By Aquarius
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10 Aug, 2022
Pre Menstrual Syndrome (PMS), (it should be called Premenstrual Distress Syndrome), is probably one of the most discomforting and frustrating dis-ease condition, that affects millions of women and girls, between age 18 and menopause. “PMS has been the subject of much discussion and controversy since its description 60 years ago… the discussion has ranged from whether it really exists as a disease entity, whether it is treatable… The controversy has ranged from a consideration of whether it is primarily a physical disorder to whether it is a mental disorder.”1 This is reminiscent of the debate on Fibromyalgia, another female oriented health condition. Is she really in pain or is it her fanciful imagination? Just about every massage therapist’s business card/promo, in print and on the Internet, proclaim that massage therapy can, naturally, alleviate the pain and distress of PMS and spare women the sometimes-debilitating symptoms of this unwelcome, Monthly visitor. I became curious about the subject and thought that it will be good to find out what, if anything, the literature says about Massage therapy and its effects on PMS symptoms. The following is a summary of some published and anecdotal information that I have seen. Definition The US Department of Health and Human Services defines PMS on its Website: Premenstrual syndrome (PMS) is a group of symptoms linked to the menstrual cycle. PMS symptoms occur in the week or two weeks before your period (menstruation or monthly bleeding). The symptoms usually go away after your period starts. PMS can affect menstruating women of any age. It is also different for each woman. PMS may be just a monthly bother or it may be so severe that it makes it hard to even get through the day. Monthly periods stop during menopause, bringing an end to PMS.2 A survey of the literature yielded very similar definitions. However, this one found on Wikippedia.org, is more or less representative of how most health professionals define this condition: “Premenstrual syndrome (PMS) (sometimes referred to as PMT or Premenstrual Tension) is a collection of physical, psychological, and emotional symptoms related to a woman's menstrual cycle. While most women of child-bearing age (about 80 percent) have some Premenstrual symptoms,”3 “…some women with PMS have symptoms of sufficient severity to interfere with some aspects of life such symptoms are usually predictable and occur regularly during the two weeks prior to menses. The symptoms may vanish after the menstrual flow starts, but may continue even after the flow has begun. For some women with PMS, the symptoms are so severe that they are considered disabling. This form of PMS has its own psychiatric designation: Premenstrual Dysphoric Disorder (PDD)”. 4 What causes PMS? Hormonal dysfunction is found to be the cause of many menstrual complaints, the most prominent being premenstrual syndrome. 5 “The causes of PMS are not clear, it is linked to changing hormones during the menstrual cycle. (However) Some women may be affected more than others by changing hormone levels during the menstrual cycle. (Though) Stress and emotional problems do not seem to cause PMS… they may make it worse. Research seems to suggest that lifestyle factors such as Caffeine, alcohol and nicotine intake may make symptoms worse. 6 Diagnosing PMS Although women for the most part seem to be satisfied in casually using the term PMS to define an array of difficulties during "that time of the month” medical professionals are obliged to fit the symptoms into a concise category in order to diagnose, treat and quantify the syndrome in scientific research. There are actually as many as 150 symptoms described in the literature as being connected to PMS, varying with each individual case.7 While some physical and emotional symptoms are more common than others, the specific symptoms identified are not necessarily critical to a diagnosis of PMS. "What is important is the cyclic fashion in which they occur…".8 In order to establish a medical diagnosis of PMS, symptoms are charted for three months to establish a continuing pattern of occurrence during the latter half of the menstrual cycle. Typically, symptoms disappear once menses begins, but in some cases they may continue through the first part of the menses, with only a few days of the month being experienced as normal. In addition to symptoms identified as PMS, pre-existing conditions such as arthritis, asthma and lupus may be exacerbated by these cyclical changes.9 Yet, “…a minority of women never experience PMS, but at the other end of the scale, as many as 40 percent have mild symptoms and up to 10 percent may be affected to the point of debilitation, being diagnosed with the severe form of Premenstrual Dysphoric Disorder.10 A clinical diagnosis of PMS is based on symptoms, when they occur, and how much they affect your life. What are the symptoms of PMS? According to medical and other health care professionals, PMS often includes both physical and emotional symptoms. I think that citing some of the most common symptoms will help women to track their own experiences, to see if they qualify for the ‘clinical’ diagnosis. Women in many parts the world knew that, just prior to their ‘period’, they suffered from distressful phenomena that affected all aspects of their being. Did they really need a ‘Clinical diagnosis’ to endorse and so justify these experiences of pain and general disintegration? It seems like the male dominated medical profession, including Gynecologists, mind you, needed to fit women’s symptoms into some kind of formal model, before they could treat. The model that eventually ‘evolved’ recognize the following symptoms of PMS: * acne * breast swelling and tenderness * feeling tired and exhausted * having trouble sleeping * upset stomach, bloating, constipation, or diarrhea * headache or backache * appetite changes or food cravings * joint or muscle pain * trouble concentrating or remembering * tension, irritability, mood swings, or crying spells * anxiety or depression.11 How do Mds diagnose PMS/PMDD? They check the patient’s symptoms and the way they relate to her menstrual cycle. The patient may also be ask to fill out a symptom chart report for several weeks. There is no test that can diagnose PMS/PMDD. The list below represents, more or less, the conventional medical approach to treatment of this condition: Severe cases Antidepressants. Antidepressants such as SSRIs are commonly used for the depression associated with PMS and PMDD (Freeman EW et al 2004; Baldessarini R 2001). Serotonin reuptake inhibitors that are commonly used to treat PMS include Prozac® (fluoxetine) and Zoloft® (sertraline) (Berga S 2005). Benzodiazepines. This class of medications is used to induce sedative, muscle-relaxant, and anticonvulsant effects (Baldessarini R 2001). Others. Bromocriptine, an ergot alkaloid that blocks the release of prolactin from the pituitary gland, is often given to treat breast tenderness associated with PMS (Meden-Vrtovec et al 1992). Mild to moderate cases. NSAIDs. Over-the-counter (OTC) medicines such as ibuprofen (Motrin®) and naproxen sodium (Aleve®) are commonly used to ease uterine cramping and breast tenderness (Mayo Clinic 2005). These drugs inhibit prostaglandin synthesis (Neal M 2002). It is Premenstrual Dysphoric Disorder (PMDD)” that caught the attention of the Touch Research Institute, (TRI) in Miami Fl., and they decided to focus on that condition for a massage study. The organizers used the official diagnostic definition of PMDD, and conducted a “double blind” study. A brief summary of the report is included below. “To meet the criteria for PMDD as laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) the patient is required to have at least five recurring symptoms, of which four are affective (emotional), along with significant interference in social or occupational functions”.12 Women suffering from symptoms of premenstrual syndrome (PMS), such as irritability, headaches, anxiety and weight gain, felt relief from regular massage sessions, according to results from a recent research study. The study, "Premenstrual symptoms are relieved by massage therapy," was conducted by the Touch Research Institute in conjunction with the University of Miami Medical School. Twenty-four women, aged 19 to 45, with premenstrual dysphoric disorder (a severe form of PMS) were selected from gynecological practices. The women were randomly assigned to a massage therapy group or a relaxation group. Those in the massage therapy group received twice-weekly, 30-minute massage sessions for five weeks. The sessions started during a premenstrual week to establish a baseline measure. Sessions began with the woman supine, and included 15 minutes of: kneading the neck; stroking the forehead; pressing down on the tops of the shoulders; stroking on the hands, arms and shoulders; circular stroking on the stomach; stroking of the feet and legs; and kneading of the thighs. The remaining fifteen minutes of the session, the woman was prone while the therapist stretched her ankles; compressed her calf muscles; kneaded her thigh muscles; gave gliding strokes to her legs; and massaged her low back, shoulders and neck. The relaxation group was given progressive muscle relaxation therapy. For 30 minutes twice a week, participants were instructed to tense and relax major muscle groups, starting with the feet and moving up. At the end of the study, results indicated that the massage therapy group experienced a decrease in anxiety, a decrease in depression… a reduction in perceived pain…, and an overall reduction in PMS symptoms including pain and fluid retention… To be Continued...