Menstruation influences the psychological state of women.

1) What is the relationship between menstruation and pre-menstrual syndrome (PMS) ? Premenstrual syndrome, defined as presence of recurring physical and/or psychological symptoms without any organic causes, occurs in reproductive age group, usually during the second half of menstrual cycle, which is usually about 5-11 days before menstruation. This symptom will resolve by end of menstruation cycle i.e. start of period. 2) Do all women experience PMS during menstruation? Pre menstrual symptoms affect up to 95% of women in varying degrees (up to 30% have moderate symptoms and 50% have mild symptoms). Up to 5% women have severe symptoms that disrupt their normal functioning (pre menstrual syndrome). It occurs more in women of late 20s and early 40s and women with personal or family history of depression. 3) How does menstruation affect the psychological state of women? e.g. : If hormone is unbalanced, how does it interfere the state of woman? Throughout the menstrual cycle, there will be changes of hormonal levels. The most plausible causes of PMS is attributed to the rapidly declining levels of progesterone (or the progesterone/oestrogen ratio) in the luteal phase of the cycle. There are several other hormonal changes that took place during menstrual cycle such as increase in reninangiotensin-aldosterone activity, changing in prostaglandin levels, vitamin deficiency, excess prolactin secretion, endogenous endorphine depletion. Other psychosocial models is that aggravate PMS are negative anticipation of menstruation, pressures of caring or family and pursuing careers, underlying predisposing personality, stereotypic expectation among men and women of premenstrual symptoms. Altogether, this hormonal changes and possibly aggravated by psychosocial models causes typical symptoms of PMS, psychologically (affective lability, anxiety or tension, depression, loss of interest, difficulty concentrating, lack of energy, sleep disturbance, appetite disturbance. Physical symptoms in PMS are breast tenderness (progesterone known to cause pain in patients with fibroadenosis of breast), fluid retention and weight gain (could attributed to change in the renin-angiotensin-aldosterone), headaches and aching joints. 4) Do food and drinks taken affect the emotional and mental well-being of women during menstruation? How? A healthy lifestyle is the first step to managing PMS. For many women with mild symptoms, lifestyle approaches are enough to control symptoms. Regular exercise and enough sleep (about 8 hours) are important to reduce stress level and thus controlling the psychological symptoms of PMS. Caffeine and alcohol also should be reduced as they can affect mood and energy level. Drinking a lot of water can help to prevent dehydration which can worsen tiredness and headache. Weight gain in PMS also can be contributed by increase in appetite. Therefore, it is advisable to include fresh fruits and vegetables as well as whole grain meal in the diet. For physical symptoms like bloating, eating small frequent meals can help to reduce the discomfort.

5) Are there any other alternatives to manage the physical disturbances during menstruation? How do they work to alleviate the symptoms? Pain and/or headache: Analgesia such as paracetamol or NSAIDs MOA: Inhibits prostaglandin Breast symptoms: Bromocriptine 2.5 5.0 mg ON Evening primrose oil 1.5 g BD MOA: provides linoleic and gamolenic acids, precursors of prostaglandin E and progestogens Danazol 100-200 mg daily Fluid retention: Spironolactone 100 mg daily (start 3 days before menses and stop during menses) MOA: Spironolactone is a diuretic agent. Therefore, helps to reduce fluid retention.