Homoeopathy for premenstrual syndrome-A natural approach to relief

Dr Silpa Sasi D

Premenstrual Syndrome is a symptom complex which occur 7-14 days prior to menstruation^.Women with Premenstrual syndrome have impairment in physical functioning, psychological fitness and also dysfunction in occupational and social domains. Most frequent symptoms are  irritability, back pain, mastodynia followed by abdominal heaviness and discomfort.

Premenstrual syndrome is very common and it affects millions of young women. Epidemiological data shows 75 % women in adolescent age suffer from some Premenstrual Symptoms, while 3-8% reported extremely severe Premenstrual  Symptoms^. Prevalence study among general population in India is not well documented, but studies pertaining among college girls of South India have revealed a prevalence of 14.3%.

Despite many decades of research, there is still controversy about the etiology and treatment of Premenstrual syndrome. In conventional system of medicine, the treatment for Premenstrual syndrome includes Combined Oral Contraceptive Pills, and Antidepressants which provide temporary relief and on long term usage side effects such as Thromboembolic diseases, Carcinoma  of endometrium, breast    are reported^.

ETIOLOGY-
The exact cause of PMS is unknown. PMS is associated with various psychological, socio-demographic factors (age, living region, marital status). Dietary and lifestyle factors can cause the syndrome including habits like smoking, alcohol consumption, caffeine beverages, exercise and fat rich diet. Other factors include parents’ income, being sexually active, long menstrual cycle and age at menarche.

Research conducted on twins has revealed a greater frequency of PMS in monozygotic twins compared to dizygotic twins

DIAGNOSTIC CRITERIA

• According to practice bulletin by American College of obstetrician and gynecology (ACOG)2001, the criteria for the diagnosis of Premenstrual Syndrome is:
• Premenstrual syndrome can be diagnosed if the patient reports at least one of the following affective and somatic symptoms during the 5 days before menses in each of the three prior menstrual cycles.

Affective:

• Depression
• Angry outbursts
• Irritability
• Confusion
• Social withdrawal

Somatic:

• Breast tenderness
• Abdominal bloating
• Headache
• Swelling of extremities

The symptoms should be relieved within 4 days of onset of menses, without recurrence until at least the next cycle day 13.

The symptoms should present in the absence of any pharmacologic therapy, hormone ingestion, or drug or alcohol use.

MANAGEMENT
Combination of pharmacotherapies (such as NSAIDs, SSRIs, anxiolytic agents, gonadotropin-releasing hormone (GnRH) agonists, spironolactone, oral contraceptive pills) with non pharmacological treatments, mainly cognitive and behavioural therapies, exercises, massage therapy, light therapy along with dietary and nutritional modifications have been proven beneficial for the treatment of premenstrual symptoms.

Impact of dietary patterns and nutrients on PMS

• Diet appears to be an essential modulating factor in reducing and managing some of the symptoms of PMS. Following a healthy diet and managing stress are important factors in preventing and managing PMS .
• Western dietary patterns were positively associated with PMS found in a case-control study conducted among 225 women, whilst the healthy and traditional dietary patterns were inversely associated with it.
• A high carbohydrate intake mainly composed of refined sugars may worsen premenstrual symptoms.

Calcium ,Vitamin D supplementation seems to be an effective strategy to improve inflammation and antioxidant markers in vitamin D deficient women with PMS.

Dietary supplements, such as evening primrose oil, zinc gluconate, . Magnesium and vitamin B6, curcumin showed the efficacy in the management of PMS during menstruation. And also saffron, fruit extract of Vitex agnus-castus is also found to be effective

HOMOEOPATHIC CONCEPT:

MIASMATIC CONCEPT:
Hahnemann in “The Chronic Diseases” has proposed three basic miasms as the basis of all chronic diseases. They are psora, syphilis and sycosis.

A woman’s reproductive systems are not free  to the impact of  miasms, according to J. H. Allen in “The Chronic Miasms.” In a typical, healthy woman, all functions ought to be normal. He says there should only be a simple consciousness of presence of function of any organ and even small degrees of suffering is indication of a diseased condition.

Sl no	SYMPTOMS OF PMS	PSORA	SYCOSIS	SYPHILIS
1	Depressed mood (Morose), before menses	+	–	–
2	Hopelessness ( Despire).	+	–	+
3	Anxiety ( Menses before)	+		–
4	Irritability .	+	+	–
5	Lack of interest (indolent)	+	–	–
6	Lack of concentration(dullness)		+	+
7	Fatigue	+	–	–
8	Decreased appetite	+	–	–
9	Sleeplessness	+	–	+
10	Oversensitive	+	–	–
11	Headache (menses before )	+	–	–
12	Breast tenderness(menses before	+	+	–
13	Distended abdomen	+	–	–
14	Weight gain	–	+	–
15	Eruption –pimples	–	–	–

HAHNEMANNS VIEW OF FEMALE DISORDERS
In footnote of aphorism 74 in 6th edition of Organon of Medicine,he mentions about pms as the only possible case of plethora shows itself with the healthy woman, several days before her monthly period, with a feeling of a certain fullness of womb and breasts, but without inflammation. In footnote of aphorism 89 in 6th edition of Organon of Medicine he says that the character of menstruation is to be noted during case taking. In aphorism 94 he says that while treating chronic diseases of females we should pay special attention to sexual desire, sterility,pregnancy, deliveries, miscarriages, suckling, and the menstrual discharge. We should find out whether the menses returns at normal intervals or whether it is delayed or occurs too early, how many days the bleeding lasts, whether the flow is interrupted or continuous, how much is the blood loss, what is the color of the blood, either dark or bright. We should ask whether leucorrhea is present and if present the time of its occurrence. We should also ask about the mental ailments or other pains or other sensations that occurs before or accompany or succeed the menses.

REPORTORIAL REPRESENTATION OF PREMENSTRUAL SYNDROME:

1.KENTS REPERTORY:

GENERALS – MENSES, – before : 3 mark remedies: BOV. CALC. CALC-P. CUPR. LACH. LYC. NAT-M. PULS. RHUS-T. SEP. SULPH. VERAT. ZINC.

2 mark remedies: Am-c. Bar-c. Carb-v. Hyos. Kali-c. Kreos. Mang. Merc. Nat-p. Ph-ac. Phos. Plat. Vib.

GENERALS – FAINTNESS,fainting – menses, – before : Lyc. Murx. Nux-m. Sep. Thuj.

GENERALS – WEAKNESS,enervation – menses, – before: Bell. Cocc. Mag-c. Nat-m.

CHEST – PAIN – Mammae – menses, – before : 3 mark remedies: CALC. CON.

2 mark remedies: Lac-c.

CHEST – FULLNESS – menses,before : SULPH.

CHEST – SWELLING – Mammae – menses, – before : 2 mark remedies: Calc. Lac-c. Tub.

CHEST – PALPITATION heart – menses, – before : 3 mark remedies:SPONG.

2 mark remedies: Cact. Cupr. Iod. Nat-m. Sep.

VERTIGO – MENSES, – before: Calc-p. Caul. Con. Lach. Puls. Verat. Zinc.

HEAD – PAIN, – menses, – before: 3 mark remedy: KREOS.

2 mark remedies: Acon. Am-c. Asar. Bell. Borx. Bov. Brom. Bry. Calc. Carb-v. Cimic. 17

HEAD – PAIN, – menses, – before – amel.when flow begins: Lach. Meli.

STOMACH – NAUSEA – menses, – before: Hyos. Ip. Lyc. Nat-m. Nicc. Puls.

RECTUM – CONSTIPATION – menses, – before: KALI-C. Lach. SIL.

RECTUM – DIARRHOEA – menses, – before: Am-c. BOV. Cinnb. LACH. Nat-s. Sil. Verat.

EXTREMITIES – PERSPIRATION – Foot – menses – before and during: Calc.

EXTREMITIES – SWELLING – Foot – menses, – before : Lyc.

MIND – ANXIETY – menses, – before:. Cocc. Graph. Ign. Nat-m. Nit-ac. Nux-v. Stann. Sulph.

MIND – EXCITEMENT,excitable – menses, – before: Kreos. Lyc. Nux-v

MIND – FEAR – menses, – before: Acon. calc. sulph.

MIND – HYSTERIA – menses, – before: Hyos. Mosch. Plat.

MIND – IRRITABILITY – menses, – before: Caust. Cham. Lyc. Nat-m. Nux-v. Sep.

MIND – RESTLESSNESS, nervousness – menses, – before:. Kreos. Nux-v. puls. SULPH.

MIND – SADNESS, mental depression – menses, – before: Calc. Caust. Con. Lyc. NAT-M. Nit-ac. PULS. Sep. STANN. Verat.

MIND – SENSITIVE, – menses,before: Nux-v. Sep.

MIND – WEEPING,tearful mood,etc. – menses, – before: Cact. Lyc. Phos. Puls. Zinc.

2.SYNTHESIS by Dr. Frederik Schroyens.(99)

GENERALS – WEAKNESS – menses – before – agg.: Alum. Am-c. Bell. Chin. Cocc. Haem. Helon. Mag-c. Nat-m. sulph. Verat.

GENERALS – WEAKNESS – menses – before – agg.: Alum. Am-c. Bell. Chin. Cocc. Haem. Helon. Mag-c. Nat-m. Verat.

MIND – IRRITABILITY – menses – before: Aur-m-n. Aur-s. Caust. Cham. FOLL. Lyc. Nat-m. Nux-v. Puls. Sep.

MIND – SADNESS – menses – before: Aur-m-n. Aur-s. Calc. Caust. Cimic. Con. Ign. LACH. Lyc. Murx. NAT-M. Nit-ac. PULS. Sep. STANN. Verat.

MIND – ANXIETY – menses – before: Cocc. Graph. Ign. Nat-m. Nux-v. Stann. Sulph.

MIND – FEAR – menses – before: Aconite

MIND – ANGER – menses – before: Sep. 18

MIND – WEEPING – menses – before: Cact. Lyc. Phos. Puls. Zinc.

FEMALE GENITALIA/SEX – MENSES – before – agg.: Cimic. graph. kali-c. lac-c. Lach. lil-t. Murx. phos. sep. zinc.

CHEST – Pain – Mammae – menses – before – agg.: Bar-c. CALC. Chlor. CON. cycl. Foll. kali-c. KALI-CHL.. Lac-c. NAT-M. Phos. Puls. zinc.

CHEST – PAIN – Mammae – menses – before – agg. – sore: Calc. CON. cycl. Lac-c. nat-m. Puls. sep. Tub.

HEAD – PAIN – menses – before – agg.: Am-c. Asar. Bamb-a. Bell. Borx. Bov. Brom. Bry. Calc. Carb-v. caust. Cimic. Cinnb. Cycl. foll. Gels. graph. Kali-c. kali-p. KREOS. Lac-c. Lach. Lyc. Meli. Nat-c. Nat-m. Nux-m. Plat. Puls. Sang. Sulph. Ust. Verat. Xan. Xanth. zinc.

RECTUM – CONSTIPATION – menses – before – agg.: Apis. Graph. KALI-C. Lach. Plb. sep.SIL.

RECTUM – DIARRHEA – menses – before – agg.: Am-c. Am-m. BOV. Cinnb. Hyos. LACH. Nat-s. Puls. Sil. Verat.

THROAT – PAIN – menses – before – agg.: Mag-c. Merc.

STOMACH – VOMITING – menses – before – agg.: Am-m. Calc. Cocc. Cupr. Cycl. Ip. Kreos. Nux-v. Puls. Sep. sulphur.

STOMACH – NAUSEA – menses – before – agg.: Am-m. Cycl. Hyos. Ip. Lyc. Nat-m. Nicc. Puls.

SLEEP – DISTURBED – menses – before – agg.: Alum. calc-phos.

BACK – PAIN – menses – before – agg. – aching: calc. Caust. Gels. PULS.

BACK – PAIN – menses – before – agg.: Calc. Caust. KALI-C. Lach. Lyc. Mag-c. Nux-v. Podo. PULS. Ust. Vib.

THERAPEUTICS

LACHESIS:
The remedy is adapted to persons of a melancholy temperament with dark eyes. They have great sensitiveness to touch in throat, stomach and abdomen and cannot bear bed-clothes or night-dress to touch throat or abdomen, because clothes cause some uneasiness. Menses occurs at regular time,scanty, too short, and feeble and pains all relieved by the menstrual flow , better during menses. Before menses there is vertigo, headache, nosebleed and labor like pains in uterine region.

PHOSPHORUS:
Phosphorus is adapted to persons of sanguine temperament who are tall and who has fair skin and delicate eye lashes.Menses too early and scanty but too protracted or might be too early, too profuse and of too long duration. Before menses there is bleeding from ulcers, constant desire to urinate, sadness and weeping mood.

NATRIUM MURIATICUM
Indicated in the anaemic and cachectic with great emaciation; losing flesh while living well Menses may be early or profuse or scanty and delayed. Suffers from backache before menses, which is >by lying down on something hard. There is also headache which is < before menses. There is moroseness and irritability before menses. There is hot feeling during menses.

SEPIA OFFICINALIS:
Sepia is adapted to persons of dark hair with rigid fiber, but is mild and has an easy disposition .Headache occurs at menstrual time with scanty menstrual flow is seen. Irregular menses of nearly every form is seen – early, late, profuse, scanty, or amenorrhea or menorrhagia occurs.Menses is painful and associated with downward pressure as if something coming is going to come out of vagina. Attack of depression before menses is seen.

ARSENICUM ALBUM:
Arsenicum album is indicated in people who are emaciated. Menses is too early and copious, and is preceded by great suffering. Patient has great prostration before menses. Her depression is worse before menses and she cries if she is left alone. Anxiety also increases in the premenstrual period.

IGNATIA:
It is suited to people of nervous temperament, with dark skin and dark hair. Complaints from bad effects of grief, bad news and from suppressed mental suffering. She likes to be alone.Menses is too early and flow is of black blood of putrid odour. Her depressive symptoms are aggravated before menses and she wants to be alone during this time.

 NITRIC ACID:
This drug is indicated in thin persons, with rigid fiber and dark complexions. They have ailments from loss of sleep, or from overexertion of body or mind, or from long lasting anxiety. Menses very early and profuse, blood is dark and thick. There is sadness before menses. Headache,lameness and bruised feeling in limbs before menses.

SOME OTHER REMEDIES OF IMPORTANCE FOR PREMENSTRUAL SYNDROME:

AMMONIUM CARB: Indicated in stout fat women who are delicate and must have smelling bottle continually at hand. Menses is too early and profuse and before menses there is violent colic. Flow is acrid and it makes the thigh sore. Flow more at night and when sitting.

Before menses there is constipation and tenesmus. There is violent pain in small of back and between scapulae. Uncontrollable sadness before menses.

BOVISTA LYCOPERDON: It is adapted to old maids with palpitation and nervous temperament. She is very awkward and things fall from her hands. Discharge from all mucous membranes very tough, stringy and tenacious. Intolerance of tight clothing around the waist is an important feature, menstrual flow is too early and profuse, occurs only at night, no flow during daytime. Traces of menses are seen between menses. There is diarrhoea and before and during menses.

CONIUM: Complaints of conium come on from suppression of sexual desire or from excessive indulgence. Menses is delayed and scanty and it is easily suppressed by taking cold or by putting hands in cold water. Breasts enlarge and they become painful before menses. CYCLAMEN: Before menses labor like pains, abdomen bloated and swollen. Melancholy mood ameliorated by menses.

FOLLICULINUM: Migraine like headaches before menses. Congestion of abdomen comes on before menses, which is worse 3or 4 days before menses. Breasts become swollen, congested, and cannot bear constriction or touch and the pain disappear with start of menstrual flow. There is weight gain before menses. Menses is prolonged and it is of bright red blood.

SENECIO AUREUS: Inflammatory condition of throat chest and bladder before menses.

SPONGIA: Before menses there is palpitation of heart, pain in sacrum and hunger

VESPA CRABRO: Before menses there is depression and constipation.

XANTHOXYLUM FRAXINEUM: Before menses patient is despondent, full of fear, has headache as if top of head would fly off and there is grinding pain in pelvis before menses

REFERENCES

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Dr Silpa Sasi D
PG Scholar, Department of Materia medica
Under the guidance of Dr Rs Patil HOD, Department of Materia medical, GHMC Banglore
Email : Shilpasasipkd94@gmail.com