Symptoms
The onset of this syndrome is abrupt, generally with a headache which is often accompanied by vomiting. A general feeling of depression and irritability permeate the entire experience. What is worse, these symptoms intensify progressively, making the last day of the PMS the worst.
Tension headaches are common during this period, but in some cases, migraines attacks occur with severe pain and vomiting. The patient suffers from breast tenderness, which is sometimes so severe that it is almost unbearable. There may also be abdominal bloating , accompanied in some cases, by odema of the ankles and hands. Some women resort to dieting to get rid of the abodminal bloating but this only leads to fatigue and depression. Others may experience a craving for sweet foods.
Some of the less common symptoms are exacerbation of epilepsy dizziness, back ache, hoarse voice, greasy hair , acne and allergic reactions.
Patients suffering from premenstrual tension may show a gain of weight of one kg or more in the latter part of the menstrual cycle due to salt and water retention. The retention of fluid is partly due to ovarian steroids, but there is also an increased output of anti diuretic hormone from the posterior pituitary gland.

Diagnosis
There is no specific laboratory diagnosis of the premenstrual syndrome. The problem can be diagnosed on the basis of past history showing a clear, recurrent relationship between a stage of the menstrual cycle and the onset of symptoms as well as the coincidence of relief with the start or cessation of menstruation. The patient may maintain a personal diary about her symptoms and feelings during those days. The record should be kept for atleast three cycles.

Causes
The causes behind the premenstrual syndrome still remain unexplained. Some authorities believe that deficiency of hormone progesterone may result in PMS but this has not yet been satisfactorily proved. Emotional stress can often contribute to the symptoms, and the social relationship of the patient needs to be reviewed.
A team of researchers at Sinai Hospital in Baltimore and John Hopkins University School of Medicine, London, through carefully controlled studies concluded that dietary deficiencies particularly that of vitamin E and vitamin B6 or pyridoxine are the most common causes of PMS.

Treatment
Treatment depends on the severity of the symptoms. Where only mild symptoms are experienced , the problem can be elevated by a change of routine. Extra work and stressful situation should be avoided. Fluids should be moderately restricted and care should be taken not to add extra salt to the food.The patient’s partner and family members should be educated about all the facets of the PMS. The patient should not take any oral contraceptives as these may cause fluid retention and lowering the plasma levels. Hormonal imbalance and infections of the uterus can be helped by a natural diet regimen.
As most women feel tension arising from chronic constipation it is essential to treat this condition first. In constipation, the putrefying faecal matter may be reabsorbed into the bloodstead, and the same blood, if supplied to the brain, will cause gradual enervation. Constipation can be relieved by a lukewarm water enema and liberal intake of seasonal fruits and vegetables and simple fibrous meals.
Other treatment for the PMS include regular cold hip baths for 10 to 15 minutes twice a day. This will congestion and inflammation of the uterus and connected organs. Tension will also be dissipated with this treatment. Hot foot baths followed by a cold compress to the lower abdomen and the inner surfaces of the thighs also help to relieve uterine congestion and tension.
If the cold hip bath is not practicable, a wet girdle pack applied twice a day on empty stomach is very beneficial for clearing up uterine congestion and improving bowel function.
All these statements should be suspended during the menstrual flow.
Diet pays a significant role in preventing premenstrual syndrome. The patient should avoid refined carbohydrates, sugars, coffee, tea, tobacco, other stimulants, oily, fried or spicy food and all meats.
A regular practice of yogasanas, especially those recommended for strengthening the genito-urinary system will be very useful in overcoming premenstrual syndrome. These asanas are bhujangasana, shalabhasana, vajrasana, paschimotanasana, ardhamatsyendrasana and trikonasana. Other helpful measures are brisk walks and abdominal exercises which are good for strengthening the abdominal muscles and pelvic organs.
Great relief can also be obtained by manipulating the tender points gently, on the big as well as other toes of the feet. Manipulation on the middle portion of the leg foot which relates the uterus and vagina will help to correct the disorder of the uterus.
Mental poise is an important factor. Negative mental attitudes like fear, worry, anger, jealousy , tension and inferiority complex should be eliminated by positive thinking, meditation and good company.

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