Pre-Menstrual SyndromePremenstrual syndrome is the name of a group of symptoms that start seven to 14 days before a
woman's period (menstruation). The symptoms usually stop soon after the period begins. If a woman
is going through menopause, a woman may have symptoms during and after the period as well.
Most women feel some discomfort before their periods. But if a woman has PMS, they may feel so
anxious, depressed or uncomfortable that they feel they can't cope at home or at work.
What Causes PMS?
No one knows for sure. But PMS appears to be related to fluctuations in estrogen and progesterone.
Estrogen and progesterone may cause transitory fluid retention, which seems to explain some PMS
symptoms. Recent data suggest that women with PMS metabolize progesterone differently, producing
less allopregnanolone (a neurosteroid that enhances GABAA receptor function in the brain and that has
anxiolytic effects). Production of pregnenolone, which has an opposite effect in the brain, may be increased.
PMS is not caused by stress or psychological problems, though these may make the symptoms of PMS worse.
Symptoms of PMS
The type and intensity of symptoms vary from woman to woman and from cycle to cycle. In many, symptoms
are significant but brief and not disabling; in others, normal functioning is disturbed. Symptoms last a few hours
to >= 10 days, usually ceasing when menses begins; however, in perimenopausal women, symptoms may
persist through and after menses.
*Acne *Mood swings
*Bloated abdomen *Headache
*Craving sugar, salt, chocolate *Trouble concentrating
*Depression *Feeling irritable or tense
*Feeling angry or hostile *Feeling tired
*Trouble sleeping *Wanting to be alone
*Weight gain *Thoughts of suicide
*Lack of interest in sex *Fast heartbeat
*Crying spells or feeling *Joint pain
more sensitive than usual *Constipation
TREATMENT ALTERNATIVES FOR PMS
Treatment involves relief of symptoms. Fluid retention may be relieved by reducing sodium intake
and using a diuretic, starting just before symptoms are expected. Diuretics promote sodium and water
excretion but do not relieve all symptoms and may have no effect. Counseling may help the woman and
her partner cope with PMS, and the woman's activities can be modified to reduce stress. For some women,
hormonal manipulation is effective. Regimens include progesterone by vaginal suppository (200 to 400 mg/day)
or by injection (5 to 10 mg IM in oil) for 10 to 12 days premenstrually; a long-acting progestin
(eg, medroxyprogesterone acetate 200 mg IM q 2 to 3 mo); or a gonadotropin-releasing hormone
agonist (eg, leuprolide 3.75 mg IM or goserelin 3.6 mg IM monthly) with low-dose estrogen-progestin
"add-back" therapy to eliminate cyclic changes. Changing the diet (eg, increasing protein, decreasing sugars)
and supplementing with vitamin B complex (especially pyridoxine, sometimes with magnesium) may help.
Tips on controlling PMS
*Eat complex carbohydrates (such as whole grain breads, pasta and cereals), fiber and protein. Avoid sugar and fat.
*Avoid salt for the last few days before your menses to reduce bloating and fluid retention.
*Cut back on caffeine to feel less tense and irritable and to ease soreness. If caffeine affects you a lot,
you may need to cut it out completely.
*Try eating up to six small meals a day instead of three larger ones.
*Get aerobic exercise. Work up to four 20-minute periods a week. Exercising even more often the
week before your period may also help.
*Get plenty of sleep--about eight hours a night.
*Keep to a regular schedule of meals, bedtime, and exercise.
*Try to schedule stressful events for the week after your period.
*Join a support group of women with PMS.
Menses in the Sunnah
Narrated Al Qasim 'Aisha said, "We set out with the sole intention of performing Hajj and when
we reached Sarif, (a place six miles from Mecca) I got my menses. Allah's Apostle came to me while
I was weeping. He said 'What is the matter with you? Have you got your menses?' I replied, 'Yes.' He said,
'This is a thing which Allah has ordained for the daughters of Adam. So do what all the pilgrims do with the
exception of the Tawaf (Circumambulation) round the Ka'ba.' " 'Aisha added, "Allah's Apostle sacrificed cows
on behalf of his wives." (Bukhari 1.293)
Narrated Aisha, The Prophet used to lean on my lap and recite Qur'an while I was in menses. (Bukhari 1.296)
Narrated Abu Said Al Khudri Once Allah's Apostle went out to the Musalla (to offer the prayer)
on 'Id-al-Adha or Al-Fitr prayer. Then he passed by the women and said, "O women! Give alms,
as I have seen that the majority of the dwellers of Hell-fire were you (women)." They asked,
"Why is it so, O Allah's Apostle?" He replied, "You curse frequently and are ungrateful to your husbands.
I have not seen anyone more deficient in intelligence and religion than you. A cautious sensible man could
be led astray by some of you." The women asked, "O Allah's Apostle! What is deficient in our intelligence
and religion?" He said, "Is not the evidence of two women equal to the witness of one man?" They replied in
the affirmative. He said, "This is the deficiency in her intelligence. Isn't it true that a woman can neither pray
nor fast during her menses?" The women replied in the affirmative. He said, "This is the deficiency in her
religion." (Bukhari 1.301)
Narrated Maimuna (the wife of the Prophet) During my menses, I never prayed, but used to
sit on the mat beside the mosque of Allah's Apostle. He used to offer the prayer on his sheet and in prostration
some of his clothes used to touch me." (Bukhari 1.329)
Narrated Salim That Abdullah bin Umar told him that he had divorced his wife while she was in
her menses so 'Umar informed Allah's Apostle of that. Allah's Apostle became very angry at that
and said, "(Ibn 'Umar must return her to his house and keep her as his wife till she becomes clean
and then menstruates and becomes clean again, whereupon, if he wishes to divorce her, he may do
so while she is still clean and before having any sexual relations with her, for that is the legally
prescribed period for divorce as Allah has ordered." (Bukhari 6.431)
Narrated Aisha The Prophet intended to return home after the performance of the Hajj, and
he saw Safiya standing at the entrance of her tent, depressed and sad because she got her menses.
The Prophet said, "Aqra Halqa! (an expression used in the Quraish dialect) You will detain us."
The Prophet then asked (her), "Did you perform the Tawaf Al-Ifada on the Day of
Sacrifice (10th of Dhul-Hijja)?" She said, "Yes." The Prophet said, "Then you can leave
(with us)." (Bukhari 8.178)
The scholars agree that it is obligatory for menstruating women and women with post childbirth
bleeding to break the fast and to make up the missed days later on. Al-Bukhari and Muslim
recorded that 'Aishah said: "When we would have our menses during the lifetime of the Prophet,
we were ordered to make up the days of fasting that we had missed but were not ordered to make
up the prayers that we had missed. (Fiqh us Sunnah 3.120)