, FSH and LH levels are high but the ovaries do not produce enough estrogen to cause normal menses.
The changes in hormone levels that accompany normal aging help to explain why the type of period a woman has may change with age or after childbearing. This plays the greatest part in actual PMS. For example, a young girl may begin to menstruate painlessly, but in her late teens or early twenties, the periods may change in character and she may begin to have severe cramping (dysmenorrhea) with her periods. This may indicate that she was not ovulating with her periods at first and when she did begin to ovulate she began having cramping. But one cannot discount that adverse unpredictable result of hormone fluctuations.
An ovulation can be brought on by organic, environmental, and/or emotional causes. Medical problems such as obesity, thyroid disorders or other endocrine disorders can result in anovulation (eggs not released). More often, the cause is not serious; weight gain or loss, heavy athletic training or stress may cause anovulation. It is possible that a week of final exams or an airplane flight might be the cause of an abnormal menstrual cycle. The medical community is still researching conclusive findings.
Other causes of irregular bleeding include infections, fibroid tumors of the uterus, and endometrial cancer. Therefore, it is recommended women with irregular bleeding or amenorrhea (absence of periods), be examined by a health practitioner, so that treatable causes can be identified before any hormonal treatment is initiated.
There are several treatments that are available for PMS and PMS-related conditions; however, as stated earlier, PMS has not been researched to the extent that (in the opinion of this writer) appropriate medication can be pharmaceutically prescribed. Therefore, rather than incite the trendy advertisements made by companies to entice women to buy their products, I will introduce natural remedies and practices to ease the discomfort and instability of PMS and PMDD.
Here are a few recommendations and remedies.
General Rules of Nutrition
· Take several (around six) small meals a day. Don’t go for more than three hours without food.
· Decrease intake of refined sugar, salt, red meat, alcohol, and caffeine (coffee, tea, soft drinks with caffeine, chocolate).
· Increase intake of complex carbohydrates, leafy green vegetables, fruit cereals, and whole grains.
· Take Vitamin B6 (pyridoxine) supplement. Dose between 50 mg and 300 mg daily are usually sufficient to alleviate PMS symptoms. Do not exaggerate the dose, as side effects (numbness and tingling in the hands and feet) may occur with mega doses of vitamin B6 (the side effects are reversible and disappear after discontinuation of the vitamin).
· Take vitamin E supplement. Doses of 600 IU daily can decrease the tenderness of the breasts and size of the breast lumps.
· Take Magnesium supplement (look for amino acid-chelated magnesium). Magnesium relieves sugar craving and breast tenderness. Doses of 300-500 mg/day are efficacious, and are needed only during the time when the symptoms are present.
· Take primrose oil, around 1500 mg per day. This supplement should relieve mood swings, irritability and depression symptoms.
· Cut out salt and drink more water to reduce bloating; avoid high-sugar foods, caffeine and alcohol to improve mood and energy. Eat a diet rich in carbohydrates, fruits and vegetables.
· Taking calcium carbonate can prevent mood swings, bloating, depression, back pain and food cravings. This supplement is used to improve mood, reduce irritability and prevent weight gain.
· Fruit is widely used in Europe for PMS. Experts say chaste berry balances hormones (estrogen and progesterone) during a woman's menstrual cycle. However, do not take it if pregnant or diagnosed with depression.
Other Resources to Curtail the Effect of PMS
Work Place Education
Work place education is an indispensable resource in the relief of stress. Employees should not have to give special notice to employers when suffering from variants of PMS; it should be as recognized as any other diagnosed disorder.
Planning Ahead
By charting your menstrual cycles, you can accurately predict menstruation and therefore the pre-menstrual time. When you record your physical and emotional symptoms, such as acne, abdominal pain, cramps, clumsiness, slurring, memory, libido, energy levels, mood etc., against the record of your fertility, you can establish a premenstrual pattern of symptoms to diagnose PMS. You can at that point gauge and assess your reaction to different treatments and self care management. Your charts provide some "hard copy" to show to family, friends, doctors, and counselors to back you up and give them the information they need to support you during your difficult times. It is best to discuss how others can help before the symptoms appear.
Avoid Instant Cures
Pain and discomfort often force the bearer to seek, understandably, instant relief. What we must understand and appreciate is that this pain is a consistent, reoccurring pain. Often, as consumers, we fall prey to advertisers promoting an instant cure to an illness that is not fully understood. We need to realize that no such remedy exists to give instant relief.
As stated constantly in these writings, PMS is basically in its infant stage of research and remedy and we can all be rest assured that new developments will develop on a routine basis, some with encouraging results and some results encouraged by profit, with no real relief for the patient.
According to Carol E. Watkins, MD of the Northern County Psychiatric Associates, there is an estimated 40 to 80% of women generally affected. Of that percentile, 5% have the more severe symptoms of PMDD. At a later point, we will address the correlations of PMDD and PMS.
PMDD differs from PMS in that the symptoms (premenstrual) must create a marked impairment in your ability to function in everyday situations including work, home, social and relationship interactions. In other words, the emotional symptoms of PMDD (premenstrual dysphoric disorder) are significantly more pronounced than in the case of PMS. This research suggests that of the 80% of women who experience symptoms of PMS, approximately 20% of these women meet the diagnostic criteria for PMDD.
PMDD is a recent provisional additional to the American Psychiatric Association’s lists of recognized illnesses. This categorization merely acts to stigmatize the condition and further alienate women affected. Many are reluctant to discuss PMDD with their doctor. Others fall prey to the recent mass marketing of a specific drug, which promises effortless relief.
Diagnosis of PMS or PMDD is made by evaluating a pattern of symptoms. This explains why it so important for women to chart their menstrual cycle and symptoms. It is a simple matter of recording specific information on a calendar. Many women also find this practice helpful in allowing them to prepare themselves by calculating their next cycle.
Here is an example is based on a typical menstrual cycle of 28 days, with symptoms of PMS lasting 10 days. You may need to adjust this to comply with your cycle.
On the first day of your next period, count forward 28 days (make a cryptic mark to indicate the start of your next period). Then count back 10 days and make another cryptic mark to indicate the potential start of your PMS. (The cryptic marks are, of course, for privacy.)
The most common question posed about PMS is: what are its instigations and effects? PMS occurs each month, 2-14 days before a woman’s menstrual cycle. Most symptoms expire once the actual menstrual cycle begins. A common misconception is that PMS occurs during the cycle. PMS is the biological warning system of the female’s reproductive system, indicating the oncoming of her cycle. These indicators come in the form of hormonal imbalance and vitamin deficiency, as well as fluctuations in blood sugar levels. However, since the medical community has only researched this since the 1980’s, no clearly defined research has been established that can pinpoint this syndrome’s foundation. It is this writer’s belief that the female body builds up certain hormones, proteins and vitamins, as well as increases in sugar levels, in anticipation of nourishing life. When the ovum does not become fertilized, it is this writer’s opinion that the female body dispenses with its surplus inventory, which entails a negative or positive physical and mental response from the host female. Currently, as stated earlier, research is still in its development stages. Women today have renamed PMS accordingly as “Pamper Me Softly,” which clearly illustrates a greater need for compassion and understanding that women - for half a month, every month, during their fertile stages of age 16-55 – experience, in some cases, incredible discomfort, mood swings and irritability. As a man, it is unfathomable to even guess at the true nature of an affliction of this sort. I think that writing and researching promotes an understanding of the extent of female suffering, truly identifying its scale and scope.
Separately, I think that public awareness should be balanced against companies and their pseudo-quasi remedies that do not cure but blur the ailment. As indicated in this discourse, PMS is a relatively new disorder that has no true foundation of stability or regularity. The only truly common denominator is gender. Therefore, all manufactured remedies are guesswork in a puzzle with many unanswered questions. As a society, it is our duty to treat EVERY complaint with seriousness and concern, not minimize it as whimsical whining, simply based on gender stereotypes. This is another form of male-perpetuated prejudice. As a society, we digress when we open apertures like these even wider. It is the responsibility of each citizen to accept faults and good attributes equally. This is a typical Western response to a situation or application that is not understood. As illustrated earlier, PMS and a woman’s cycle is a cause for celebration, not concealment or embarrassment.
References:
Lori A. Futterman, RN., PH.D and John E. Jones, PH.D. (1998) The PMS and Perimenopause Source Book., Lowell House. pg 127, 129, 214-215
Stephanie Degraff Bender and Kathleen Keller (1996). PMS: Women Tell Women How To Control Premenstrual Syndrome, New Harbinger Publications Inc., pg. 158-164
Elsimar Coutinho with Sheldon J. Segal. (1999). Is Menstruation Obsolete?., OxfordUniversity Printing Press., Incorporated., pg. 53-60
Alma Gottilieb and Phillip Graham (1993). Parallel Worlds: An Anthropologist and Writer Encounter Africa., Crown Publishers Inc.: NY. pg 183, 238
http://www.aomc.org/NewsRelease.pms.html (2001). Hormones Trigger PMS symptoms – But Susceptibility Still A Mystery
http://onewoman.com/redspot/cultures.html. (2001). The Red Spot.
Carol E. Watkins, MD. http://www.baltimorepsych.com/PMS.htm. (2001) Dealing With PMS,
http://www.pmssolutions.com/PMSSymptoms.html (2001) PMS Solutions
