What is Premenstrual Syndrome?

Sitting down with my head in my hands, “do I really have to go through this again this month?” I feel like screaming at someone right now!!? My whole body aches and why are my breasts nearly twice their usual size? why do I feel hungry all the time? I feel so tired I can hardly get out of bed? Why am I so emotional? These are some of the questions so many women ask during a certain time of their monthly cycle, if this is you, it could be premenstrual syndrome/tension (PMS/PMT) you are experiencing.

Premenstrual syndrome is a condition characterised by psychological, physical, and behavioural symptoms that occur in the time between ovulation (when your ovaries release an egg) and start of your period, and these symptoms can range from being mild to severe. As peculiar to premenstrual syndrome, these distressing, and daily activities altering symptoms tend to significantly reduce or disappear altogether when the woman’s period starts. Keeping a cycle diary, done over at least two cycles, answering these questions may help to know if it premenstrual syndrome you are experiencing:

When do the symptoms start? i.e. what day in your cycle, first day being when you start your monthly bleed.

How are these symptoms affecting your daily activities and relationship?

Do you get relief after starting your period?

Premenstrual Syndrome Symptoms

The recorded symptoms of premenstrual syndrome are known to be nearly 150! However the most common ones are:

• Feeling of tiredness
• Bloating
• Reduced level of concentration
• Feeling tensed
• Irritable, aggressive or angry.
• Low mood and anxiety
• Loss of confidence and feeling emotional.
• Breast swelling
• Bloated tummy
• Swelling of the feet or hands
• Weight gain and an increase in headaches.

Some other pre-existing long term conditions can be made worse by premenstrual syndrome e.g. asthma, cold sores or genital herpes. A woman may also experience disruption of sleep pattern, reduced sexual feelings and increased appetite. The craving and comsumption of more carbonhydrate and sweets, caused by the progesterone hormone, makes it more challenging for some women to maintain their weight.

We do not quite know yet the actual causes, however, research showed that a woman can experience premenstrual syndrome if her body is overly sensitive to the dominating hormone, progesterone, during ovulation, and the body’s sensitivity to progesterone can reduce the level of serotonin (this is the hormone which helps us feel emotionally stable). You may be asking, “How will I know for sure this is what I am going through?” the best way to know is to keep a diary as discussed earlier (one of the many things we women are good at 😊) over at least two cycles (a cycle runs from the 1^st day of your period to the start of the next), this is to identify a pattern.

PMS and black women

There is a well-documented indication that black women are significantly less likely than white women to experience PMS/ Premenstrual dysphoric disorder (PMDD) in their lifetimes. The prevalence has been estimated to be 2.9% among black women and 4.4% among white women. I think this is a welcome change for black women, from the predominantly disadvantaged position for many other health outcomes compared to whites. A little contrary to this, is a study carried out in Nigeria, among female medical students in 2010, which showed the rate of PMS/PMDD is high and closely linked with moderate to severe intensity of dysmenorrhoea.

Therefore the question we are asking is why? Again no clear cut answer to this yet however some research have suggested this may be as a result of the culture or psychology of black women as explained below, although further research is still needed to fully explain this health advantage.

• Overall, blacks are less likely than whites to suffer from some psychiatric disorders, including depression, anxiety and recreational drug-abuse but long term and sustained major depression is known to be higher among blacks than for whites.

• Most blacks who experience long term depression do not receive any form of therapy i.e. medicine or psychotherapy. This got me thinking, could this be due to our cultural perception of mental health and the inclination to keep silent in order to avoid stigmatisation?.

• Two studies carried out by Gold (2007) showed that blacks are significantly less likely than whites to report premenstrual symptoms.

• It has been reported that in some cases white women see menstruation as an aversive event and are more likely to pay more attention to PMS which can possibly lead to more anxiety, depression and stress.

• Blacks are more likely to have more positive disposition toward menopause than whites and they mostly do not see their symptoms to be disruptive to their daily lives. Could this be the same attitude towards PMS for those who experience it or do we try to just get on with life until it becomes too much to handle, or we do not know what to do about it, or do we think our support network will not understand how best to support us through what we are experiencing? Or can it be that blacks have more family social support (as mentioned in my article Hypertension and social support) and this buffers against the stressor of PMS, making it easier to cope with it on our without seeking professional support?

• Lastly, a scientific study showed that black women have an outlet of relieving stress through spirituality and taking part in religious activities which include praying and having faith that everything will work out well and therefore get on with life as usual.

If you are reading this article today, and you think this is me however I am okay managing it that fab!! or if you would like to get further support in looking after yourself please read on. There are few things you can do on your own to improve your symptoms:

Know your body as per keeping diary as discussed earlier.

Try to avoid scheduling important, stressful or attention detailed events during this period.

Speak to other women about how you feel, you will be surprised to know you are not alone.

If PMS is affecting your relationships, speak to those involved and understanding what you go through your relationship can get better.

Try relaxation techniques during this period for example yoga.

Some women have reported regular exercising has helped to relieve their symptoms.

Regular use of Vitamin B6 MAY be useful

Healthy eating including reduced intake of salt and sugar, alcohol and caffeine.

If you still like to speak to your healthcare professional ANP/GPs, there are a few things they can do to help manage your PMS. These include:

Use of Oral contraception.

Medication called Selective Serotonin Reuptake Inhibitor (SSRI) maybe suggested.

What will be suitable will differ from one woman to another hence it is important to speak to your ANP/GP if you need further support and most especially if PMDD is suspected.

Would you be happy to share with us in the comment section below how you are managing your PMS?