a comparison of western and ayurvedic perspectives of
TRANSCRIPT
AComparisonofWesternandAyurvedicPerspectivesofPremenstrualSyndromeAReviewofLiteratureBreannaMurphy
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INTRODUCTION
Premenstrual syndrome (PMS), also sometimes referred to as Premenstrual Disorder (PMD) is a
widespreadandprevalentconditionassociatedwiththesecondhalfof the femalereproductivecycle.
Manywomenat somepoint in theirmenstruating yearsexperience someof the countless symptoms
that go along with PMS. This review of literature is focused on the understanding of the disorder
comparatively from a western and Ayurvedic perspective. It will not go into the in-depth Ayurvedic
treatmentprotocol,onlyageneralinsighttotreatmentasitcomparestowesternmedicine.Thereader
shouldhaveabasicknowledgeofAyurvedicanatomyandphysiology.
DEFINITION
PMSisnotadiseasebutasyndrome,somethingthatdoesn’thaveadefinitivecausebutproducesmany
symptoms.Itcanbedefinedas“arecurrentluteal-phaseconditioncharacterizedbyphysical,
psychological,andbehavioralchangesofsufficientseveritytoresultindeteriorationofinterpersonal
relationshipsandnormalactivity.”1ThekeypointthatdistinguishesPMSfromothermenstrualdisorders
isthatthesymptomsarerelieveduponthestartofmenses,orshortlythereafter.Somesourcessaythat
awomanhastopresentwithbothphysicalandmentalsymptomsinordertogainadiagnosisofPMS.
EPIDEMIOLOGY
PMSisahouseholdnameasfaraswomen’shealthgoes.Ifawomanhasn’texperiencedPMSherself,it
is likely she knowsof at least oneotherwomanwhohas. Thepercentageof effectedwoman ranges
fromsourcetosource,anywherefrom20%to80%.Thisnumberisprobablyduetoestimations,asitis
not likely that all womenwill seek out a doctor and get a diagnosis of PMS. UpToDate reports that
clinicallysignificantPMSonlyoccursin20%to30%ofwomen,andhere’swhy:
TheprevalenceofPMSinthepopulationhasbeenoverestimatedbecauseofthefailuretoapply
strict inclusion criteria. Estimates as high as 80 percent have been reported, based upon the
inclusion of women who have some form of premenstrual mood or physical symptoms. The
problemwiththeseestimatesisthattheydonotconsiderwhethersymptomsaremoderateto
severeoriftheyinterferewithfunctioning.2
This challenges the severityof symptomsandwhat actually constitutes asPremenstrual Syndrome. It
moreorlessimpliesthatmoremildsymptoms,thoughunpleasant,inrealitydon’tfallintothecategory
ofPMS.Again, thismaybewhywomendon’tseekhelp for itand justaccept itaspartof theircycle.
3
Regardlessofexactnumbersorintensityofsymptoms,thebottomlineisthatthismenstrualsyndrome
isverycommoninourhigh-stress,fasted-pacedsociety.
THEHEALTHYMENSTRUALCYCLE
A solid grasp on the basic workings of the female reproductive cycle will help us to have a greater
understandingofthesymptomsandthepathogenesisfrombothawesternandAyurvedicperspective.
Therearefivemainhormonesinvolvedinthemenstrualcycle:gonadotropin-releasinghormone(GnRH),
follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. The
hypothalamus delivers Gonadotropin-releasing hormone (GnRH), which may also be referred to as
luteinizinghormone-releasinghormone(LHRH)tothepituitaryglandtotrigger it toreleasetwoother
hormones:follicle-stimulatinghormone(FSH)andluteinizinghormone(LH).FSHinfluencestheovaries
tobringfolliclestomaturationinpreparationforovulation.LHguidesfolliclestoreleasetheireggand
alsotomakethehormonesthatgettheuterusreadyforimplantationofafertilizedegg.3
Theothertwohormonesthatplayasignificantroleareestrogenandprogesterone.Estrogenstimulates
thedevelopmentandmaintenanceofsecondarysexcharacteristicsandaffectsthecyclicchangesinthe
uterine lining. Italsoworksoutsidethefemalereproductivetractand is interestinglyenoughfound in
every tissue of the body as lubrication and nourishment. Not enough estrogen results in dryness
throughout the body, not just the vagina. Toomuch can look like weight gain, lethargy, depression,
tender breasts, or water retention. We need both good quality estrogen as well as appropriate
quantitiesit.4
The corpus luteum (the structure that develops from the mature follicle after ovulation) releases
progesterone. This hormone prepares the uterus for implantation, it maintains pregnancy though
inhibiting uterine contractions, it primes themammary glands for lactation, and it also balances the
effectsofestrogen.Progesteronehelpsthebodytodefenditselfagainstestrogen-inducedovergrowth
(likebreastfibroids)anditkeepstheuterineliningbuiltbyestrogeninplace.Italsoneutralizessignsof
excessestrogenbyusingfatforenergytopreventweightgainandinhibitswaterretentionthroughits
diuretic properties and also manages normal blood clotting. The two hormones work quite well
together,andas longasthenaturalchecks-and-balancessysteminthebodyisfunctioningproperly,a
womancanexperienceasymptom-freecycle.5
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Withanawarenessofthemajorrolesofeachhormone,wecanlookattheovariancycle.Itbeginswith
thefollicularcyclewhenthehypothalamusreleasesGnRHtostimulatethepituitaryglandtoreleaseFSH
aswellassmalleramountsofLH.Lowlevelsofestrogenfromthedevelopingfolliclesapplyanegative
feedbackeffectonthehypothalamusandpituitarywhile increasingtheeffectofFSHonthefollicle.A
negativefeedbackeffectsimplymeansthatEstrogenlevelsincreaseasthefollicles,undertheinfluence
ofFSH,continuetogrowuntilthemiddleofthecycle.Duringtheovulatoryphase,highestrogenlevels
fromthematurefollicleexertapositivefeedbackeffectonthepituitarygland,whichresultsinasurge
ofLHaswellasasmallerspike inFSH.ThehighamountofLHcausesthefollicletorupture(ovulate),
afterwhichestrogendeclinesconsiderably.ThelutealphasebeginswhenthesurgeofLHstimulatesthe
development of the corpus luteum to secrete progesterone along with lesser amounts of estrogen.
ThesehaveanegativefeedbackeffectonthehypothalamusandanteriorpituitarysothatFSHandLH
levelsdecline.As LH levelsdrop, the corpus luteumactivitywanesand removes the inhibitoryeffect.
Thecyclestartsover.6
Theuterinecycle ishappeningsimultaneouslywith theovariancycle. Itbeginswith themenstruation
phase,whichshouldgenerallylastfrom3to5days.Duringmenstruation,thestratumfunctionale(the
endometriumexcludingthebasal layer)detachesfromtheuterinewallandaccompaniedbybleeding,
exitsthroughthevaginaasmenstrualflow.Duringthistime,thefolliclesaregrowingintheovaryunder
the influence of FSH. The proliferative phase beginswith the end ofmenstruation and typically lasts
eightdays.Theincreasinglevelsofestrogenfromthegrowingfolliclesintheovarystimulatetherepair
oftheendometriumintheuterus.Atthetimeofthisphase,theendometriumthickens,glandsdevelop,
and blood vessels grow in the new tissue. Ovulation in the ovarian cycle happens at the end of the
proliferativephase.Thesecretoryphasefollowsnextandcorrespondstothelutealphaseoftheovarian
cycle. Progesterone from the corpus luteum stimulates the continued growth and thickening of the
endometrium.Arteriesandglandsproliferateandenlarge.Iffertilizationdoesnottakeplace,thecorpus
luteum in the ovary begins to degenerate, halting the supply of progesterone and leading to
menstruation;thecyclestartsover.7
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Figure1:Theaboveleftimageportraystheroleofthehormonesintheovariancycle.8
Figure2:Theaboverightimageillustratestheinterrelationshipofeventsbetweentheovarianand
uterinecycles.9
InDr.ClaudiaWelch’sbookBalanceYourHormones,BalanceYourLife,shementionsascientistbythe
name of Margie Profet who explored the idea of what the point of a women’s menstrual cycle is.
Besides theobvious roleof fertility, shesurmised that themenstrualcyclewasaway for thebody to
protect its reproductive organs.Dr.Welch says “menstrual blood is rich in immune cells…when the
menstrualbloodflows,itfreelybathesandcleansestheuterus,cervix,andvaginawithitsantibacterial,
antiviralproperties.”ThisideabecomesimportantwhenlookingatthewesterntreatmentofPMSusing
oralcontraceptives(birthcontrolpills)thatstopthebodyfromovulatingandgoingthroughitsnatural
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rhythms.Althoughwomenmaystillbleedwhentheyuseoralcontraceptives, it isnot thesameasan
uninhibitedmenstruation.Theintuitiveurgesofthebodytoovulateandbuildauterinelininghavebeen
suppressed,sothebleedingthatoccursisnotthenourishingmensesmentionedabove.10
ANAYURVEDICUNDERSTANDINGOFTHEMENSTRUALCYCLE
AncientAyurvedaalsohadanawarenessofthemenstrualcyclethatcloselyrelatestotheuterinecycle,
the more easily observable cycle. The ancient Indian authorities divided the menstrual cycle into 3
phases based on physiological changes that take place in the body - rutukala, rutavateta kala, and
rajahkala.Beforewetakeacloserlookateachofthephases,wemustgobackandremindourselvesof
thethreenaturalstagesofdoshadevelopment.
Thedoshas are continuously ebbing and flowing throughout thebody and are influencedby external
factors.Thesefactors includeaperson’sconstitution, theclimatethatthey live in, thetimeofday,as
wellasthetimeoftheyear(season),andtimeoftheirlife(age).Thedoshasallrise,peak,andretreatas
part of the natural stage of doshic development. The first stage is sanchaya or accumulation. This is
wherethedosharisesandtypicallycausesunnoticed,mildsymptomsinthedigestivetract.Thesecond
stage is prakopa or aggravation. This stage is when someone may become more aware of their
symptoms; if taken care of, the doshawill retreat into the final phase. The last stage is prashamaor
alleviation.Thisiswhenthedoshawithdraws,andtheseriesofeventscanbeginagain.11
The first phase, rutukala, begins aftermenstruation and is relatable to the proliferative phase of the
uterine cycle aswell as the follicular phase of the ovarian cycle.We can say that Kapha governs this
phase for two reasons: the uterus is building tissue and Kapha is rasa, a main component of the
endometrium.Inthisphase,Kaphaaccumulates(kaphachaya)andpeaks(Kapha-prakopa).Allthewhile
Kapha is aggravating, Pitta is accumulating (Pittachaya) and Vata is alleviated (vatashama). Kapha is
essential forgrowthof theuterine lining,andbecauseVata impedesgrowth, itmustbealleviated for
properformationoftheuterinelining.12
Thenextphaseisrutavatetakala,whichisrelatedtothesecretoryphaseoftheuterinecycleandit is
governedbyPitta.Pittaworks throughRaktatobuildmaketheglandularandvascularchanges in the
endometriumtobestprepare it for implantationof theegg. In thisphase,PittakeepsKapha incheck
and prevents it from overgrowing. Pitta’s aggravation here causes Kapha’s alleviation (Kaphashama).
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ThePittathatwasaccumulatingduringthelaterphaseofrutukalanowmovesintoaggravation,orPitta-
prakopa.13
Meanwhile, Vata is accumulating (Vatachaya) and when Vata hits its peak (Vata-prakopa), the last
phase,calledrajahkala,begins.Vataactsthroughthearteriesbyspasm,whichhelpstheuterustoshed
the stratum functionale. Apana Vayu is the downward force that helps the menstrual fluid find its
proper exit through the cervix and out the vagina. Once menstruation starts, Pitta diminishes into
Pittashama. The Sushruta Samhita describes healthy menstrual flow as, “blood which is red like the
bloodofahare,orthewashingofshellacandleavesnostainsonclothes(whichmaybewashedoffby
simplysoakingtheminwater).”14Kaphachayabeginsoncemenstruationends,andstartsrebuildingthe
tissuethatwasjustsloughedoff.15
Belowisatablethatsummarizesthewesternovariananduterinecyclesandmatchesthemupwiththe
Ayurvedicmenstrualcycle.
AyurvedicPhase Rutukala Rutuvatetakala Rajahkala
AggravatedDosha Kapha Pitta Vata
AccumulatingDosha Pitta Vata Kapha
AlleviatedDosha Vata Kapha Pitta
OvarianPhase FollicularPhase Ovulation/LutealPhase Luteal/FollicularPhase
UterinePhase ProliferativePhase SecretoryPhase MenstruationPhase
Solongasthedoshasarebalancedandojasissubstantial,themenstrualcycleremainshealthyand
withoutsymptoms.Whenadoshadoesn’tstaybalancedandisn’talleviated,thebeginningsofdisease
starttomanifest.Thedoshagoesintoprasara,theoverflowphase.Itmovesintotherasavahaand
raktavahasrotamsi,whereitcancirculatethroughthebody,thoughitusuallycausesonlymildand
transientsymptomsatthistime.Usually,peoplewillignoretheirbody’ssignalsthattellthemsomething
isoutofbalance.Ifnotmanagedatthispoint,thedoshawilladvanceintosthanasamshraya,the
relocationstage.Thisiswhenadoshasettlesintotypicallytheweakestdhatuofthebody.Iftheperson
stilldoesnotseekmanagementatthispoint,itwillprogresstothefifthdiseasestagecalledvyakior
manifestation.ItisfinallyatthispointthatWesternmedicineusuallyrecognizesadiseaseandgivesita
nameandtreatment.Thelaststageisdiversification,orbheda,andbythen,thesymptomsaresevere
andthedamagetothedhatumaybebeyondrepair.Thisconceptofdiseaseprogressionisimportant
8
becauseitshowsusthatAyurvedarecognizesthatwecanstepinlongbeforewegettothefifthorsixth
stageofadisease.16
Figure3:ThebeautifulimageabovedepictstheAyurvedicunderstandingofthemenstrualcycle,broken
intothreephases.17
CLINICALMANIFESTATIONS
SymptomsofPMScanbeeitherphysicalorbehavioral,andwomencanexperienceanynumberofthem
fromeither category. Physical symptoms include bloating or fluid retention, constipation or diarrhea,
backaches,headaches,tenderbreasts,acne,andfoodcravings.Behavioralsymptomsincludeirritability,
mood swings, anxiety, depression, forgetfulness, lack of focus, and trouble sleeping or oversleeping.
Some of these symptoms, like depression or anxiety, can look like other conditions, so a proper
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diagnosisfromahealthcareproviderisimportant.IfitisPMS,thesymptomsceasearoundtheonsetof
menses; if there isnoperiodof relief, thepersonmayhaveadifferent issuegoingon.Adiagnosisof
PMSwillmostlikelyincludeacompletemedicalhistory,aphysicalandpelvicexam,andthehealthcare
providermayaskthepatienttotracktheirsymptomsalongwiththeircycleforseveralmonthstogeta
betterideaofthetiming,onset,anddurationofthesymptoms.18
AYURVEDICRUPA
Aswesaw in theClinicalManifestations section, symptomsarevariousandnumerous.Ayurvedaalso
recognizesthisbut isabletoclassifytherupabydosha,whichallowsforspecifictreatment.Themost
common rupa are listed below, divided by doshas. Notice how conditions are all Vata, Vata/Pitta, or
Vata/Kapha.ThisisduetoVata'sstronginfluenceonthefemalereproductivetractbecauseitshomeis
inthelowerabdomen.19
Vata Vata/Pitta Vata/Kapha
Moodswings AlternatingConstipation&
Diarrhea
Anger/outbursts WeightgainduetowaterretentionConstipation RedRashes
Irritability AcneSluggishness/lethargy
Lackofclarity Fatigue Diarrhea/Loosestools
Paininbody Insomnia BreasttendernessAdditionally,anyVatarupa
Anxiety Bloating Additionally,anyVatarupa
ETIOLOGYOFPMS
TheexactcauseofPMSismoreor lessunknown.Somestudieshaveshownastronggenetic factor in
thepredisposition toPMS,but theremayalsobeenvironmental factorsor learnedbehaviors that go
alongwith this aswell (nature vs. nurture). One causemay be that the tissues in the body are very
perceptive tohormone levels that changeduring themenstrual cycle. Some studiespropose that the
risingandfallinglevelsofhormones,likeestrogenandprogesterone,mayalsoimpactthechemicalsin
thebrainlikeserotonin-aneurotransmitterinchargeofperceptionofpain,thesleep-wakecycle,and
mood.Westernmedicinecan’ttelluswhysomewomendevelopPMSandothersdonotbecausethey
have found that the levelsofestrogenandprogesteronearecomparable inwomenwithandwithout
these symptoms. It is likely that somewomenare justmore sensitive tonormal changes inhormone
levels.20Symptomsappear toworsenwhen individualsareunder stressaswell.A studydone in2015
measured thebrainactivityofwomenwithPMS (aswell aswomenwithout it) byusing resting state
functionalmagneticresonanceimaging,orrs-fMRI.Theparticipantsalsocompletedemotionscaleson
10
anxiety (BAI) anddepression (BDI) and the stressperception scale (VAS)beforegoing through the rs-
fMRI.Thestudyfoundthat“comparedwiththecontrolgroup,thePMSgrouphadhigheranxietyand
depressionscoresaswellaslowerstressperceptionscores.Thisconfirmedagain,fromtheperspective
of subjective perception, that PMS is a stress-relatedmooddisorder that results in general effects in
patientssimilartothoseinstressdisorderssuchasPTSD.”21
TherewasastudydonecomparingthemetabolicandhormonalprofilesofwomenwithPMSconcluding
thattherewasasignificantassociationbetweenPMSscoresandtheprevalenceofmetabolicsyndrome.
According toWebMD,metabolic syndrome can be described as “a group of risk factors - high blood
pressure,highbloodsugar,unhealthycholesterollevels,andabdominalfat.”22Theseresearchersfound
thatprolactinlevels(ahormoneproducedinthepituitarywhosemainfunctionistostimulatemammary
glandstoproducemilk)weresignificantlyhigher inwomenwithPMS.Thestudystatesthat“prolactin
plays an indirect role in PMSandmay cause renal retentionofwater, sodium, andpotassium, and it
interacts with lithium. Prolactin can also interact with ovarian hormones to cause symptoms of
depression,anxietyor irritablehostility.”This justgoes toshowhowcomplex thehumanbody isand
how intertwined the hormones are with each other. It is so difficult to determine specifically what
hormones are involved in the disorder when there could potentially be seemingly unrelated factors
causingthesymptoms.23
SIDENOTE:ESTROGENDOMINANCE
Some naturopaths and other alternative health practitioners look to a condition called “estrogen
dominance”asasuspectinsomeofthePMSsymptomsthoughwesternmedicaldoctorsdonottypically
identify this as an actual condition. Estrogen dominance basicallymeans that awoman’s estrogen to
progesteroneratioisskewedinthedirectionofestrogen.Thisdoesn’tnecessarilymeanthatawoman
hasanobsceneamountofestrogeninherbody;shecouldhavealowlevelofestrogen,butshewould
haveanevenloweramountofprogesterone.Iftheliverisoverworkedorsluggish,itcannotdothejob
ofremovingexcesshormonesfromthebloodstreamefficiently, leavingresidualestrogencirculatingin
the body. Keep inmind that the first half of themenstrual cycle is dominated by estrogen, and the
second half of the cycle is dominated by progesterone. If the body doesn’t produce enough
progesteronetocounteracttheestrogenfromthefollicularphase,thenitmightgointothis“estrogen
dominance”state.This imbalancehasthepotential formanysideeffects includingonesassociatedto
estrogen-relatedPMSsymptoms.24
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CausesofestrogendominancethatarerecognizedbyNaturopathic.orginclude:
Excessiveexposuretoxenoestrogens
Syntheticestrogens(birthcontrol,HRT)
Anovulation(alackofovulation)
Digestionissues(stressontheliver)
Prolongedstress Unresolvedemotionalissues Unhealthfuldiet Poorlifestylechoices
(smoking,alcoholetc.)
AYURVEDICNIDANA
AccordingtoAyurveda,themostimportantcausativefactorofPMSislowojas.Additionally,Vatais
predominantlyimbalancedandmaybeaccompaniedbyPittatoalesserdegree,andKaphaevenlessso.
Vatamaybevitiatedbytakingcold,dry,lightfoods,excessivetravel,extremetemperatures(hotor
cold),andprolongedstress.Allofthesefactorsalsohaveanegativeimpactonojas.25Amacomesinto
playinthisconditionaswell,andwecanconnectittopossibleestrogendominance.Ifamaisblocking
theestrogenreceptorsites,thenthebodyisn’ttakinginenoughestrogen,anditcontinuestocirculate
throughoutthebody.Normally,theliverwouldtakecareoftheexcessestrogencirculatingbypullingit
outandthebodyexcretesit.Ifitisboggeddownandoverworked,thenitcannotdoitsjobproperlyand
theestrogenisnotremoved,andthebodythengoesinto“estrogendominance.”26
PATHOGENESIS
TheexactmannerofdevelopmentofPremenstrualSyndromeisn’tclearlyunderstood.Thereareafew
factorsthatplayaroleandthoseincludehormones,gammaaminobutyricacid(GABA),andserotonin.
Unfortunately it isbeyondthescopeofthispapertodive intothe intricaciesofeachfactor,however,
wecangraspthegeneralconceptofeachone.
1.Hormones:thesymptomsofPMSaregenerallypinnedonprogesteroneoriginatingfromthecorpus
luteumintheovary
Althoughwesee thatprogesteroneoftengetsblamed forPMS, itappears thatclassicalprogesterone
receptor is not implicated in the pathophysiology of this condition. There have also been numerous
studies that have been unable to show any progesterone excess or deficiency as the cause of this
condition. Researchers have theorized that “a metabolite of progesterone may contribute to the
generationoftheaffectiveandphysicalsymptomsofPMDsthroughmodulationofadifferentreceptor
mechanism.”27Aswe’vetouchonbefore,theroleofhormonesinthebodyisincrediblycomplexandno
oneisyetsurewhatroletheyplayexactly.
2. GABA:anaminoacid thatactsasaneurotransmitter in thenervous systemandblocks impulses
betweencellsinthebrain-lowlevelsofGABAmaybelinkedtoanxietyormooddisorders
12
Because progesterone itself didn’t appear to be the solution, researchersmoved on to examine the
neuroactive metabolites of progesterone that were known to affect mood and behavior. GABA is a
widelydistributedneurotransmitteraswellasthemaininhibitoryneurotransmitter inthebrainandis
significant in the management of stress and anxiety. In other words, GABA may play a role in why
progesteroneisassociatedwithnegativemoodsymptomsinPMS.28
3.Serotonin:aspreviouslydescribed,itisthemainmoodstabilizerinthebrain
Lowlevelsofserotonincancausesymptomsof“depression,moodswings,irritability,self-deprecation,
poorimpulsecontrol,sleepdisturbances,decreasedpainthreshold,carbohydratecravingsanddifficulty
concentrating.”ManyofthosesoundfamiliartothesymptomsofPMS,whichmakessensebecause it
hasbeenshownthatserotonergicfunctionismodifiedinthelutealphaseofwomenwithPMS.29
AYURVEDICSAMPRAPTI
Ayurvedalookssamprapti(pathogenesis)inaverydifferentwaythanwesternmedicine.Itstartsfrom
theabsolutebeginninginthedigestivesystemandworksitswayoutfromthere.Thisgivesacomplete
pictureofhowthedisorderprogressedtohowitmaybemanifestingnow.
Vata’shomeisinthepurishavahasrotas(colon).Thisiswhereitaccumulatesandaggravates,andifnot
alleviated,overflowsintotherasavahaandraktavahasrotamsi.Vatathenrelocatesintotheartavavaha
srotasandcommonlydisruptsthemanovahasrotasaswell.Vataagitatestheharmonyofthehormone
systemintheartvahavahasrotas.IfVatagetstothemanovahasrotas,itcausesthebehavioralrupa
mentionedaboveintheAyurvedicRupasection.Vatacanalsosettleinanyoftheotherdhatusor
srotamsiwereitcouldcausebrieformoresubtlerupaaswell.30
Pitta’schieflocationisintheannavahasrotas,specificallyinthelowerstomachandsmallintestine.This
isthelocationofitsaccumulationandaggravation.Whenitisn’talleviated,Pittaoverflowsintothe
rasavahaandraktavahasrotamsiandthenrelocatesintotheartavahasrotas,manovahasrotas,andthe
mamsadhatu.Pittacanalsodisruptthehormonalsystemoftheartavavahasrotas,causeangerinthe
manovahasrotas,andcausehotskinconditionslikeacne,inthemamsadhatu(ofwhichtheskinisan
upadhatu).31
Kapha’smainsiteisthestomach,whichisalsopartoftheannavahasrotas.Hereitwillaccumulateand
aggravate,andoverflowintotherasavahaandraktavahasrotamsiifnotalleviated.Itcanrelocateinthe
13
ambuvahasrotascausingfluidretention-andasaresult,weightgain.Pleasenotethatthisisnotweight
gainofthemedovahasrotas.32
WESTERNTREATMENTOFPMS
TheWestern treatment of PMSwill vary depending on the severity of the symptoms. It is likely that
doctorswill try tomanagemoremild symptomswithdietandexercise suggestionsalongwith stress-
reductiontechniques.Dietaryrecommendationsmayincludereducingrefinesugarintake,minimizingor
eliminatingcaffeineconsumptionespeciallyduringthesecondhalfof thecycle,anddecreasingsalt in
thedietifbloatingorswellingisapredominantsymptom.A2017studydoneinAustraliadidnotfinda
lowerprevalenceofPMS inwomenwhoparticipated inhigh levelsofphysicalactivitycomparedwith
thosewhodida loweramountornophysicalactivityatall.33Dependingonhow intense theexercise
was,thismakessense.Ifthebodyisunderstressalready,andthenintenseexerciseitaddedontopof
that, thebody ismost likelygoing togetmorestressed,not lessstressed, therefore thesymptomsof
PMSwouldnotgoaway.
Formoremoderate toseveresymptoms, thereare twomainapproaches to treatment,which include
prescribing pharmaceuticals. The first method is to prescribe selective serotonin reuptake inhibitors
(SSRIs)andSerotonin-norepinephrinereuptakeinhibitors(SNRIs)totargettheserotoninsystem.These
can be taken continuously or just in the second half of the cycle, the luteal phase. For womenwho
chooselutealphasetherapy,ithasbeenstatedthattheadvantagetothisislesssideeffectsandalower
cost to the patient. Doctors may suggest continuous or luteal phase only, or even symptom-onset
therapy treatment based on the type of symptoms and how long they typically express for, the
regularityorirregularityofawoman’smenstrualcycle,andhowpredictablethesymptomsare.34
The second common approach is to use oral contraceptives (OCs) to stop recurring changes in sex
steroids (steroid hormones that act on androgen and estrogen receptors) by suppressing the
hypothalamic-pituitary-ovarianaxis.Eventhoughthesepillsareusedtotrytotreatthediscomfortsof
PMS, they can often produce side effects that are very similar to those symptoms that they are
supposed to treat. Some common side effects include breast tenderness, headaches,mood changes,
and weight gain.35Researchers have done numerous studies to try to figure out the immeasurable
complexityofhowthehormonesworkinthebodyandwhysometreatmentsproducetheseundesirable
14
sideeffects.Tothatend,therearemanydifferentkindsofOCs,allwithdifferentintentionsinsidethe
body.Onefactoristhelevelofhormonesineachofthepillsthroughoutthemonth:
• MonophasicOC:everyactivepillhasthesameamountofhormones
• MultiphasicOC:theactivepillshormonecontentfluctuatesduringthemonth
According to Dr. Andrea Rapkin and Dr. Alin Akopians, a randomized placebo-controlled trial
demonstrated that multiphasic OCs decreased the physical symptoms but not the mood symptoms.
They also state that there was another study comparing monophasic OCs to multiphasic OCs that
inferredthemonophasiconewas lesspronetocauseunfavorablemoodchanges.Another factor that
goesintoanoralcontraceptive’seffectivenessisthehormone-freeperiod,thetimewherethewoman
bleeds.Thetraditionalratio is21/7(21daysofactivepillsandsevendaysofhormone-freepills).This
longerintervalwithouthormoneinterventionsupportsthecontinuedhormonefluctuationinthebody
andthismaybecontributingtoadversesymptomsthatresemblethephysicalsymptomsofPMS.Ithas
beensuggestedthatwomentrya24/4regimenwith24activepillsandfourhormone-freeones.36Then
thereareofcoursevarying levelsofsyntheticprogesteroneandestrogen indifferentpills,somehave
strongerdosesofoneortheother.Again,itisbeyondthescopeofthispapertogointothefinedetails
ofhoweitherworks,butjustbeawarethatdoctorsmaytinkerwithhormonelevelstotrytoalleviate
PMSsymptoms.
If oral contraceptives and SSRIs donotwork, or cannotbe toleratedby thewoman, there is another
therapyusedcalledaGnRHanalogue.AsstatedbyDr.RapkinandDr.Akopians:
AGnRHanalogue isasyntheticpeptidethat interactswithaGnRHreceptorandconsequently
elicits release of follicle-stimulating hormone and luteinizing hormome from the anterior
pituitary.Aftertheinitialsurgeofproductionofovariansteroidproduction, itthensuppresses
ovarian steroidproductionand therefore results ina ‘medicalmenopause’with its associated
reliefofsymptomsofPMS.37
This is obviously a more extreme treatment and comes with its own set of side effects. When
administered without any progesterone or estrogen addback therapy, they tend to have a
“hypoestrogenism”effectonthebody.This includesallsymptomsassociatedwithlowestrogeninthe
body:drynessandbonemineraldensityloss,forstarters.Doctorswillremedythisbyaddingsynthetic
estrogen as well as synthetic progesterone in low doses. It is typically used for no more than 6
months.38
15
Now that we’ve looked at the western understanding of PMS, we can look at how Ayurveda would
approachthisdisorder.SinceAyurvedadoesn’tuseSSRIs,oralcontraceptives,orGnRHanalogues,we
get to come at this condition from a totally different angle. Ayurveda uses diet, lifestyle, five sense
therapies,andherbstotrytohelpwomenwiththiscondition.Alloftheseapproachesarenotdescribed
inthispaper,however,onesrelevanttoWesternmedicineandstudiesare.
AYURVEDICCHIKITSA
Ayurveda teaches us that our treatment must always consider the state of a person’s digestive fire
(agni),toxinsinthebody(ama),andtheoverallstrengthofthetissuesandsystemsofthebody(ojas).
Treatment begins in the digestive systemwith the regulation of agni through a dosha-pacifying diet.
Ama is dealt with through purification, either by Pancha Karma, Ayurveda’s strongest means of
eliminatingama fromthebody,orbypalliation,amoregentleandapproach for thosewith lowojas.
Strongojasisbuiltthroughproperdietandlifestyle,alldependentonaperson’svikruti(currentstateof
health). BecauseAyurvedahas an understanding of the doshas in the body, it can givemore specific
recommendationsbasedonaperson’sconstitutionandthenatureoftheconditiontheyhave.Wehave
determinedthatVataisthedoshawiththegreatestimbalanceinPMS,sothegeneraltreatmentmust
befocusedonpacifyingVata.
Westernmedicinemakes some dietary suggestions, but falls short. Ayurveda teaches that there are
threetastesthatcansoothevata:sweet,sour,andsalty.Sweetisaheavytastehowever,somonitoring
theagniandmakingsureitisstrongenoughtodigesttheheavyqualitiesisessential.
Medicaldoctorsmaysuggestexercise tohelporpreventsymptoms,butAyurvedaagaincantakethis
onestepfurther.TheancienttextCarakaSamhitastates,“perspiration,enhancedrespiration,lightness
of the body, inhibition of the heart and such other organs of the body are indicative of the exercise
beingperformedcorrectly.”39TheAshtangaHrdyamaddstothat,“thosewhoindulgedailyintoomuch
exercise…perish,justasalion,aftervanquishinganelephant.”40Thesepassagesaretryingtorelaythe
message that while exercise is important to health, over exercise can be extremely detrimental.
AyurvedaalsosaysthatthoseespeciallywithaprimaryVataimbalanceshouldavoidexcessiveexercise,
as thiswill further vitiate the dosha. Gentle yoga asanas can be very beneficial for pacifying Vata. A
studydoneonmedicalundergraduatesshowedyogacanofferanaturalandeffectivewaytoalleviate
16
PMS symptoms and can serve as an alternate to painkillers and hormonal supplements. Along with
stressreduction,itprovidesamoderatedegreeofexerciseandtonificationofthebody.41
Meditationandmindfulnesscanbeveryeffectiveforstressreductionandcalmingtheerraticmovement
oftheelementairinVata.Astudypublishedin2016lookedattheeffectofmindfulness-basedcognitive
therapy(MBCT)onthesymptomsofPMS.Theparticipantsofthestudyweretaughtavarietyofstress
management techniques like yoga, meditation, and self-care. The meditation practice was used to
increaseawarenessandattention.TheparticipantsusedMBCTtorecognizehowanxiousordepressive
thoughts may exacerbate PMS symptoms. The researchers state, “MBCT provides individuals with a
heightenedabilitytosimplyobservethoughts,feelings,andexperiencesinordertodisengageautomatic
and often dysfunctional reactivity and then to allow them toworkwithmore balanced relationships
withthemselves.“42TheCarakaSamhitasays,“Thesensefaculties,togetherwiththemind,getvitiated
by excessive utilization, non-utilization, and wrong utilization of the objects concerned.” 43 This
statementistellsusthatwecanputourselvesoutofbalancebymisusingoursenses,butbybecoming
awareofthis,wecanalsogetourselvesbackintobalance.MBCTiscertainlyonewaytobecomeaware
of how we use or misuse our senses, and can help us make more conscious choices. It is always
encouragingwhenmodern science canbackupwhatAyurvedahasbeen suggesting for thousandsof
years. This study mentioned teaching the participants self-care, and Ayurveda is an expert in this
subject.Theancienttextsalltalkaboutsneha,whichistheSanskritwordforoil,butitalsomeanslove.
Ayurvedaishugeonabhyanga:aself-oilmassagedonedailytonotonlyprotecttheskin,butalsothe
mind.TheCarakaSamhitaexpandsuponthis ideaandsays,“Asapitcher,adryskin,andanaxis(ofa
cart),becomestrongandresistantbytheapplicationofoil, sobythemassageofoil thehumanbody
becomesstrongandsmooth-skinned; it isnot susceptible to thediseasedue tovata; it is resistant to
exhaustions andexertions.”44Massagehelps bring thenervous systemback into theparasympathetic
andrelievesstressandtension,whichhelpstopacifyVata.
As we have seen, Western science has began to describe the sophisticated and perplexing role of
hormonesandchemicalsinthebodyandhowtheymayhavearoleinthedevelopmentofPMS.Though
thereisalotoffascinatinginformationoutthere,modernscienceseemstofallshortintreatmentand
management of the condition. Ayurveda has a huge advantage here and recognizes imbalances long
before they manifest in to more serious illnesses. By studying Ayurvedic anatomy and physiology,
practitionersmaybeabletohelponadeeperlevel,withoutchemicalintervention.
17
Endnotes
1Moreno,MeganA.,MD,MEd,MPH,AnnE.Giesel,MD,CaraBethRogers,andLianaRoxanneClark,MD,MS."PremenstrualSyndrome."PremenstrualSyndrome.September01,2016.AccessedMarch01,2017.http://emedicine.medscape.com/article/953696-overview.2Yonkers,KimberlyA.,MD,andRobertF.Casper,MD."EpidemiologyandPathogenesisofPremenstrualSyndromeandPremenstrualDysphoricDisorder."EditedbyRobertL.Barbieri,MD,WilliamF.Crowley,Jr,MD,andKathyrnA.Martin,MD.InUpToDate.AccessedApril15,2017.www.uptodate.com/contents/epidemiology-and-pathogenesis-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder?source=search_result&search=premenstrual%2Bsyndrome&selectedTitle=3~150.3Applegate,Edith."ReproductiveSystem."InTheAnatomyandPhysiologyLearningSystem,431-32.4thed.London:ElsevierHealthSciences,2011.4Welch,Claudia."SexHormones:TheAmbassadorsofYin."InBalanceYourHormones,BalanceYourLife,18-21.Cambridge,MA:DaCapoLifelong,2011.5Ibid.,21-22.6Applegate,TheAnatomyandPhysiologyLearningSystem,431-32.7Ibid.,4328Fig1.From:Applegate,TheAnatomyandPhysiologyLearningSystem,431.9Fig2.From:Ibid.,431.10Welch,"Menstruation."BalanceYourHormones,BalanceYourLife,53-58.11MarcHalpern,DC."AyurvedicPathology."InPrinciplesofAyurveda,169-70.11thed.12Joshi,Dr.NirmalaG."ConceptofMenstruation."InAyurvedicConceptsinGynaecology,22,23,31.NewDelhi,India:ChaukhambaPublishingHouse,2013.13Ibid.,32.14Suśruta,andKunjalalBhishagratna.AnEnglishTranslationoftheSushrutaSamhita.Vol.2.Varanasi:ChowkhambaSanskritSeriesOffice,1996.125.15Joshi,AyurvedicConceptsinGynaecology,33.16Halpern,PrinciplesofAyurveda,171-74.17Fig3.From:Joshi,AyurvedicConceptsinGynaecology,32-3318Yonkers,KimberlyA.,MD,andRobertF.Casper,MD."ClinicalManifestationsandDiagnosisofPremenstrualSyndromeandPremenstrualDysphoricDisorder."EditedbyRobertL.Barbieri,MD,WilliamF.Crowley,MD,andKathrynA.Martin,MD.InUpToDate.AccessedApril18,2017.www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder?source=search_result&search=premenstrual%2Bsyndrome&selectedTitle=2~150. 19Halpern,Marc,DC."Women'sHealthPartII."InClinicalAyurvedicMedicine,5-89--94.6thed.20"PatientEducation:PremenstrualSyndrome(PMS)andPremenstrualDysphoricDisorder(PMDD)(BeyondtheBasics)."InUpToDate.AccessedApril27,2017.www.uptodate.com/contents/premenstrual-syndrome-pms-and-premenstrual-dysphoric-disorder-pmdd-beyond-the-basics?source=search_result&search=premenstrual%2Bsyndrome&selectedTitle=4~150.21Liu,Q.,Li,R.,Zhou,R.,Li,J.,&Gu,Q.(2015).AbnormalResting-StateConnectivityatFunctionalMRIinWomenwithPremenstrualSyndrome.PLoSONE,10(9),e0136029.http://doi.org/10.1371/journal.pone.0136029
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22"WhatIsMetabolicSyndrome?"WebMD.AccessedApril01,2017.http://www.webmd.com/heart/metabolic-syndrome/metabolic-syndrome-what-is-it#1.23Hashemi,S.,RamezaniTehrani,F.,Mohammadi,N.,RostamiDovom,M.,Torkestani,F.,Simbar,M.,&Azizi,F.(2016).ComparisonofMetabolicandHormonalProfilesofWomenWithandWithoutPremenstrualSyndrome:ACommunityBasedCross-SectionalStudy.InternationalJournalofEndocrinologyandMetabolism,14(2),e28422.http://doi.org/10.5812/ijem.2842224Lucille,Holly,ND,RN."EstrogenDominance:TooMuchofaGoodThingCanCertainlyBeBAD!"EstrogenDominance-AANP.AccessedApril19,2017.http://www.naturopathic.org/content.asp?contentid=401.25Halpern,ClinicalAyurvedicMedicine,5-91.26Thompson,Mary,CAS."Women'sHealthIIHomeworkReview."Lecture,CaliforniaCollegeofAyurveda,NevadaCity,CA,March28,2017.27Rapkin,AndreaJ.,andAlinL.Akopians."PathophysiologyofPremenstrualSyndromeandPremenstrualDysphoricDisorder."Review.PostReproductiveHealth,June1,2012,53.AccessedApril4,2017.journals.sagepub.com/doi/abs/10.1258/mi.2012.012014.28Ibid.,53-5429Ibid.,54-5530Halpern,ClinicalAyurvedicMedicine,5-9131Ibid.,5-9232Ibid.,5-9433Casper,RobertF.,MD,andKimberlyA.Yonkers,MD."TreatmentofPremenstrualSyndromeandPremenstrualDysphoricDisorder."EditedbyRobertL.Barbieri,MD,WilliamF.Crowley,MD,andKathrynA.Martin,MD.InUpToDate.FirstpublishedinJune8,2016.AccessedApril9,2017.www.uptodate.com/contents/treatment-of-premenstrual-syndrome-and-premenstrual-dysphoric-disorder?source=search_result&search=premenstrual%2Bsyndrome&selectedTitle=1~32.34Ibid.,35RapkinandAkopians,“PathophysiologyofPremenstrualSyndromeandPremenstrualDysphoricDisorder”,55-5636Ibid.,5637Ibid.,5638Ibid.,5639Caraka,RāmaKaraṇaŚarmā,andBhagwanDash."Non-SupressionofNaturalUrges."InCarakaSaṃhitā,152-53.Vol.1.Varanasi:ChowkhambaSanskritSeriesOffice,2012.40Vāgbhaṭa,andR.K.SrikanthaMurthy."DesireforLongLife."InVāgbhaṭa'sAṣṭāṅgaHrdayam,25.Vol.1.Varanasi:KrishnadasAcademy,2013.41Bharati,M.(2016).ComparingtheEffectsofYoga&OralCalciumAdministrationinAlleviatingSymptomsofPremenstrualSyndromeinMedicalUndergraduates.JournalofCaringSciences,5(3),179–185.http://doi.org/10.15171/jcs.2016.019 42Panahi,F.,&Faramarzi,M.(2016).TheEffectsofMindfulness-BasedCognitiveTherapyonDepressionandAnxietyinWomenwithPremenstrualSyndrome.DepressionResearchandTreatment,2016,9816481.http://doi.org/10.1155/2016/981648143DashandSharma,CarakaSamhita,Vol.1.169.44Ibid.,124.
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AbstractsTitle:RecreationalPhysicalActivityandPremenstrualSyndromeinYoungAdultWomen:ACross-SectionalStudyAuthors:Kroll-DesrosiersAR,RonnenbergAG,ZagarinsSE,HoughtonSC,Takashima-UebelhoerBB,Bertone-JohnsonER.Journal:PLoSOne.2017;12(1):e0169728.Published:onlineJan12,2017PMID:28081191INTRODUCTION:Itisestimatedthatupto75%ofpremenopausalwomenexperienceatleastonepremenstrualsymptomand8-20%meetclinicalcriteriaforpremenstrualsyndrome.Premenstrualsyndromesubstantiallyreducesqualityoflifeformanywomenofreproductiveage,withpharmaceuticaltreatmentshavinglimitedefficacyandsubstantialsideeffects.Physicalactivityhasbeenrecommendedasamethodofreducingmenstrualsymptomseverity.However,thisrecommendationisbasedonrelativelylittleevidence,andtherelationshipbetweenphysicalactivity,premenstrualsymptoms,andpremenstrualsyndromeremainsunclear.METHODS:Weevaluatedtherelationshipbetweenphysicalactivityandpremenstrualsyndromeandpremenstrualsymptomsamong414womenaged18-31.UsualpremenstrualsymptomexperiencewasassessedwithamodifiedversionoftheCalendarofPremenstrualExperiences.Total,physical,andaffectivepremenstrualsymptomscoreswerecalculatedforallparticipants.Eightywomenmetcriteriaformoderate-to-severepremenstrualsyndrome,while89metcontrolcriteria.Physicalactivity,alongwithdietaryandlifestylefactors,wasassessedbyself-report.RESULTS:Physicalactivitywasnotsignificantlyassociatedwithtotal,affective,orphysicalpremenstrualsymptomscore.Comparedtothewomenwiththelowestactivity,womenintertiles2and3ofactivity,classifiedasmetabolicequivalenttaskhours,hadprevalenceoddsratiosforpremenstrualsyndromeof1.5(95%CI:0.6-3.7)and0.9(95%CI:0.4-2.4),respectively(p-valuefortrend=0.85).CONCLUSIONS:Wefoundnoassociationbetweenphysicalactivityandeitherpremenstrualsymptomscoresortheprevalenceofpremenstrualsyndrome.Title:TheEffectsofMindfulness-BasedCognitiveTherapyonDepressionandAnxietyinWomenwithPremenstrualSyndrome.Authors:PanahiF.,FaramarziM.Journal:DepressResTreat.2016;2016:9816481Published:onlineNovember29,2016PMID:28025621OBJECTIVE:LittleresearchhasbeendoneregardingtheroleofpsychotherapyinthetreatmentofPremenstrualSyndrome(PMS).Theaimofthisstudywastoexaminetheeffectofmindfulness-basedcognitivetherapy(MBCT)onthePMSsymptomsanddepressionandanxietysymptomsinwomenwithPMS.DESIGN:Inarandomizedcontrolledtrial,atotalof60studentsatMazandaranUniversitywithmildtomoderatePMSwhohaddepressivesymptoms(Beckdepressionscores16-47)wererandomlyallocatedtoeitheranexperimental(n=30)oracontrol(n=30)group.TheexperimentalgroupreceivedMBCTin
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eightgroupsessions(120 mineach)over8weeks.Thecontrolgroupreceivednointervention.AllparticipantscompletedthePremenstrualAssessmentScale(PAS),BeckDepressionInventory(BDI),andBeckAnxietyInventory(BAI)atthebeginningandtheendofthestudy.Repeated-measureANOVAwasusedtoanalyzethedata.RESULTS:Attheendofstudy,theexperimentalandcontrolgroupsshowedthefollowingscores,respectively(mean±SD):depression,15.73±6.99and25.36±7.14;anxiety,16.96±7.78and26.60±9.38;andtotalPAS,42.86±8.02and58.93±8.47.MBCTimproveddepressionandanxietysymptomsandtotalPASscore.CONCLUSION:MBCTinterventionisacceptableandpotentiallybeneficialinwomenwithPMSsymptoms.PsychotherapyshouldbeconsideredasatreatmentoptionformildtomoderatePMSinwomenwithdepressivesymptoms.Title:ComparingtheEffectsofYoga&OralCalciumAdministrationinAlleviatingSymptomsofPremenstrualSyndromeinMedicalUndergraduates.Author:BharatiM.Journal:JCaringSci.2016Sep1;5(3):179-185.Published:onlineSeptember1,2016INTRODUCTION:Medicalundergraduatesareheavilyburdenedbytheircurriculum.Thefemales,inaddition,sufferfromvividaffectiveorsomaticpremenstrualsyndrome(PMS)symptomssuchasbloating,mastalgia,insomnia,fatigue,moodswings,irritability,anddepression.ThepresentstudywasproposedtoattenuatethesymptomsofPMSbysimplelifestylemeasureslikeyogaand/ororalcalcium.METHODS:65medicalfemalestudents(18-22years)witharegularmenstrualcyclewereaskedtoself-ratetheirsymptoms,alongwiththeirseverity,inavalidatedquestionnairefortwoconsecutivemenstrualcycles.Fifty-eightstudentswerefoundtohavePMS.Twentygirlsweregivenyogatraining(45minutesdaily,fivedaysaweek,forthreemonths).Anothergroupof20wasgivenoraltabletsofcalciumcarbonatedaily(500mg,forthreemonths)andrest18girlservedascontrolgroup.DatawereanalyzedbySPSSver.13software.RESULTS:Theyogaandcalciumgroupsshowedasignificantdecreaseinnumberandseverityofpremenstrualsymptomswhereasinthecontrolgrouptherewasnotthesignificantdifference.Conclusion:Encouragingaregularpracticeofyogaortakingatabletofcalciumdailyinthemedicalschoolscandecreasethesymptomsofpremenstrualsyndrome.Title:ComparisonofMetabolicandHormonalProfilesofWomenWithandWithoutPremenstrualSyndrome:ACommunityBasedCross-SectionalStudy.Auhtors:HashemiS,RamezaniTehraniF,MohammadiN,RostamiDovomM,TorkestaniF,SimbarM,AziziF.Journal:IntJEndocrinolMetab.2016Apr;14(2):e28422Published:onlineFebruary14,2016BACKGROUND:Premenstrualsyndrome(PMS)isreportedbyupto85%ofwomenofreproductiveage.AlthoughseveralstudieshavefocusedonthehormoneandlipidprofilesoffemaleswithPMS,theresultsarecontroversial.
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OBJECTIVES:ThisstudywasdesignedtoinvestigatetheassociationofhormonalandmetabolicfactorswithPMSamongIranianwomenofreproductiveage.MATERIALSANDMETHODS:Thisstudywasacommunitybasedcross-sectionalstudy.Anthropometricmeasurements,biochemicalparameters,andmetabolicdisorderswerecomparedbetween354womenwithPMSand302healthycontrolsselectedfromamong1126womenofreproductiveagewhoparticipatedintheIranianPCOSprevalencestudy.Pvalues<0.05wereconsideredsignificant.RESULTS:Prolactin(PRL)andtriglycerides(TG)weresignificantlyelevatedinwomenwithPMS,whereastheirtestosterone(TES),highdensitylipoprotein(HDL)and17-hydroxyprogesterone(17-OHP)levelsweresignificantlylessthantheywereinwomenwithoutthesyndrome(P<0.05).Afteradjustingforageandbodymassindex(BMI),linearregressionanalysisdemonstratedthatforeveryoneunitincreaseinPMSscoretherewas12%riseintheprobabilityofhavingmetabolicsyndrome(P=0.033).CONCLUSIONS:TherewasasignificantassociationbetweenPMSscoresandtheprevalenceofmetabolicsyndrome.FurtherstudiesareneededtoconfirmandvalidatetherelationshipsbetweenlipidprofileabnormalitiesandmetabolicdisorderswithPMS.Title:AbnormalResting-StateConnectivityatFunctionalMRIinWomenwithPremenstrualSyndromeAuthor:QingLiu,RuiLi,RenlaiZhou,QuanGuJournal:PLoSOne.2015;10(9):e0136029.Published:onlineSeptember1,2015OBJECTIVES:Premenstrualsyndrome(PMS)referstoaseriesofcyclingandrelapsingphysical,emotionandbehaviorsyndromesthatoccurinthelutealphaseandresolvesoonaftertheonsetofmenses.AlthoughPMSiswidelyrecognized,itsneuralmechanismisstillunclear.DESIGN:Toaddressthisquestion,wemeasuredbrainactivityforwomenwithPMSandwomenwithoutPMS(controlgroup)usingresting-statefunctionalmagneticresonanceimaging(rs-fMRI).Inaddition,theparticipantsshouldcompletetheemotionscales(BeckAnxietyInventory,BAI;BeckDepressionInventory,BDI,beforethescanning)aswellasthestressperceptionscale(Visualanalogscaleforstress,VAS,beforeandafterthescanning).RESULTS:Theresultsshowedthatcomparedwiththecontrolgroup,thePMSgrouphaddecreasedconnectivityinthemiddlefrontalgyrus(MFG)andtheparahippocampalgyrus(PHG),aswellasincreasedconnectivityintheleftmedial/superiortemporalgyri(MTG/STG)andprecentralgyruswithinthedefaultmodenetwork(DMN);inaddition,thePMSgrouphadhigheranxietyanddepressionscalescores,togetherwithlowerstressperceptionscores.Finally,thereweresignificantlypositivecorrelationsbetweenthestressperceptionscoresandfunctionalconnectivityintheMFGandcuneus.TheBDIscoresinthePMSgroupwerecorrelatednegativelywiththefunctionalconnectivityintheMFGandprecuneusandcorrelatedpositivelywiththefunctionalconnectivityintheMTG.CONCLUSION:Thesefindingssuggestthatcomparedwithnormalwomen,womenwithPMSdisplayedabnormalstresssensitivity,whichwasreflectedinthedecreasedandincreasedfunctionalconnectivitywithintheDMN,bluntedstressperceptionandhigherdepression.