dark side of women (pms)

Op.Dr.Kenan Ertopcu

Premenstrual Syndrome (PMS) has existed since the existence of womanhood and even today its causes and solutions have not been fully elucidated. Is PMS a disease? Or is it a collection of physiological symptoms?
Many women experience some mental and physical changes that begin a week before menstruation and disappear with menstruation. In some women, these symptoms are very mild, while in others, they are severe enough to affect their work, social and private life.
Premenstrual syndrome complaints can be so severe that they can drive women and all people around them mad.
If most women experience this fluctuation and these experiences in the premenstrual period, can we consider it natural or normal? This syndrome can have more than 200 symptoms.How does it affect women’s life and environment?
PMS first entered the medical literature in 1931. PMS, which we can translate into Turkish as Premenstrual Tension Syndrome; It is a collection of symptoms that appear in the week before menstruation, disappear within a few days with menstruation after an average of 6 days, and are not seen in the first week after the end of menstruation. Mild premenstrual complaints are present in most women. In order to call these symptoms PMS, it must affect work, school and social life and lead to deterioration in them. It should also be known that these symptoms are not related to another illness or psychological condition such as depression, panic disorder and personality disorders.
It should be observed that PMS symptoms repeat at least two consecutive menstrual periods.
What are the symptoms of PMS?
Psychic symptoms of PMS; It may appear as a feeling of burnout, depression, hopelessness, fatigue, excessive sleepiness or insomnia, decreased interest in the environment, fluctuations in emotions, irritability, tension, sensitization, irritability, and a tendency to cry. Appetite changes, cravings for overeating, and cravings for certain foods, especially sugary foods, may be observed.
Physically, there may be tension and enlargement of the breasts, breast tenderness and breast pain, swelling in the whole body, especially in the abdomen, weight gain, headaches, muscle and joint pain, diarrhea or constipation. Libido (sexual desire) may decrease or, on the contrary, increase.
The most common and earliest symptoms of PMS are nervousness and tension (irritability).
Female defendants accused of murder, arson and assault in 3 cases in England in the 1980s were found not guilty on the grounds of Premenstrual Syndrome. These cases found wide coverage in the press.
Who gets PMS?
PMS is a reproductive age problem. The most common period is between the ages of 30-45. It is not seen before puberty and in menopause. It is thought to have a tendency to be inherited. PMS is more common in young girls whose mothers have PMS. If one of the identical twins has PMS, it is seen in 93% of the other twins.
PMS may be more common in overweight people. In addition, it may cause psychological trauma; PMS is more likely to occur in women who have experienced life events such as accidents, sexual abuse and violence. Stress is a risk factor for PMS.
How common is PMS?
Mild manifestations of PMS occur in up to 90% of women of reproductive age. However, PMDD (premenstrual dysphoric disorder), which is the severe form of PMS, is found in 3%-8% of women of reproductive age in different studies.
Why does PMS occur?
Many different views have been put forward regarding the causes of PMS. Throughout history, women and female sexuality have been viewed as bad and the woman has been compared to the devil. In 1873, Edward Clark, a professor of psychiatry at Harvard University, argued that educated women are unhealthy and less natural. Edward Clark explained this thesis as follows; Blood is drawn from the uterus to get more blood to the brain, and therefore more educated women are more aggressive, irritable and less fertile!
Today, the validity of such a thesis has not been accepted.
Although the exact cause of PMS is not known, the only thing that is known to be true is that PMS is associated with ovulation (ovulation).
PMS is observed in women of reproductive age with ovulation.
PMS findings are not very common, as ovulation is irregular within a few years after the first menstruation begins and in the pre-menopausal period. Since women with menstrual delays and irregularities or diagnosed with polycystic ovary may also have ovulation problems, we encounter less PMS complaints. PMS complaints are also less in women who suppress ovulation temporarily with birth control pills. PMS complaints do not occur in those who have lost their ovarian function after menopause or who have had their ovaries removed by surgery, chemotherapy, radiotherapy and other medical treatments.
Two hormones are secreted from the ovaries during the reproductive age of women. These are estrogen in the period before the egg is released and progesterone in the period after the egg is released. According to many scientifically accepted views, the effect of progesterone hormone on substances such as serotonin and GABA secreted from the brain causes PMS.
PMS is not observed as the progesterone hormone will not be secreted from the ovaries during periods when there is no ovulation. PMS is less common in women who do not have children due to ovulation problems.
According to some researchers, the decrease in the level of endorphins, also known as the happiness hormone, secreted from the brain causes PMS. In addition, there are those who advocate the view that the deficiency of vitamins A, E, B6 or the deficiency of minerals such as zinc and magnesium is the cause of PMS.
PMS treatment;
Women with PMS complaints on average 6 days a month experience this unpleasant experience every month for a total of 3000 days until menopause during their reproductive years. Especially women who experience these symptoms intensely may experience problems in their work, school, social and private lives and relationships, and therefore treatment should be given importance.
As in many diseases, the first and most important treatment in PMS is lifestyle changes.
Sleep patterns should be taken care of. Negative psychological symptoms of PMS can be improved by avoiding insomnia or excessive sleep. Exercise is important and can be helpful in preventing or reducing signs of PMS by increasing endorphins, known as the happiness hormone. As an intense exercise, for example, jogging can be done for at least 20 minutes a day 3 days a week, or brisk walking for at least 30 minutes a day at least 4 days a week as a moderate-weight exercise.
It should be fed in a balanced and regular manner. Nutrition should be in the form of 3 main and 3 snacks and attention should be paid to adequate calorie intake. Salt restriction may be recommended for women who complain of swelling (edema) due to water retention in the body. Smoking and alcohol increase the symptoms of PMS and should be restricted in the premenstrual period. Avoid foods containing caffeine such as coffee, chocolate and cola. In the diet, simple carbohydrates such as refined sugar and instant fruit juice should be reduced, while complex carbohydrates in fiber and wholegrain foods should be included.
There are studies showing that PMS symptoms are reduced by 50% with a daily intake of 1200 mg of calcium, increasing milk and dairy products or calcium and vitamin D supplementation with medications may be beneficial. In addition, there are studies that argue that magnesium and vitamin B6 supplementation is also beneficial. It has been stated in some studies that vitamin E is beneficial in breast tension and pain.
Although there is not enough evidence about the effectiveness and side effects of alternative medicine methods, there are those who believe that herbal teas can help relieve swelling due to their water-repelling properties. Evening primrose oil tablets, herbal remedies containing Vitex agnus castus extracts are claimed to reduce PMS symptoms.
In medical treatment; Painkillers known as NSAIDs are widely used in the fight against menstrual pain and premenstrual headache, muscle and joint pain. These drugs should be taken with food because they can trigger stomach problems.
Birth control pills are effective in treatment by suppressing ovulation, which is thought to cause PMS. Evidence-based medicine especially emphasizes that birth control pills containing drospirenone reduce the symptoms of PMS in the first 3 months.
The effectiveness of the contraceptive pill, which is used for 28 days without a break and contains active pills for 24 days, was emphasized in the treatment of PMS.
In addition, antidepressants known as SSRIs, which are commonly used by psychiatrists that increase the level of serotonin in the brain, are beneficial in women with PMS mental symptoms.
Rarely, GnRH analogues, which temporarily disable ovarian functions, but increase the risk of osteoporosis, are tried in treatment. In women with very severe PMS complaints and who do not respond to any treatment, surgical removal of the ovaries is the last option in treatment.
After all, it’s even harder to be a woman with this crazy cycle every month.

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