Explained: ‘Mood swings’ before periods? Here’s what you need to know about PMS

As many as 80 per cent of Indian women in the reproductive age group experience physical and behavioural changes in the days leading up to their menstrual cycle, found a study published in the International Journal of Community Medicine and Public Health in 2020. According to the research, about 80 per cent of women respondents reported mild degree of distress, 20-40 per cent reported a moderate degree of distress and in 10 per cent of women, distress was severe enough to impact the quality of life.

The International Journal of Reproduction, Contraception, Obstetrics and Gynecology, defines premenstrual syndrome or PMS as, "cyclical physical and behavioural symptoms that appear in days preceding menstruation and interfere with work or life style followed by a symptom free interval."

In 2017, a Menstruation Benefits Bill introduced by Ninong Ering, a former Member of Parliament from Arunachal Pradesh, had called for two days of menstrual leave for women every month and access to menstrual health facilities for female employees, extending it to school goers too. While it was not passed, the bill initiated conversations about period leave, the physical and mental health of individuals who menstruate, and the need for policy intervention.

Currently, 12 companies in India including Swiggy, Culture Machine, Gozoop Online and FlyMyBiz reportedly provide menstrual leave to female employees. In 2020, Zomato announced that it would grant up to 10 days of paid period leave per year to its female and transgender employees to counter the stigma around menstruation. Women employees at BYJU's are entitled to 12 paid menstrual leaves per year.

Mid-day Online reached out to Dr Gayathri D Kamath, senior consultant - Obstetrics and Gynaecology, from Fortis Hospital, Bengaluru, and Mumbai-based psychiatrist Dr Sonal Anand, Wockhardt Hospitals, to understand what are the most common symptoms and causes of PMS and ways in which one can manage them.

What are the most common symptoms of PMS?

Kamath: PMS manifests in the form of both physical and mental symptoms.

The most common physical symptoms women with PMS complain of are bloating, breast tenderness and feeling heavy in the lower abdomen, backache, headaches, acne and leg cramps. The mental symptoms are usually feeling down on moods, a little bit of sobbing, and some tend to have easy conflicts with family members, such as getting snappy and having a short fuse.

Anand: Anxiety related to PMS or even biased labelling by a near one can have negative emotional outcomes and can lead to low or zero productivity. "It can lead to relationship issues due to angry outbursts. Puffing due to water retention can give one temporary body image issues too.

Do PMS symptoms change with age?

Kamath: Premenstrual syndrome is actually encountered in girls and women in the reproductive age group. In my clinical practice, I encounter girls and women aged between 15 to 30 years, who tend to have premenstrual symptoms. Over the years, women and girls have learned to handle it by different measures, and they don't tend to complain any longer.

What are the ways in which one can deal with the mental impact of PMS?

Kamath: To overcome the mental impact, girls and women must do regular physical activity. Any physical activity involving sweating, like intense exercises such as cycling or aerobics, can help in reducing the impact of premenstrual syndrome.

Making people understand the physiology of the menstrual cycle can also go a long way in learning how to deal with PMS. So, girls and women need to understand that fluctuating hormone levels, which is natural during menstrual cycle, and chemicals like serotonin and gamma-aminobutyric (GABA) can cause these symptoms.

It is also essential to involve the family and make them understand that they need to be compassionate during this phase. Additionally, healthy conversations about PMS among peers can also help in countering the stigma associated with menstrual health. With family counselling and introspection, most of the mental symptoms of PMS can be managed.

Anand: Awareness can help in relaxing the mind and giving a better health outcome. Women should know the psychological effects of PMS and be more mindful during this time. Cognitive re-structuring is required. Knowing that one is prone to irritability can help avoid outbursts and disputes.

What dietary changes can one adopt to deal with stomach cramps, body pain, fatigue and acne before and during menstruation?

Kamath: Eat a well-balanced diet and ensure adequate consumption of fluids. Having up to 3 litres of water can help. Avoiding coffee, tea and colas is much recommended. A well-balanced diet includes eating a variety of fresh fruits and vegetables with food with complex carbohydrates (Quinoa, Barley, Potato, Oatmeal, Beans etc).

Complex carbohydrates enter the bloodstream gradually, causing only a moderate rise in insulin levels, which can help stabilize your mood and keep your cravings under control. Consuming less salt is particularly recommended for patients since excess salt can cause water retention and bloating. Lean meats, nuts, and low-fat dairy should be ideally incorporated into the diet since they provide much-needed Vitamin D, calcium, and iron.

Try to refrain from indulging in junk, beverages, and chocolates, which can induce a sugar rush. These can cause more symptoms. Stomach cramps can be overcome by avoiding dietary habits that cause constipation, going for short walks, and having warm water baths.

As the impact of PMS varies from person to person, are there common indicators - physical and mental - which call for seeking medical consultation?

Kamath: Most often, PMS does not need medical consultation. Premenstrual syndrome has a wide spectrum depending on the symptoms. At one end of the spectrum is the mild premenstrual syndrome and at the opposite end of the spectrum is the premenstrual dysphoric disorder (PMDD). It is advised that women suffering from premenstrual syndrome record their symptoms and effects on daily life for two consecutive menstrual cycles. Women need to find out where on the spectrum they stand (If at all).

Women suffering from the mild premenstrual disorder can manage their day to day activities; can feel better with counselling and reassurance with no need for medical treatment. Women who experience PMDD see a marked decrease in quality of life causing a significant impact with work, school performance or interpersonal relationships. Management of PMDD requires a multidisciplinary clinical approach to treating/ alleviating their symptoms.

Could you please shed some light on PMDD and how it is different from PMS?

Kamath: PMDD or premenstrual dysphoric disorder is an extreme variety of premenstrual syndrome. It is a remarkable change in the mental faculties of the individual going through PMS. It can cause deep depression and suicidal tendencies, and lead to irrational behaviour.

PMDD is difficult to tackle because lifestyle changes may not help overcome it. Cognitive behavioral therapy, hormonal treatment with third generation oral contraceptive pills, hormonal injections and selective serotonin receptor inhibitors help in alleviating the symptoms. Simultaneously, routine physical activity and maintaining a balanced diet can tone down its symptoms.

Does the absence of premenstrual symptoms indicate that one is healthier than one who experiences it?

Kamath: No, this is not an indicator to define health. Premenstrual syndrome is a common medical condition. As per the Royal College of Obstetricians and Gynaecologists' green top guideline about 25 to 40 percent of women tend to have these premenstrual symptoms. Not having premenstrual symptoms does not mean one is healthier. Also, if one does not see premenstrual symptoms at one point in their life, it doesn't mean they won't get it eventually, so this is not a way to indicate the health of women.

Any common myths about PMS that you would like to bust?

Kamath: Premenstrual syndrome is a very common condition. I would not call it a disease at all. Most often, you don't need any medications. Lifestyle remedies go a long way in overcoming premenstrual syndrome. Women need to be expressive of their symptoms and seek help in case PMS is affecting their quality of life. Having support groups and discussing the problem with peers and health care providers can also help them counter the stigma around PMS. Isolating self is not a solution and it is advisable to indulge in healthy lifestyle with a well-balanced diet and the right amount of exercise.

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