Recurring mayhem

It’s a physical disorder, not a mental one. She needs a gynaecologist, not a psychiatrist.

“PMS symptoms are more commonly seen in women who are working and stressed out, though the exact cause is still not known,” says Kamal Buckshee, former Head of Gynaecology, All India Institute of Medical Sciences(AIIMS), New Delhi, The PMS symptoms become evident just after ovulation, which takes place on the fourteenth day of a 28-day menstrual cycle. “Hormonal changes in a woman’s body causes fluid retention in the brain, which leads to physical changes like weight gain and emotional ones like depression,” says Deepika Deka, noted Gynaecologist.

The weight gain is a result of water retention, which makes the body heavier and movements more difficult. The breasts may become enlarged, feel heavy and tender. Similarly, the rest of the body, too, exhibits skin changes and bloating. Acne, unexplained bruises, blotches and white appear, even as the abdomen, legs and ankles swell up. Coordination slow poor and the woman feels fatigued all the time.

These are some of the physical manifestation if PMS. The psychological ones are more difficult to cope with. Take Sonalika Jain, a senior consultant with Godfrey Phillips, who found herself becoming short-tempered and snappy when she was in her early twenties. “Isuddenly found that very few people liked me, so one day I asked myself, why?” says this peppy 31-year-old. “I used to go through these phases, when I’d alternate between weeping and shouting in anger for little or no reason. I was scared, thinking I has turning into some kind of a loony, always looking at the darker side of things and feeling sorry for myself.”

She found the answer in a magazine she was flipping through. It listed the symptoms of PMS, and Jain found that she experienced most of the psychological manifestations when she was going through a “phase”. “I went to my gynae who explained what my body was going through and gave me some vitamins to make me feel better. I don’t know whether it was that or whether knowing that I was not going completely batty, but it helped, and I’m all right now,” says Jain.

Jain was lucky to have realised what was wrong with her. Many women don’t, and pay the price. Recalls Buckshee: “Not knowing what’s wrong with you can be terrifying to the extent ofmaking you almost suicidal. A woman came to me suffering severely from guilt pangs and depression because she realised that she was constantly snapping at her husband and children for no reason. But she couldn’t stop herself, however hard she tried.” “Personality disorders get heightened and become more evident during this period,” says Deka. “This is the time when most women commit suicide.” It’s the mood swings which are more debilitating, because they leave the woman confused, wondering whether she is losing her mental equilibrium.

Unfortunately, there is no permanent cure for this common disorder. The treatment is more oriented towards counselling, both of the patient and the family. Not only should the woman understand that it is a temporary phase bought on by physical changes taking place in her body but it is equally important for the members of her family to be supportive. Avoiding situations which precipitate tension in and around her is an effective way to control mood swings.

The treatmentso far has been more symptomatic than curative. A woman who suffers from PMS should cut down on her salt intake to reduce water retention or edema. A diuretic is sometimes prescribed for edema as well. Mood elevators are prescribed to women who suffer from severe depression during this period, but these should be taken strictly under a doctor’s supervision. Vitamin-B6 and Vitamin-E, a neuro-tonic, have been found to help, as do minerals like Manganese and Zinc. Anti-estrogenics are given if the breasts feel enlarged or tender.

If all these fail, hormone therapy is advocated. The oil of the evening primrose flower is being used by some which provides Gamma-Linolenic Acid, which helps relieve some symptoms. Doctors in India, however, are have not been prescribing this on a large scale as it is relatively expensive. Says Buckshee: “Oil of the evening primrose flower helps relieve symptoms for one or two cycles only, and has no long term effect.” The reason why PMS has such a devastating effect on many womenis because at that time, their coping mechanism is at its nadir. Reassurance is what they need more than medicine.