PMS is no joke

 When a woman loses her temper, gets moody or gives a snippy response, it is often laughingly blamed on PMS which has become a catchall explanation for female bad-temperedness.
   But for women whose premenstrual symptoms leave them incandescent with irrational rage, or suffering from chronic insomnia or with crippling depression, it’s no joke.
   PMS is no longer considered a mythical side-effect of periods and doctors now take it more seriously than ever before.
   Gynaecologist Dr. Barry Richter explained that PMS can manifest itself both physically and psychologically.
   “Symptoms can range from physical symptoms like abdominal bloating and breast tenderness, or more psychological symptoms like moodiness, anxiety, feeling a little bit down or aggression, or it can be a combination of physical and psychological,” he said.
   There is no shortage of women who turn to medical professionals to rid themselves of PMS. Some women never get it, others get a mild form of it, while for some, it is a monthly nightmare from which they can’t wake up.
   Treating it can be a challenge, especially as symptoms are so varied, doctors say.
   But Dr. Richter, who is based at the Cayman Clinic, said sometimes treatment can be straightforward.
   “Over the years I’ve found people respond best to a simple solution. A lot of people just don’t accept that until they try it and then find they respond really well to it – it’s a healthy diet and regular exercise.
   “That works really well for most people. It’s the best long-term cure,” he said.
   For those who do not respond to diet and exercise or who don’t want to give it a try, there are medical treatments available.
   “Other medical treatments for bloating are low doses of diuretics. If there are more psychological symptoms, it helps to go on a low dose of oral contraceptive to stop ovulation and stop hormonal swings,” Dr. Richter said.
   Some women turn to supplements like evening primrose oil, which have been found to help, he said.
   “Some anti-depressants are [US Food and Drug Administration] approved for PMS symptoms, like Prozac. I have found limited long-term success with those. They can have a lot of side effects, but people take them in the more severe cases,” he said.
   Another Cayman-based gynaecologist, Dr. Sarath de Alwis also sees a lot of patients with debilitating PMS and he says the symptoms are wide and varied.
   “PMS is very common. There can be up to 200 different symptoms. Some people have 100, some can have one, some can have six or seven,” he said.
   The doctor, who has a clinic at Chrissie Tomlinson Memorial Hospital, said research into the phenomenon of PMS had been continuing for 30 years.
   Doctors have been treating PMS with a variety of medications and approaches for decades. These include drugs, hormones, behavioural modification, acupuncture, hypnotherapy, counselling and advising patients to cut out caffeine, change their diet and take more exercise.
   Dr. de Alwis describe one patient in his care whose psychological symptoms were so severe, she threatened to kill her own children.
   “She got so mad and angry sometimes, she would say that. She’s fine now,” he said, adding that some patients become so aggressive that they can assault others “quite easily”.
   How he treats patients with PMS depends on their symptoms. There is no single cure, he said.
   “You have to take a holistic approach, not just one symptom at a time,” Dr. de Alwis said.
   “You have to analyse them and spend a lot of time with the patient,” he said.
   Patients are often asked to keep a menstrual diary over a number of months, so Dr. de Alwis can see how the symptoms present themselves.
   With some patients, treatment is as simple as talking to them and explaining what is happening to them, he said.
   As both doctors pointed out, exercise can remedy some of the symptoms of PMS.
   Yoga can ease some of the psychological stresses and anxieties wrought by PMS, says Janelle Kroon, co-owner of Bliss
Living Yoga in Marquee Plaza fitness studio in Cayman.
   “Yoga soothes the body and eases the mind. There are a number of exercises that help to combat PMS,” she said.
   These include breathing exercises, like alternative nostril breathing and Katalabhati breathing, which is an internal cleansing technique.
   Ms Kroon also recommends the simple Child’s Pose as an exercise everyone can do and one that immediately relaxes the person. “It calms the body and mind. Doing this pose benefits without applying any pressure on the abdominal area,” she says.
   The Bow Pose is also beneficial, she said, helping to strengthen muscles in the back and improve posture. “The blood flushes through the abdominal area, through the reproductive area,” she said. Eagle Pose can also be done as it has a tourniquet effect. “When you release out of the pose, blood rushes to the joints and reproductive region,” she explains.
   Another pose she says works wonders is Downward Facing Dog which increases lymphatic blood flow by 15 times.
   The Frog Pose, which stretches the legs and spreads the hips is good for the bloating that many women get prior to their periods.
   “Yoga overall is good for depression and anxiety. It elevates mood. Also it helps blood flow,” Ms Kroon said.
    Women who suffer severely from PMS should consult their doctor.
   “PMS is very common. There can be up to 200 different symptoms. Some people have 100, some can have one, some can have six or seven.” – Dr. Sarath de Alwis