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.

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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

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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

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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

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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

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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

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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

20

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.