Hormonen Anhang P.M.S.
https://openscholar.dut.ac.za/bitstream/10321/3060/1/SUKATIBNS_2018.pdf
The efficacy of a Homoeopathic mother tincture complex
(Vitex agnus castus, Melissa officinalis and Valeriana officinalis) in
the management of Premenstrual Dysphoric Disorder
[Behlulile Nonsikelelo Stoppy Sukati]
[Erwin Schlüren]
„Homöopathie in der Frauenheilkunde und Geburtshilfe“
Perioden-Störungen
-»KENT1897 / III 763, KLUNKER 111 522)
Die homöopathische Behandlung der Perioden-Störungen ist besonders
dankbar. Es gelingt meist nicht so schnell wie mit Hormonen, sofort die Periode
zum gewünschten
Zeitpunkt zu erreichen (die dann oft keine echte ist, sondern eine Hormonabbruch-Blutung), dafür
ist die Wirkung
des homöopathischen Mittels eine echte. Sie regt die
Hormondrüsen zu eigener normaler Tätigkeit an.
Die Anlaufzeit ist oft (nicht immer) länger, der Erfolg hält dann aber
meist nach Absetzen des Mittels auch an.
Es gibt nicht wenige Patientinnen, die Hormone nicht vertragen oder bei
denen sie kontraindiziert sind.
Hier ist die
homöopathische Behandlung besonders aktuell.
Periode unregelmäßig
-> KENT 1902 / III 768
Cimic. D 4-12, Nux-m. D 4-12, Arg-n. D 6-12,
Nit-ac. D 6-12 Sep. D 6-12, Lach. D12, Senec. D 2-4, Lyc., Con., Sil. (Calc-c.,
Calc-p., Cycl., Phos., Kali-p., Puls., Lil-t.,
See., Tub., Apis, Ign.) Nux-v., Okou.
Amenorrhoe
-> KENT 1897 / III 763, KLUNKER III522
Je länger die Amenorrhoe besteht, desto schwieriger ist ihre
(allopathische und homöopathische) Behandlung. Besteht sie länger als ein
halbes Jahr, so ist es oft ratsam,
zuerst eine künstliche Blutung mit Hormonen zu erzeugen und danach das
homöopathische Mittel zu geben. Besteht eine ganz junge, noch nicht erkennbare
Gravidität, so kann durch die homöopathischen Mittel kein Schaden
angerichtet werden.
Acon. D 3-6
Schreckamenorrhoe (Op., Ign.), Folgen von trockener Kälte,
Gemütserregung, Ärger, Furcht (Nux-v.)
Arist-cl. D 12 besonders bei Hypoplasie, anovulatorischen Zyklen und
Zyklen mit verspätetem Eisprung, evtl. im Wechsel mit Mang. D 6
Cimic. D 3-4
Amenorrhoe durch Kälte, Fieber, Aufregung, intersexueller Typ (auch
hypophysär mager, fett)
Graph. D 6-12 hypothyreotisch,
fett, frostig, obstipiert, faul
Puls. D 4-30 Erkältungsamenorrhoe durch nasse Füße, Amenorrhoe mit
Asthma (Spong.), Abneigung gegen Fett, evtl. mit Verat-v. D 3 im Wechsel (oder
mit Kali-s.)
Senec. Dl-3-12
Sulf. D12
Amenorrhoe junger Mädchen (Apis), Amenorrhoe (dafür Kitzelhusten),
Nasenbluten bei Aussetzen der Periode
Amenorrhoe nach Krankheiten, besonders nach Grippe, durch Unterdrückung
Weitere Mittel bei Amenorrhoe
Ph-ac. D 3-6, Alnus 0-D 6, Abrot.
Am-n. mit brennendem Schmerz vom Rücken zum Schambein
Amenorrhoe vom Kaltbaden
Amenorrhoe junger Mädchen (Senec.)
Amenorrhoe mit Blähungen mit anämischen Kopfschmerzen und Atemnot
(eventuell Tee) alles kommt zu spät mit Beckenkongestion und Schmerzhaftigkeit
des
Uterus statt Periode Abgang von wässrigem Blut oder Schleim
Amenorrhoe durch Reisen (Plat-met.), vikariierendes Nasenbluten
(Überhitzung, Erkältung bei heißem Wetter)
Amenorrhoe nach Erkältung bei Pastösen (Calc-p.)
Amenorrhoe bei physischer Überanstrengung bei jungen Frauen
Amenorrhoe nach Kaltbaden, Amenorrhoe führt zu Epilepsie (Gels.)
seelische Depression, körperliche
Überanstrengung, Sehstörungen
Hypoplasie, Frigidität, Dysmenorrhoe, Fluor
Amenorrhoe durch Kälte, Feuchtigkeit
Amenorrhoe, dafür Nasenbluten oder Brustschwellung
Amenorrhoe bei Anämie, frostig (Periode sonst verfrüht, verstärkt,
verlängert) bei Jugendlichen mit Nasenbluten Ant-c. D 4 Apis D 4-6 Apoc.
D 4 Ars-i.D6-12
Art-v.Dl-2 Aur-met. D 6-12 Aven. Bar-c. D
6-12-30 Bell. D 4 Bell-p. D 3-4 Berb. D 2-4 Bry. D 6 Calc. D 6-12 Cann-s. D 6
Carb-s. D 6, Caul. D 6, Cina, Con. D 6,
Cardiosp. Cina Cupr-met. D 4,6 Cycl. D 4-12 Dam.
D 3 Dulc.D4,6 Ferr-met. D 4,6,12 Ferr-i. D 4, 6 Gels. D 4,6.
GOSS. D 6 Hell. D 4,6 Helon. D 3-4 Hyos. D 6
Ign. D 6 Kali-c. D 4, 6 Lach. D 12-30 Leon. D l-6 Lith. D 6 Lyc.
D 6-12 Mang-met D 6-12 Merl. D 6
Mosch. D 6-12 Nat-m. D 6-30
Nep.D3-12 Nux-m. D 6-12
Nux-v. D 6-23 Op. D 6 Podo. D 6 Polyg. D 6-12
Psor.D30, Sep. D 6-12, Sil. D 6-12, Phos. D l Rub-t. Spong. D 2-6 Staph. D 4-30
Thal. D 6-12, Torm. D 20,30
Thuj. D 4-30 Urt-u.D4-12, Xan.D2 Zinc-met. D 6-12
Amenorrhoe mit Schwäche, Apathie, Aphonie,
Schlafsucht; Unterdrückung führt zu Hirnreizung,
Epilepsie (Cuprum)
„Als ob die Periode kommen wollte“; Amenorrhoe von Anämie mit Dyspepsie
und Schwäche
Amenorrhoe durch enttäuschte Liebe (Psychose bei Amenorrhoe)
Amenorrhoe durch Schreck (Acon. Op.), Kummer,
Gemütserregung (Nux-v.), paradoxe Symptome
lymphatisch, dick, frostig, Kreuzschmerzen durch Unterdrückung
(AB-Pille) mit spastischen Bauchschmerzen und nervöser
Reizbarkeit mit Kopfschmerz, Luesinum D 30 durch Schreck asthenisch,
hydrogenoide Konstitution, evtl. im Wechsel mit Puls. (evtl. Orgasmus bei
Periode)
Amenorrhoe mit Ohnmachtsanfällen (Nux-m.) durch Flucht, mager, trotz
gutem Appetit, Hyperprolaktinämie
Amenorrhoe mit Ohnmachtsanfällen, durch Gemütserregung, Überanstrengung
Amenorrhoe durch Gemütserregung, Ärger (Acon., Ign.)
Amenorrhoe durch Schreck (Acon., Ign.)
Amenorrhoe mit Pressen im Schoß Amenorrhoe führt zu Abneigung gegen Koitus
blass, anämisch
Amenorrhoe mit Asthma (Puls.)
Amenorrhoe durch Ärger (Nux-v.)
Amenorrhoe nach Pockenimpfung
Amenorrhoe in der Menarche mit Herunterkommen, langsame
Auffassungsgabe, gutartig,
Ovarialgie links
Verat. D 4, 6 (sonst Periode verspätet)
Ovaria siccata D 3 Tbl.
Hypophysis, Follikulin, Ovariin je in D 3 können evtl. zusätzlich zu
den anderen Mitteln gegeben werden (auch Injektion).
Tub. D 30, Med. und andere Nosoden (Parotitis D 30) nach den
entsprechenden Krankheiten sind oft sehr erfolgreich.
Weitere biologische Zusatzmittel
• Massage der Zonen D 10-L 4,
Moorbäder
• Schröpfen an der Innenseite
der Oberschenkel
• Akupunktur MP 6(d), Di4(7),
Ko4(l)
• Reibesitzbad nach KÜHNE:
Kaltes Wasser in einen Bottich, 2-3 Stunden stehen lassen. Schmales
Brett darüber. Nur den Unterleib frei machen! Mit kaltem Waschlappen 5-10
Minuten
gegen die Vulva spritzen (evtl. steigern) (vgl. LÖHLE, Hom.
Monatsblätter 97/9, 1972,210).
Periode unterdrückt
- aus geringstem Anlass
- Folgen von, oder
Verschlimmerung durch Unterdrückung
Statt Periode oder Periode unterdrückt, dafür Abgang von wässerigem
Blut oder Schleim
- Asthma
- Bewusstlosigkeit
- Blähbauch, schmerzhafter
- Blutungen vikariierend
- - Blase
- - .blutiger Husten
- - Nase
- - blutiger Stuhl
-» KENT 1902 / III 768, KLUNKER III 769 s. auch „Statt Periode"
Bry. D 3-6
Mosch. D 3-12
Berb. D 4
Asaf. D 4, Puls. D 4, Spong. D 4-6
-> KENT 19 / 119
Lach. D 12-30
Cast. D 4
-> KENT 1851 / III 717
Senec. Dl-3
-> KENT 1286 / III152
Erig. D 3-6, Lach. D 12, Phos. D 6-12, Senec. D 1-3 (Puls., Bry.,
Harn., Abrot., Dulc.) Graph. D 6-12, Ust. D 4, Ham. D 2, Zinc. D 6 Senec. Dl-3 blutige Diarrhöe
Menstruation
Brustschmerzen - Schwellung
Diarrhöe
Epilepsie
Erbrechen
Fluor
- Galaktorrhoe
- Gefühl, als ob die
Periode kommen wollte, kommt aber nicht
- Gelenkschmerzen
- Hämatome
- Hämorrhoiden
- Harndrang
- Herzklopfen
- Hirnkongestion
- Husten trocken (blutig)
- Ikterus
- Kitzelhusten
- Kopfschmerzen
- Krämpfe
Kreuzschmerzen
Milchsekretion
Nierenbeschwerden
Nymphomanie
Obstipation
Ödeme
Psychosen
rheumatische und nervöse Störungen
Zinc-met6-30 Dulc. D 4-6 Senec. Dl-3 Gels. D 4-12, Cupr-met. D
6-12
-> KENT 1591 / III 457
Chin. D 4-12 blutig, stinkend,
schwächend (Chen. D 6 und weinerliche Depression
Xan. D 6-30) Merc. D 12 GOSS. D 6 Lach. D 12-30 Senec. Dl-3 Sulf.
D 12, Phos. D 6-12 Puls. D 4-30
-> KENT 631 / II225
Verat-v. D 6-12 Senec. Dl-3, Cop. D 3-4 Chion. D 3 Senec. Dl-3 Lach. D 12-30, Verat. D 4-6
(Lob. D 4 links Schläfe, Glon. D 6) Gels. D 4-12 epileptiforme
Cupr-met. D 6-12 zur Brust ausstrahlend Verat. D 4 Cast. D 4 <
Kaffee Lob. D 4 Puls. D 4, Cycl. D 12 (Merc., Chin., Tub., Phos., Lyc.,
Rhus-t.)
Helon. D 2-3 Zinc-met. D 6-30 Graph. D 6-12 (Ham. D 2) Senec. Dl-3 Verat. D 6, Hell.
D 4 Cimic. D 4-12
- Rhinitis wässerig
- Schwindel
- Steißbeinschmerzen
- Störungen verschiedener Art
- Struma mit Exophthalmus
- Übelkeit
- Unruhe
- Zittern der Füße
- Zystitis, Pollakisurie
Amenorrhoe - nach Absetzen der
Pille nach Abstillen
Anstrengung nach Ärger - nach Grippe/nach kaltem Baden/führt zu
Epilepsie/nach Furcht/nach kaltem oder warmem Bad/nach kaltem Wasser/nach
Erkältung,
nassen Füßen nach Durchnässung, Erkältung
• nach Erkältung bei Pastösen
• durch Kälte, Fieber Senec. Dl-3
-» KENT 165 /1165
Sabin. D 4-12
-» KENT 737 / II331
Glon.D3-6 Ferr-i. D 6
-» KENT 1613 / III 479
Puls. D 4-30
-» KENT 85 /185
Puls. D 4-30 Senec. Dl-3 Lach. D 12, dazu Sumb. D 3
Oestro-Gesta comb. D 15, 30 (evtl. Injektion)
(Staufen-Pharma, Göppingen) (Cimic., Puls., Calc-c, Caust., Senec., Sep.,
Plat-met.) Sep.D6-12, Arist-cl.D3
Cycl. D 6-12, Nux-m. D 6 Acon. D 6-30, Coloc. D
4-6, Cham. D 30, Nux-v., Staph. Sulf. D 12-30 Ant-c. D 4, Acon., D 4-30, Mosch.
D 3 Cupr-met. D 6-12
(Gels.) Acon. D 30 Nux-m. D
6-12 Con. Puls. D 4-12 (+ Verat-v. D 3
im Wechsel, Calc-p.) Dulc. D 4-6 Calc-c. D 6-12 Cimic. D 4, Senec. D 6 (Kälte)
Menstruation
- durch enttäuschte Liebe Nat-m. D 30-200, Ign. D
30-200, Phos-ac. D 30
- durch unterdrückten Sil. D 12, Cupr-met. D 12
Fußschweiß
- durch allgemeine Parth. D 3
Schwäche - durch Zorn - durch
psychische Überanstrengung - durch Gemütserregung, Nux-m. D 3-6, Ign. D 6-30,
Cimic. D 6
Aufregung
- durch Flucht Arist-cl. D 12,
Nat-m. D 6-12
- durch Lager Arist-cl. D 12
- nach Schreck Acon. D
6-30 (Op., Ign., Nux-m., Lyc.)
Pubertät
- wenn Krankheiten sich
verschlechtern
- vor P. Depression
- verzögert
- praecox mit Makro-genitosomie
- Akne
- Atem stinkend
- Chorea
- Depression vor der Pubertät
- Depression in der Pubertät
- Epilepsie
- Galaktorrhoe
- Hysterie
- Kopfschmerz
- Manieriertheit, geziertes
Wesen oder Gereiztheit bei sexuell besessenen jungen Mädchen (Onanie)
Oft angezeigte Calc-p. und Senec. Puls., Senec.,
Cimic., Agar. Calc-p., Lach., Ars., Hell. Zinc. D 6-30 Epiphysis Dl-3 Trit. Puls., Arist-cl. Jug-r., Calc-p.,
potenziertes Menstrualblut C 7 Aur-met. D 6-12 Zinc-met. D 30
-* KENT 91 / 191
Manc. D 12 mit gesteigertem sexuellem Verlangen
Caust. D 6-30 Puls. Zinc-met. D 30 Croc. D 4-6, Calc-p. D 6-12 Schulkopfschmerzen Orig. D 30 Cham., Coloc,
Nux-v., Staph. Cann-s. D 6
Perioden-Störungen
- Nasenbluten
- nervöse Störungen
- Psychose
- Struma
- Uterus-Blutung vor P.
Menarche
- zum Einspielen der Periode
- Uterusblutung vor der Pubertät
- vorzeitige, zu frühe M.
- verzögerte, zu späte M.
- mit M. stinkender Achselschweiß Croc. D 2-30 (Nat-n.) Cast. D 4
Hyper. D 4-6 Ferr-i. D 6-12, Calc-i. D 6 Hed. D 6 < im Winter Mag-p. D 6,
Hydr. D 4 (keine süße Milch!)
Cina Dam. D l-3 Cina D 4-12
-»KLUNKER III 526
Acon. D 3 Calc-c. D 12 mit
Herzklopfen (Kopfschmerzen) und Mammaschmerzen
-> KLUNKER HI/539
Bar-c. D12,Kal-c. D 4-12
Arist. D 3-12 schwerer
Durchbruch der 1. Periode Puls., Aur-met. Sep., Ferr-met. Sulf., Caust.,
Melis. Dam. D 3 bei schwachen, traurigen Mädchen
PMS is a condition characterized by
nervousness, irritability, anxiety, depression, and possibly headaches, oedema,
and mastalgia, occurring during the 7 to 10 days
before and usually disappearing a few hours
after the onset of menses (Beers and Berkow, 1999:1932 - 1933). 75% of all
women suffer from PMS to some degree (Hayman, 1996).
The efficacy of Homoeopathic Simillimum in the Treatment of Premenstrual
Syndrome (PMS).
[Carrie-Ann Laister]
Premenstrual syndrome (PMS) is a condition
characterized by nervousness, irritability, anxiety, depression, and possibly
headaches, oedema, and mastalgia, occurring during the 7 to 10 days before and
usually disappearing a few hours after the onset of menses (Beers and Berkow,
1999:1932 - 1933).
There are over 150 symptoms that have been
attributed to PMS (Lichten, 2005). PMS was first identified as a true medical
disorder by Dr Robert T Frank in 1931 in his paper called “Hormonal Causes of
Premenstrual Tension” (Dixie Health, 2006)
A study conducted in a UK women’s prison showed
that half the inmate’s offences had been committed in the paramenstruum time (4
days prior to the start of the menstruation and first 4 days of menstruation)
(Hayman, 1996).
Dalton describes the Premenstrual Syndrome as
the most prevalent of endocrine disorders. The endocrine system consists of
glands that secrete substances into the blood. These substances have an action
on a specific organ.
In her book, "The Premenstrual
Syndrome", she says this title covers a wide variety of cyclical symptoms
which regularly recur at the same phase of each menstrual cycle.
The most common time for repeated symptoms is
during the premenstruum or early menstruation, but occasionally symptoms occur
at ovulation. She says that the onset
of the full menstrual flow usually brings
dramatic and complete relief, but as there may be slight menstrual loss for a
day or two before the onset of full menstruation,
it is not uncommon to find symptoms continuing
through the first day or two of each cycle (Dixie Health, 2006).
Symptoms of PMS have been reported to affect as
many as 80% of women of reproductive age some time during their lives. Recent
studies indicate that 14 - 88% of adolescent girls have moderate - to - severe
symptoms.
Another 3 - 5% of women meet the criteria for
Premenstrual Dysphoric Disorder (PMDD).
PMS affects women with ovulatory cycles.
Older adolescents tend to have more severe
symptoms than younger adolescents.
Women in their fourth decade of life tend to be
affected most severely.
PMS resolves completely at menopause (Moreno,
2006).
Singh, Berman, Simpron and Annechild (1998)
found that women were more frequently aware of symptoms related to PMS rather
than a recognition of a formalised medical syndrome.
Less than half the women reporting symptoms had
taken either over-the counter or prescription drugs.
Women who tried complementary therapies
generally found them to be effective.
The most common symptoms which women with PMS
complain about can be divided into 5 subgroups:
PMS - Type A, Characterised by anxiety:
Difficulty sleeping, tense feelings, irritability, clumsiness, mood swings
irritability, crying without reason, verbal and
sometimes physical abuse, feeling “out of control”, or Dr. Jekyl - Mr Hyde
behaviour changes (Lichten, 2001). This type of PMS is the most common subtype
affecting 65 - 75% of PMS sufferers (Lockie and Geddes, 1992:67). In some women
the anxiety is followed by depression. Symptoms < days before the menstrual
period and are relieved by its onset.
Most likely due to excessive levels of
oestrogen and inadequate levels of progesterone circulating in the body (Lark,
1984:27); however there is no scientific evidence to confirm this theory
(Sheeve, 1992).
PMS - Type C, craving Headache, cravings for
sweet foods, cravings for salty foods, cravings for other types of food
This subtype also includes symptoms like
headaches, fatigue and palpitations. This affects 24 - 35% of premenstrual
women (Lockie and Geddes, 1992:67).
Many women with PMS note an increased craving
for refined carbohydrates (sugar, chocolate and pastries) and eat larger
quantities of these foods before their period than they normally would. This craving
< stress. A few hours after indulging in these foods, many women experience
fatigue, headaches, shaking and dizziness (Lark, 1984:29)
PMS - Type D, Depression, angry feelings for no
reason, feelings that are easily upset, poor concentration or memory, feelings
of low self-worth, violent feelings
Characterised by depression: confusion,
clumsiness, forgetfulness, withdrawal, fearfulness, paranoia, suicidal thoughts
and rarely, suicidal actions (Lichten, 2001). This affects 23 - 35% of women
and is more commonly found in combination with PMS type A. The PMS type A
occurs first and is followed by type D symptoms a few days before the onset of
the period (Lockie and Geddes, 1992:67). In these women oestrogen levels are
found to be abnormally low, and the depressant effects of high or normal
progesterone are not counterbalanced
by oestrogen (Lark, 1984:30).
PMS - Type H, hydration Weight gain, abdominal
bloating, breast tenderness, swelling of extremities
Complains of heaviness or headaches: fluid
retention leading to headaches, breast tenderness, abdominal bloating and
weight gain (Lichten, 2001). This affects 65 - 72% of sufferers (Lockie and
Geddes, 1992:67).
These women tend to retain excess salt and
fluid, caused by an excess production of the pituitary hormone
adreno-corticotrophic hormone (ACTH). The ACTH is then circulated via the blood
to the adrenal glands (Lark, 1984:30). Aldosterone release causes the kidneys
to retain water and salt so less urine is excreted (Lockie and Geddes,
1992:67).
PMS - Type O, other Dysmenorrhea, change in
bowel habits, frequent urination, hot flushes or cold sweats, general aches or
pains, nausea, acne, allergic reactions, upper respiratory infections
(Moreno, 2006)
This subgroup is for all the other symptoms not
accounted for in the first 4
subgroups. Women with type O complain of
dysmenorrhoea, change in bowel habits, frequent urination, hot flashes or cold
sweats, general aches or pains,
nausea, acne, allergic reactions, upper
respiratory infections
(Moreno, 2006).
The above shows exactly how multifaceted PMS
is, with five different problem entities often coexisting in the same women
(Lark, 1984:30).
PMS is a condition characterized by nervousness,
irritability, anxiety, depression, and possibly headaches, oedema, and
mastalgia, occurring during the 7 to 10 days before,
and usually disappearing a few hours after, the
onset of menses.
Symptoms last for a few hours up to 10 days before
a period and usually stop when the flow begins. The most common complaints are
changes in mood and psychological changes
-irritability, nervousness, lack of control,
agitation, anger, insomnia, difficulty in concentrating, lethargy, depression,
and severe fatigue. There are also physical symptoms during this premenstruum
time- oedema, transient weight gain, oliguria, breast fullness and pain,
headaches, vertigo, syncope, paraesthesia of extremities, easy bruising,
cardiac palpitations,
constipation, nausea, vomiting, changes in
appetite, pelvic pressure or heaviness, backache and acne (Beers and Berkow,
1999:1932 - 1933).
The most common symptoms are:
Headache
Swelling of ankles, feet, and hands
Backache
Abdominal cramps or heaviness
Abdominal pain
Abdominal fullness, feeling gaseous
Muscle spasms
Breast tenderness
Weight gain
Recurrent cold sores
Acne
aggravations
Nausea
Bloating
Constipation or diarrhoea
Decreased coordination
Food cravings
Less tolerance for noises and light
Anxiety or panic
Confusion
Difficulty concentrating
Forgetfulness
Poor judgement
Depression
Irritability, hostility or aggressive behaviour
Increased guilt feelings
Fatigue
Slow, sluggish, lethargic movement
Decreased self-image
Sex drive change, loss of sex drive
Paranoia or increased fears
Low self-esteem (Thompson, 2004)
Hormonal imbalance
Oestrogen and
progesterone imbalance
PMS occurs when there is oestrogen dominance.
Depression, loss of sex drive, sweet cravings, heavy periods, weight gain,
breast swelling and water retention can all be attributed to oestrogen
dominance. Oestrogen dominance can be due to excessive exposure to oestrogenic
substances, or a lack of progesterone, or a combination of both (Holford, 2004:
27-8).
The variation of
oestrogen and progesterone levels coincides with the onset and relief of PMS.
However the evidence is inconsistent and is still inconclusive (Hayman, 1996).
Prolactin
Some studies have shown that there is an
increase in prolactin during the luteal phase.
[Halbreich]
Women with PMS had higher prolactin levels than
women who did not have PMS symptoms. Prolactin is produced in the pituitary
gland and its function is to stimulate the development and growth of breast
issue. If the pituitary produces too much prolactin this will lead to breast
tenderness, lumpiness and enlargement, and it may also alter the amount or
balance of oestrogen and progesterone produced in the body, and affect mood
(Hayman, 1996).
Prostaglandins
A diet-related explanation concerns the role of
prostaglandins in PMS. These are essential fatty acids that are made by the
body and which are nutritionally important for growth and health. The most
important of these is linoleic acid, a polyunsaturated fatty acid found in
cereals, legumes and vegetables. If most of the fat in a woman’s diet
is obtained from animal fat she may have a diet
that is low in linoleic acid. Prostaglandins are responsible for inflammation
and pain in response to tissue damage.
They also have a regulating effect on hormones
such as oestrogen, progesterone and prolactin. A deficiency in prostaglandins
may lead to the imbalance in hormones that causes PMS symptoms. The dietary
deficiency of essential fatty acids which leads to a deficiency in
prostaglandins would cause PMS. Some studies have indicated that prostaglandins
increase during the luteal phase and decline during menstruation as a normal
and natural part of the menstrual cycle (Hayman, 1996).
Opiods
One argument is that PMS is linked to opium-like
substances which are produced in the brain (endogenous opiod peptides or
endorphins). These are produced to control body temperature, bowel function and
whether one feels tired, hungry, happy or sad.
PMS symptoms mimic the symptoms of narcotic withdrawal
e.g. nausea, cramps and depression. (Studies show that these opiods are not
only produced by the brain but some are also affected by chemicals produced by
the ovaries, so the levels may change throughout the menstrual cycle.) If, in
common with other ovarian hormones, the levels are low in the premenstruum,
this may account for the drop in mood. Further studies are needed to
substantiate this theory (Hayman, 1996).
Blood sugar
Another theory is that PMS is related to low
blood glucose. Glucose is the body’s chief source of energy and is carried by
the blood to all tissues. If one did not eat for a long period, there would be
a decrease in blood glucose levels. However, usually the level is kept within
fairly narrow limits by the action of various hormones such as insulin,
glucagon and adrenaline. Glucose can be stored in the liver and muscles so that
if these levels begin to drop these reserves can be released.
However the release of adrenaline to stimulate
this effect has the side effect of causing stress symptoms, making one tired
and jittery. People have been noted to experience sweet cravings boost energy
levels by eating chocolates and sweets, which can actually make the situation
worse. There is a quick increase in blood glucose levels followed by an
immediate “rebound” reaction where the levels fall.
The decrease in blood glucose causes the
release of more adrenaline which has a positive feedback effect aggravating the
situation. Adrenaline releases glucose from the cells causing water uptake,
which causes the bloating experienced by PMS sufferers (Hayman, 1996).
Dietary deficiencies
Another diet-related argument is that PMS is
linked to vitamin and mineral deficiencies. The symptoms of various dietary
deficiencies can be shown to be similar to those of PMS, most notably a lack of
vitamin B6, E, zinc and magnesium, and others. Modern diets are frequently
lacking in these essential dietary factors (Hayman, 1996).
In the premenstruum, women often have cravings
for the B vitamins, which is similar to a craving for sugar. Instead of
ingesting the vitamins, sugar is eaten such as cakes and chocolates and the
craving satisfied. These cravings should be dealt with by taking vitamins
rather than sugars (Sandler, 1991).
The deficiency of the essential fatty acids
(EFAs) has come to light in recent years as a likely cause of PMS as EFAs are
essential to the production and regulation of hormones. Deficiency of EFAs
leads to hormonal imbalance that results in premenstrual symptoms. The efficacy
of Vitamin B6 pyridoxine) in the treatment of premenstrual syndrome has been
attributed to its role in metabolising EFA rather than a direct action on the
hormones (Sheeve, 1992).
Calcium supplementation has been shown to
reduce many symptoms of PMS by as much as 30%. The deduction from this is that
calcium deficiency is a cause of PMS (Balch and Balch, 2003).
Magnesium deficiency
has been linked with breast pain, water retention, cravings, tension headaches,
depression and anxiety (truestarhealth.com)
According to Dalton
(1984) the diagnostic criteria for premenstrual syndrome are:
- Symptoms must occur
exclusively during the second half of the menstrual cycle.
- Symptoms increase
in severity as the cycle progresses.
- Symptoms must be
relieved by the onset of full menstrual flow.
- There must be an
absence of symptoms in the postmenstruum.
- Symptoms have to be
present for at least 2 consecutive cycles.
Differential
Diagnosis:
Cyclic Pelvic Pain
Premenstrual Dysphoric
Disorder (PMDD) is a condition associated with severe emotional and physical
problems that are linked closely to the menstrual cycle. Symptoms occur
regularly in the second half of the cycle and end when menstruation begins or
shortly thereafter. PMDD is not just a new name for premenstrual syndrome
(PMS), a condition that affects as many as 75% of menstruating women. It is,
considered to be a very severe form of PMS that affects about 5% of
menstruating women.
Both PMDD and PMS
share symptoms in common that include depression, anxiety, tension,
irritability and moodiness.
Women with PMDD
experience severe PMS that disrupts their everyday lives to the point that they
can no longer function effectively (Madison Institute).
Dysmenorrhoea is a painful
menstrual period (Doxet al., 1993).
This can be
classified into congestive or spasmodic dysmenorrhoea. Is not part of PMS.
It is related to the
uterine contractions which cause shedding of the endometrial lining.
The pain is due to
the interruption of the normal blood flow to the muscle fibres caused by to the
strong sustained contraction of the muscle which results in an accumulation of
chemical metabolites in the muscle causing pain. Spasmodic dysmenorrhoea occurs
most often in young women and girls in the time following menarche, before the
uterine muscles have received sufficient oestrogen to complete their
development.
The pain experienced
with spasmodic dysmenorrhoea is spasmodic and occurs in the lower abdomen and
small of the back an d is a heavy, bloated, dragging feeling sometimes
accompanied by dull or shooting pain in the genital area. This is not a
premenstrual symptom as it occurs during the period. However it can occur in a
person with PMS and so the distinction between PMS and Dysmenorrhoea for the
patient difficult to distinguish.
Congestive
dysmenorrhoea is not true dysmenorrhoea as it occurs before the onset of
menses. It is due to the congestion of blood in the vessels in the pelvis. The
pain is in the pelvic and genital regions and is a dull persistent pain in
contrast to period pain which is cramp-like. Congestive dysmenorrhoea is a
symptom of PMS (Sheeve, 1992).
Mittelschmerz
Phenomenon refers to a frequently occurring unilateral lower abdominal pain
that occurs midcycle due to ovulation. Rupture of the follicle and subsequent
irritation of the peritoneum may produce pain. The pain, although sometimes
severe, resolves spontaneously (Beers and Berkow, 1999).
Endometriosis: an abnormal
condition in which the uterine mucous membrane invades other tissues in the
pelvic cavity (Dox et al., 1993).
The cyclical
engorgement of this ectopic endometrial tissue results in pain, bleeding,
diarrhoea, constipation and lower back pain. The onset of endometriosis is
usually in females between the ages of 20-45 (Haslett, et al. 2002).
In the early stages
of endometriosis pain is caused which starts several days before the menses and
continues through the first few days. This disorder becomes chronic and pain
commonly occurs at various times unrelated to the menstrual period (Beers and
Berkow, 1999).
Affective
disorders/Mood disorders
Depression
Symptoms of major
depression include feelings of sadness, loss of interest in normally
pleasurable activities, changes in appetite and sleep, loss of energy, and
problems with concentration and decision-making. Women are twice as likely as
men to experience major depression.
Depression can also
cause a wide variety of physical complaints, such as gastrointestinal problems
(indigestion, constipation or diarrhoea), headache and backache. Many people
with depression also have symptoms of anxiety (International Society for
Affective Disorders, 2006).
Seasonal Affective
Disorder (SAD) is a pattern of depression related to changes in seasons and a
lack of exposure to sunlight. It may cause headaches, irritability
and a low energy
level (Mayo Clinic, 2006).
Dysthmia is a chronic
depression of mood which does not currently fulfil the criteria for recurrent depressive
disorder in terms of either severity or duration of individual episodes.
The balance between
individual phases of mild depression and intervening periods of comparative
normality is very variable. Sufferers usually have periods of days or weeks
when they describe themselves as well, but most of the time they feel tired and
depressed; everything is an effort and nothing is enjoyable. They brood and
complain, sleep badly and feel inadequate, but are usually able to cope with
the basic demands of everyday life (World Health Organisation, 2007).
Adjustment Disorder
is when the response to a stressful or traumatic event is signs and symptoms of
depression or anxiety.
The disorder can be
acute (lasting less than six months) or chronic.
An adjustment
disorder can develop following a single stressful event or as result of an
accumulation of stress.
The behavioural
changes found in Adjustment Disorder are not restricted to the premenstruum but
the behaviour could be misdiagnosed as PMS (Mayo Clinic, 2006).
Other conditions
Peri-menopause
It may be difficult
to distinguish peri-menopause from PMS in certain instances. If one is over 40,
symptoms such as joint pain, depression, anxiety, forgetfulness, increased urge
to pass urine and cystitis may actually be caused by the climacteric (Hayman,
1996:65). In addition one should consider the possibility of premature
menopause in women under the age of 40 (Beers and Berkow, 1999).
Chronic Pelvic
Inflammatory Disease (PID)
PID is widespread
infection in the reproductive and pelvic organs. When chronic, there may be
discharge, pain and general ill health (Beer and Berkow, 1999).
PID may become worse
before a period begins (Hayman, 1996:66).
Hypothyroidism
The signs and
symptoms of hypothyroidism vary widely, depending on the severity of the
hormone deficiency. In general, problems tend to develop slowly, often over a
number of years. At first there are symptoms such as fatigue and sluggishness.
The metabolism
continues to slow down; more obvious signs and symptoms of hypothyroidism
develop, including:
increased sensitivity
to cold; constipation; pale, dry skin; a puffy face; hoarse voice; an elevated
blood cholesterol level; unexplained weight gain; muscle aches, tenderness and
stiffness; pain, stiffness or swelling in the joints; muscle weakness; heavier
than normal menstrual periods and depression. Forgetfulness and slowing of
comprehension are additional symptoms of hypothyroidism (Mayo Clinic, 2006).
TREATMENT OPTIONS
Non-pharmacologic
Therapy
The most extreme form
of treatment for PMS is a hysterectomy with a bilateral oophorectomy. This is
only considered in cases of severe PMS where the women has had children and
does not wish to have any more. This option is not viable to young girls or
women due to the finality of the surgery in relation to being able to have
children (Moreno, 2006).
Life style changes
can play a big part in curbing symptoms of PMS.
Eating properly and
getting adequate exercise and rest are the simplest steps to help relieve PMS.
Reducing the intake of sodium during the premenstruum will help reduce water
retention.
Avoiding caffeine
assists as caffeine has been linked to symptoms of breast tenderness and
anxiety. The intake of caffeine also contributes to the depletion of important
nutrients due to its diuretic action.
Women who exercise
regularly have been shown to have less PMS symptoms than women who don‟t
so getting regular exercise is a good way to control PMS (Balch and Balch,
2003).
Yoga has been found
to help in the control of PMS for three reasons. Firstly the postures and
breathing technique are designed to instil a peaceful and tranquil state which
will calm the physical and mental tension associated with PMS. It decreases
tension in the body and so decreases muscular and joint aches and pains. Yoga
teaches the maintenance of an upright and balanced posture which relieves
fatigue, lethargy and lower back pain. Thirdly some of the yoga postures have
been attributed to directly helping with congestive dysmenorrhoea (Sheeve, 1992).
A placebo controlled
study was conducted to test the effectiveness of acupuncture to treat
Premenstrual Syndrome. The participants were classified as having severe
symptoms and some were on medication (progestin and fluoxetine). The treatment
group showed a 77.8% improvement of symptoms in comparison to the 5.9%
improvement found in the placebo group.
The positive result
was attributed to the serotonin and opiod releasing effects of the acupuncture
treatment (Habek, et al. 2002).
A randomised clinical
trial was conducted to determine the efficacy of chiropractic therapy on PMS.
In this trial 54
subjects diagnosed with PMS (using the Moos PMS questionnaire plus daily
symptom monitoring) and 30 subjects with no diagnosable PMS were recruited.
The PMS gro up had a
higher positive response for each of 12 measured spinal dysfunction indexes
except for range of motion of the lower back. The indexes where the increases
were
statistically
significant (P<.05) were cervical, thoracic, and lower back tenderness,
lower back orthopaedic testing, lower back muscle weakness, and the neck
disability index.
An average of 5.4 of
the 12 indexes were positive for the PMS group compared with 3.0 for the
non-PMS group.
This study proved
that there is a relatively high incidence of spinal dysfunction in PMS
sufferers compared with a comparable group of non-PMS sufferers. This research
suggests spinal
dysfunctions as a
possible aetiological factor for PMS and that chiropractic manipulation may
offer a good alternative approach to treating PMS (Polus and Walsh, 1999).
A study was conducted
to see the effect of consuming soy isoflavone on the behavioural, somatic and
affective symptoms in women with PMS. The study used 23 women with diagnosed
PMS and took place
over a seven menstrual cycle time frame. It was a double-blind
placebo-controlled, crossover intervention study. The study proved that
isolated soya protein containing
soy isoflavones may
reduce specific premenstrual symptoms but on the totality of the premenstrual
symptoms there proved to be insignificant difference between the placebo and
active groups
(Bryant, et al.
2005).
A systemic review was
done on 27 randomised controlled trials conducted to show the efficacy of
various complementary therapies in the treatment of PMS.
(7 Herbal trials, 13
dietary supplement trials and 1 trial of each of the following disciplines:
homoeopathy, biofeedback, chiropractic, massage, reflexology, relaxation.)
This review showed
that despite positive findings in some of the trials reviewed there is very
little evidence to prove that complementary medicines are effective for the
treatment of PMS
(Ernst and Stevinson,
2001).
The trials that were
reviewed all had a small sample size. The good clinical findings would be more
indicative of the efficacy of the therapies if conducted in a larger group
because
a larger sample size
yields more statistically significant results than a small sample.
Psychological
treatment has also been found to relieve symptoms of PMS.
Education of women
about PMS and using a diary to monitor symptoms has been noted to help women
feel more in control and reduce symptoms. Teaching women how to relax by the
use of
the relaxation
response, biofeedback and guided imagery helps to relieve tension and so help
the PMS. Cognitive behavioural therapy has also been clinically noted to help
symptoms of PMS
(Moreno, 2006).
Dietary supplements
that have been evaluated in women with PMS include vitamins (A,E, and B6),
calcium, magnesium, multivitamin/mineral supplements, and evening primrose oil.
Most studies have been small or poorly designed, efficacy needs to be confirmed
in large, well-designed clinical trial before evidence-based recommendations
can be made (Dickerson et al. ,2003).
Pharmacologic Therapy
Over the Counter
drugs (OTC)
OTC drugs that are
useful to relieve symptoms of PMS include drugs containing mild diuretics,
analgesics, prostaglandin inhibitors and anti-histamines.
Caution must always
be used when combining products due to risk of inadequate dosing of some
ingredients in the drugs and excessive dosing of others.
It is preferential to
use a single product when using OTC drugs to negate this issue (Dickerson et
al., 2003).
Herbal preparations and
vitamins (discussed in 2.8.2) are included as OTC.
Herbal treatments for
PMS
Dioscorea. villosa
is known historically to treat „women’s complaints’. It has been used to
relieve cramps and mood swings. = Wild Yam contains the sterol, diosgenin, with
progesterone-like
effects which is why
it has been attributed to relieve symptoms of PMS (Dixie Health, 2006).
Agnus. castus
has been shown to help reestablish normal balance of oestrogen and progesterone
during the menstrual cycle. The action of re-establishing a normal hormonal
balance helps
women
Whose PMS is due to underproduction of
progesterone or overproduction of oestrogen.
It has a calming
soothing effect and relieves muscle cramps. Needs to be taken for at least four
cycles to determine efficacy (Balch and Balch, 2003).
Angelica. sinensis
is a traditional Chinese medicine and is often referred to as female ginseng.
It helps promote normal hormonal balance and is useful for women suffering from
premenstrual cramping and Pain (Dixie Health, 2006). Acts as a mild sedative,
laxative, diuretic, antispasmodic and pain reliever along with assisting the
usage of hormones by the body (Balch and Balch, 2003).
Chamaelirium luteum is a Native American traditional medicine
which is useful in treating amenorrhoea, painful menstruation and other
menstrual irregularities (Dixie Health, 2006).
Psychotropic agents Anti-anxiety and
anti-depressant drugs are often utilised to treat the emotionalsymptoms of PMS
(Hayman, 1997).
Anti-anxiety agents such as Alprazolam (Xanax)
and Buspirone (BuSpar) have been effective in helping the anxiety-related
symptoms of PMS.
The Selective Serotonin Re-Uptake Inhibitors
(SSRI), Fluoxetine (Prozac) and Sertraline (Zoloft), are the first-line drugs
for severe emotional symptoms.
They work best when taken throughout the month.
Clomipramine (Anafranil) given for the full
cycle or half-cycle has been effective in treatment of emotional symptoms.
Nefazodone, an antidepressant that blocks
serotonergic and noradrenergic uptake, recently was shown to be effective in
relieving symptoms (Moreno, 2006).
Diuretics
Many women complain of bloating and cyclical
weight gain due to fluid retention.
Diuretics help to turn these excess fluids in
the body into urine, increasing the frequency and quantity of urine.
Side effects of nausea and dizziness are not
uncommon.
Some research suggests that not only is premenstrual
bloating a normalaspect of cyclical change, but that it is not associated with
an actual increase in girth.
Fluid may shift around the body, and there may
be an increase in distension or pressure in the abdomen, but the actual
external measurements do not increase.
If this is so diuretics would not be an
appropriate treatment (Hayman, 1998: 106).
Prostaglandin Inhibitors
Non-Steroidal Anti-Inflammatory (NSAIDS) are
agents which are useful for managing the general aches, pains, and dysmenorrhoea
associated with PMS.
Commonly used drugs in the treatment of PMS are
Ibuprofen and Mefenamic Acid (Thompson, 2004).
Agents used to alter the menstrual cycle
The oral contraceptive pill (OCP) has been used
to regulate the menstrual cycle and alleviate the symptoms of PMS.
However in a study conducted in the Royal
Edinburgh Hospital where 276 women who considered themselves to have PMS were
studied, 171 of which were on the OCP, found
that women on OCP experienced delayed or more
prolonged pattern of perimenstrual negative mood (Bancroft and Rennie, 1993).
Menstrual disorders at all ages and stages can
be treated effectively with homoeopathy (Bloch, 2003).
PMS
Martinez (1990) conducted a double-blind placebo-controlled
trial using Folliculinum
in potencies 9 C and 15 C in 32 participants.
A questionnaire was given to all the
participants prescribed Folliculinum at their first consultation, to be
collected at the subsequent consultation.
The duration of the treatment was two to four
months. Of all the participants, 88% showed a satisfactory response to the
treatment according to the questionnaire.
Most of the participants (61%) noted an
improvement from the second cycle after having started the treatment.
93% of the participants felt that the treatment
had physiological effects while only 7% felt that the effects might be due to
the placebo effect.
The most marked effect on particular symptoms
was on breast swelling, metorrhagia and menstrual irregularities.
Kirtland (1995) conducted a double-blind
placebo controlled study involving 31 women from the greater Durban area where
she compared the effect of Folliculinum 15CH to placebo.
The results were based on a subjective questionnaire
filled in by the participants.
The test group (16 women) had 89% improvement,
4% unchanged and 7% worsening of the premenstrual symptoms.
The placebo group (15 women) had 7%
improvement, 4% unchanged and 89% worsening of premenstrual symptoms.
The improvement ascertained during the trial
was statistically significant.
A double-blind study of the homoeopathic
treatment of Premenstrual Syndrome used a complex, Premenstron®.
Containing:
Agnus castus D1,
Chamomilla radix D3,
Lillium tiginum D3,
Caulophyllum
thalictroides D4,
Equisetum arvense D4,
Zincum valerianicum
D4,
Ignatia amara D6
Kali carbonicum D6
compared to placebo.
Thirty participants were randomly selected and
divided into their respective groups.
The statistical results were overall 53.3%
improvement in the placebo group while 46.7% worsened. In the treatment group
86.7% showed improvement and 12.3% worsened.
The improvement in the treatment group was not
significant enough to verify that the complex was effective when analysed
statistically and in comparison with the effect
of the placebo (Sarawan, 2001).
As the study was conducted as part of a
mini-dissertation the test sample was small which resulted in there not being
statistical significance in the findings.
However based on the clinical findings the
homoeopathic complex had significant improvement to merit further research.
A study was conducted in Israel to test the
efficacy of treating PMS with homoeopathic simillimum using the cluster method
to derive the remedy.
The simillimum was selected by the subject
filling in a questionnaire which related to the keynote symptoms of 5
polychrest remedies commonly used in the treatment of PMS:
Sepia officinalis, Nux
vomica, Pulsatilla nigrans, Natrum muriaticum and Lachesis mutans.
The prescription was made based on the cluster
of „yes‟ answers relating to each remedy.
The remedy with the most positive response was
considered the simillimum. The subject was then given a single powder (either
the placebo or the selected simillimum).
The subjects were then monitored for 3 months
on a once monthly basis to see the effect of their treatment. The study was a
double-blind and placebo-controlled in which the
results were only correlated at the end of the
study.
They observed improvements greater than 30% in
90% of participants receiving the active treatment and in 37.5% receiving
placebo (Yakir et al., 2001).
The limitation of this study was the restriction
of homoeopathic remedies which could be prescribed for PMS.
The focus of the study was the efficacy of the
method of prescribing rather than the efficacy of a homoeopathic simillimum.
Women were excluded if their symptom profile
did not correlate with the selected remedies.
However, simillimum prescribing is a holistic
process taking the symptom profile of the entire person rather than just the
premenstrual symptoms.
The statistical evidence indicates that
homoeopathic simillimum is ineffective in the treatment of PMS.
Nat-m.: the most
prescribed remedy with 12 prescriptions of the total 39 prescriptions made up
in the research. Of this group 6 completed the study. It was apparent that many
of the women experiencing PMS had to be “in
control of themselves to protect themselves and keep their lives together”.
This is a common trend in Nat-m. Nat-m. women are very
sensitive and protect themselves by working
through hurts and “walling off” their feelings. Their bodies do not necessarily
comply with this mentality and, therefore, manifest
physically what they refuse to manifest
emotionally. This occurs around the time of menstruation. Averse to consolation
or company and may have periods of involuntary and
hysterical weeping. Also known for symptoms of
water retention due to the very nature of sea salt and its affiliation for
attracting water.
Some PMS symptoms experienced:
< menses
Involuntary and hysterical weeping
Depression
Headache before menses
Craving salt
Insomnia
Feeling trapped
Anaemia
Aversion to sex
Water retention
Fastidious
(Vermeulen, 2002:958-967)
Carc.
prescribed 4x out of the total 39 prescriptions. All 4 participants completed
the study.
Sep. 5x out of
the total 39 prescriptions and of these, 4 completed the study and were able to
be used for statistical purposes.
Calc.
prescribed 4x out of the total 39 prescriptions and of these, 3 completed the
study.
[Joop van Dam/Bob C. Witsenburg]
‡ On the Treatment of the Premenstrual Syndrome,
Marjoram Comp. (Menodoron) and the Menstrual Cycle-A Report
(Originally printed
in the Dutch Weleda Information for Physicians. English by A.C. Barnes.)
In the last two years
frequent complaints have been made by patients of what may be characterized as
"premenstrual
syndrome." They
have complained of headache, a feeling of heaviness, and tiredness; they have
felt empty, dark,
depressive,
despairing, almost suicidal; sometimes there have been feelings of
depersonalization; and finally there
has often been
abdominal pain.
Ego and astral body
lose their healthy relationship to the physical and etheric bodies. In view of
the point of
time at which the
complaints occur, this disharmony of the four bodies must be sought
specifically in the processes
of the uterus and
ovaries.
It became apparent
that certain remedies were almost always effective, so that we were led to
experience them as
specific for this
syndrome. Pulsatilla was used as the first remedy, mostly as D12. It is a plant
in which light and
darkness are in
competition: the flower that first hangs down and later straightens up again.
The bell-shaped,
dark-colored flower shows a profound influence from the astral. The plant is
known in homeopathy as
a gynecological
remedy particularly for women who need to weep a great deal. The light-organism
(astral) regulates
the fluid- organism
(including tears).
This was later joined
by Hepar/Magnesium D4 dil. This brilliant idea from Treichler and Wolff has
convincingly proved
its effectiveness in
the treatment of particular forms of depression, being especially helpful in
those depressions
where there is an
underlying lack of vitality or exhaustion. Light (magnesium) and life are
restored to the fluid-
organism, in
particular to that of the liver, and this then extends to affect the rest of
the metabolism.
Finally Tormentilla
D30 dil. In the ninth case in Steiner and Wegman's Fundamentals of Therapy, the
root of this plant
(which is of a
remarkable size) is regarded as a specific in its effect on the relatively
independent part of the ego-organisation that primarily regulates the reproductive
organs. Where the relationship of the ego and astral body to
the etheric and
physical bodies has become blocked (expressing itself, for instance, in
amenorrhea and cramps),
Tormentilla in high
potencies can break through this blockage via the ego-organisation.
Pulsatilla
D12/Hepar-Magnesium D4/Tormentilla D30 dil. ana 15 gtts. a.d. TID during the
week before menses brought
about a good
alleviation of the premenstrual syndrome in the approx. 50 patients given this
treatment.
For marked fluid retention
(often with increased headaches), Betula/ Gummi Cerasi 10 gtts. TID was given.
When a migraine headache came to the fore. Cyclamen europaeum D3 was indicated.
Here (as with
Tormentilla) we have an impressive rootstock, an intense odor, and a number of
phenomena indicating a conflict in the plant between light and darkness (purple
color and a stem with downward curvature at the end followed by upward-pointing
petals). In addition to the medication mentioned above as used in the week
before menstruation. Marjoram comp. (Menodoron) was also given, as well as 10
gtts. TID during the second and third weeks of the cycle. In order to clarify
the rationale behind this, there now follows a discussion of Marjoram comp. and
then of the menstrual cycle itself.
Marjoram comp.
(Menodoron). The recipe was conceived by R.S. in 1921:
(1) Achillea
millefolium (Flores) + (2) Capsella bursa-pastoris (Herba) + (3) Majoran
(Fructus) +
(4) Quercus rubra
Cortex) + (5) Urtica dioica (Flores)
Decoct or infuse
according to the part of the plant used and then take 20% of (1), 15% of (2),
30% of (3),
25% of (4) and 10% of
(5). 20% of this mixture in the final preparation. Approximately 25% of alcohol
is added to the solution as a preservative. Indications for use: menorrhagia and
metrorrhagia. The five plants come from different families:
‡ Achillea millefolium is a composite, an aromatic
composite like Calendula and chamomile, but with a strong emphasis on the form.
The etheric oil is blue, as is also the case with chamomile. In both cases the
blue color can be experienced as an expression of the dominant force, which
works upon the metabolic processes. The metabolic processes are aroused but
simultaneously given form. Rudolf Steiner calls Achillea a "miracle"
of the plant-kingdom for the way in which the sulphur works together with other
substances in it, particularly the potassium.
Capsella
bursa-pastoris is a crucifer which, compared with other members of the family,
is physically not very substantial and only becomes clearly noticeable in its
flowering stage and in the subsequent seed-setting stage. The plant has great
vitality and grows on bare patches of soil.
As with the other
crucifers, the sulphur-process plays an important role, though in this case
accompanied by a powerful silicon-process that gives the plant sturdiness.
Origanum majorana is
a labiate, a warmth-plant. It is on the watery side within its family:
peppermint and balm are drier, while dead-nettle is even wetter. It begins to
bloom in late June, and the flowers appear progressively lower on the stem. The
astral forces sink deeper and deeper into it, lignifying the stem downwards.
The odor is warm but somewhat astringent. The substances of interest are mainly
the etheric oils.
Quercus rubra belongs
to the amentiflores, the catkin-bearers. It occupies a special position among
the 5 plants used in Marjoram comp. (Menodoron) only by virtue of its being a
tree. A great power resides in the oak, yet a restrained one. It comes into
flower late in the year, the leaves lose their color late, and the foliage is
retained for a long time. The restraint is to be seen also in the shape of the
leaf. This form of life is expressed substantially in the substances, viz.
tannic acid and calcium. The calcium moderates the life- processes where these
threaten to get out of hand (see also Ch. XVII of Fundamentals, which discusses
the role of calcium in menorrhagia).
Urtica dioica is a
plant of strong rhythmic structure, where the emphasis is on the leaf.
"Sie musste eigentlich den Menschen urns Herz herum wachsen, denn sie ist
in der Natur draussen in ihrer inneren Organisation eigentlich ähnlich
demjenigen, was das Herz im menschlichen Organismus ist" (It should
actually grow around the human heart, for it is, in the natural world outside,
actually analogous in its inner organization to what the heart is in the human
organism.)
The rhythmic man is
being addressed, but in his relation to metabolic processes. The
sulphur-processes, together with silicon, potassium and especially iron, bring
about this alignment. The flowers of the stinging-nettle are used, and the
stinging-nettle effect is conducted to the metabolism, to the rhythmic organ in
that sphere, the uterus. Rudolf Steiner speaks of the interdependency of heart
and uterus in the “Course for Young Doctors”.
In order to determine
the mutual relationships of the plants, or the way in which they complement one
another, one may investigate their relationship to the ether-types. Marjoram
has, like all labiates, a powerful warmth-ether effect. In Capsella,
representing the crucifers, the chemical ether plays an important part. The oak
has in its bark the earth aspect of the life-ether. In Achillea, with its
deeply-indented leaf ("millefolium" means "thousand-leaved"!),
the light-ether is particularly noticeable.
The stinging-nettle
has all four ether-types united in it: the life-ether in the lignifying
quadrilateral stem, the chemical ether in the typical metabolic processes in
the leaf, the light-ether in the sharply-indented leaves, and the warmth-ether
(among others) in the exploding seed of the flowers.
As a diagrammatic aid
we can place the five plants on the points of a pentagram, with the
all-inclusive Urtica at the top:
One could equally
imagine a hand with its five digits, each having its own separate and different
function, where there is a clear difference between the four fingers and the
thumb, just as the oak-bark has a function in the preparation that is clearly
different from the four herb-plants.
What all five plants
have in common is that they have great vitality and that their life-cycle, in
contrast to that of many other herbs, extends over a large part of the year.
They arouse powerful, enduring, constructive life- processes. In view of this
characteristic, one is led to allow Marjoram comp. (Menodoron) to continue
working for quite a long time (months on end).
Decoctions and
infusions are made of the plant substances, and these are administered on a
percentage basis; both principles indicate that the effect is directed at the
metabolic sphere.
The menstrual cycle
In order to get a
clear view of the menstrual cycle and its irregularities, we shall attempt to
describe it as the result of the action of the upper and lower poles upon the
reproductive system.
At the end of the first
week of the cycle, the endometrium begins to build up (proliferative phase) as
a result of an increase in the estrogens.
At the end of the
second week ovulation occurs, with a slight rise in temperature and in
progesterons, and the endometrium enters the secretory phase.
At the beginning of
the 4th week estrogens and progesterones decrease, and the endometrium begins
to become ischemic due to the contraction of the spiral arteries, until on the
28th day the endometrium is shed and excreted into the external world as
menstruation, and then at the end of the week the process begins again.
From a hormonal point
of view we may regard estrogens and progesterones as construction-initiators of
the female reproductive system. The construction begins at the end of the first
week and continues until the beginning of the fourth week, i.e. roughly
covering the second and third weeks. The destruction phase, expressed
hormonally as (among other things) the decline of the two hormones mentioned,
covers therefore the fourth and first weeks. Ovulation and menstruation occur
in the middle of these two phases respectively.
What can these two
phenomena tell us? In the Carpentry-shop Lecture (Der uebersinnliche Mensch in
Uns. Das
der Therapie zugrunde
liegende Pathologische, 1923), R.S. urges us to see all processes and events in
the body as an interaction between, on the one hand, nerve-sense processes
working from above downwards and from outside inwards and, on the other hand,
metabolic processes working from below upwards and from inside outwards. As
soon as one process threatens to become too powerful, a re- harmonizing or
healing occurs, caused by a rebelling reaction from the other pole. Or, as we
can see from the example of the splinter, where initially the nerve-sense or
destruction processes dominate (splinter in the skin-sphere as being in the
domain of the upper pole), the metabolic system subsequently rebels and conveys
the broken-off matter outwards (centrifugally) as a suppuration. A
physiological example of this is what can happen when one looks into the sun:
the impact of the excessively powerful light-processes on the body is brought
into balance by an equally powerful reaction from the metabolism, e.g.
sneezing. An example from pathology would be damage to the intestinal mucosa,
whether by a virus or by a toxic substance, where the metabolism shows a
reaction to this intensified destruction process in the form of an excretion to
the outside as diarrhea.
Conversely, if
initially the metabolic or construction processes dominate (deeper inside the
organism, as being in the domain of the lower pole), the nerve-sense system
subsequently rebels and conveys the excess of construction materials inwards
(centripetally) out of the blood as an incapsulation. In his notebook for that
day Rudolf Steiner calls this "being on the way to disappearance from the
physical world"! An example of such an encapsulation would be any
calculus-formation or sclerosis. Excessive metabolic processes, as exemplified
for instance by cholesterol (see Husemann), are excreted inwards by the
rebelling upper pole. Like an encapsulated splinter it remains thereafter in
the body as an attempt to restore the balance, be it only temporarily.
If we now try to see
the phenomena of the cycle as a special case of the above dynamic system, we
come to the following conclusions:
In the 4th week when
the ischemic phase begins, it takes several days before the destruction has
proceeded far enough for a "falling out of life" to be achieved (as a
suppuration), and for the metabolic processes, as a result, to have rebelled
far enough for them to arrange for an outward excretion in the form of
menstruation, so making an appearance in the physical world outside.
Conversely, after the second week when the construction has reached a certain
strength, there follows a rebelling reaction from the upper pole, leading to an
ovulation, i.e. an expulsion (or rather, inward impulsion) into the free
abdominal cavity. This cavity is actually not a cavity at all, but a virtual space,
an absorbent space, a non-physical, i.e. etheric, space.
Ovulation is actually
a disappearance from the physical world (see the splinter case terminology!).
It is not without significance that it is precisely with the disappearance from
this physical world that a cosmic world becomes accessible (fertilization).
Just as a fever is an
intensified activity of the lower pole (reaction) following upon an impulse
from the upper pole (action), so is the rise in temperature consequent upon
ovulation to be seen as a result of this intensified interaction between upper
and lower poles. A normal menstruation, a healthy excretion, without
troublesome premenstrual phenomena, can occur only if the lower pole has had
its full force in the preceding weeks. If this is not so, the destruction
phenomena (feeling of heaviness, fluid-retention, depression, headache) will be
observed at the moment that they begin, i.e. at the beginning of the fourth
week. (This is analogous to early waking at 3 a.m. when the anabolic phase of the
liver has not been powerful enough and the beginning of the catabolic phase
simultaneously brings awakening with it. As is well known, Fragaria Vitis comp.
(Hepatodoron) is an excellent hypnotic in this case.)
From the above we may
now conclude that a healthy cycle can occur only if construction and
destruction both have their full force and alternate cyclically with one
another.
Hence, a
cycle-therapy means a strengthening of the construction in the construction
phase in the 2nd and 3rd weeks and a strengthening of the destruction in the
destruction phase in the 4th and 1st weeks.
For these reasons we
have given up administering Marjoram comp. (Menodoron) through the whole cycle
or in the second half and now give it in the 2nd and 3rd weeks, while Pulsatilla
and Tormentilla are given in the 4th and 1st weeks. This provides a foundation
for further individual development of treatment
In the past year we
have treated 26 women along these lines, and most of the complaints disappeared
during treatment. After stopping the treatment for several months the
complaints returned for about ¾ of the experimental subjects. We realized from
this that we must in any case advise a much longer use of this treatment. We
must wait and see whether a lasting cycle-regulation will yet be achieved by
this means.
Finally, we are well
aware that the above is only the beginning of an attempt to see the influence
of the 4 bodies on the cycle and its disturbances in the light of the approach
urged in the Carpentry-shop Lecture. ‡
Behandlung Menseszyklus-/Wechseljahrenbeschwerden/nach Babypille:
Pre-Menstrual Syndrome.
Foll.
Homö-opathi-kum |
Typ |
Zyklus |
Blut |
PMS |
Libido |
Sonstiges |
Ergänzungsmittel |
Agn |
Deprimiert. erschöpft. frigide |
Hypo- + Oligo- |
Alle Variationen möglich |
Akne. Herpes. Mastodynie. depressive Verstimmung |
Abscheu vor Koitus |
Hautleiden + Zyklus- Steril infolge Gestagen- |
Phyt: Basilikum. Art-vg. Dam. Rosm |
Apis |
hastig. hektisch. linkisch |
Amenorrhoe mit Nach-untenziehen. „Als ob Periode kommen wolle“ |
Meist hell mit Klumpen |
Unruhe |
Normal bis erhöht |
Hals + Bauch berührungs- |
Phyt: Hyper. Meli |
Calc |
Fett. frostig. furchtsam. schlaff; oft blond |
Amenorrhoe (Regel zu früh. reichlich + lang) |
Membranös. intermittierend |
Mastodynie. Frost. Kopfschmerz.
Kolik. reizbar. Rücken- |
Schwäche nach Coitus |
Hypophyse- + Schilddrüs- |
Phyt: Art-vg. Fuc. Rosm. |
Graph |
Fett. faul. frostig. frigide. verstopft |
A-. Hypo- + Oligo- |
wässrig. wund- |
Mastodynie. Fluor gussartig. Obstipation. Hautleiden |
Empfindungs- |
Hypothyreose. Hautleiden. Erkältlichkeit. Fettsucht. Anämie |
Phyt: Art-vg. Fuc. Lev. Rosm. |
Mag-c |
Essstörung; Bulimie; launisch. erschöpft. empfindlich |
Hypo- (im Rücken) |
Dunkles Blut; braun. pechartig. klumpig. nachts |
Angina. Fresslust. Hautleiden.
Obstipation. Kopf- + Rücken- |
Verlangt Geborgenheit |
Folgen von FÜRsorge ( Heimweh);
Magen- |
Phyt: Basilikum. Meli. Sep |
Nat-m |
Stress Kummer. verklemmt. oft magersüchtig |
Amenorrhoe (Notstand/ Flucht) Hypo- + Oligo- |
Membranös. Blass/ dunkel/dünn |
Alles schlimmer. Kopfschmerz. Depressiv/reizbar Trauer |
Schmerz beim Coitus |
Trockene Schleimhäute. Hitzeempfindlich Hyperprolaktinämie/-Hyperthyreoidismus |
Phyt: Basilikum. Dam.
Meli. Puls. Sep |
Phos |
Furchtsam (Alleinsein. Gewitter,...). sensibel. leicht erschöpft. medial |
Amenorrhoe/Fluor statt Periode; Hypomenorrhoe. zu früh + zu lang; Zwischenblutungen |
Membranös; hellrot. wässrig |
Alles schlimmer vor der Regel; Harndrang. weinerlich |
auch Nympho- |
Leber- |
Phyt: Card-m. Meli |
Puls |
Schwammig. frostig. launisch. weinerlich. oft blond. religiös; "Apriltag" |
A-. Hypo- + Oligo- |
Wechselt; blass. dick. braun. schwarz. Klumpig |
Depressiv/unruhig Stimmungs- |
Männer abgeneigt |
Wechselnde Beschwerden (Unterleib/Magen-Darm/Lunge) Akne bei Zyklusstörung |
Phyt: Art-vg.Fuc. Rosm. Hom: Agn. Calc. Graph. Phos. Hypophysis. Ovarium |
Sep |
Xantippe: garstig. Launisch/frustiert; oft dunkler/stark behaarter Typ |
A-. Hypo- + Oligo- lange + reichliche Menses; Zwischenblutungen |
Meist hellrot. stinkend. membranös |
Harndrang. Rücken- Brüste berührungsempfindlich |
Schmerz beim Coitus |
Leberbeschwerden. Bindegewebsschwäche (Senkungsbeschwerden. Varizen). Hirsutismus |
Phyt: Basilikum.
Card-m. Dam. Hyper. |
Alch-vg: Wirkt gestagenartig
Ange-a u. A. sinensis): Erwärmt den ganzen unteren Menschen; v.a. die chinesische Art regt Eisprung und Östrogenproduktion an (Bestandteil chinesischer Frauentees).
Art-v: Regt Östrogen- und Gestagenproduktion an. Teekuren fördern Eisprung, Entschlackung und Menstruation (siehe Text).
Oci-b: Mild östrogenartig, regt Eisprung und Libido an. Wurde schon von Paracelsus zur Fruchtbarkeitssteigerung junger Frauen empfohlen.
Dam: Allgemeines und sexuelles Tonikum der Maya; Tee oder Extrakte regen Eisprung und Libido an (östrogenähnliche Wirkung).
Genis-t: wirkt schwach östrogenartig.
Gins: Allg. und sexuelles Tonikum mit leicht östrogenartiger Wirkung.
Puni: Enthält im Samen Östron
Lup: Zubereitungen aus frischen Hopfenzapfen wirken östrogenähnlich; dämpfen den Geschlechtstrieb von Männern und steigern die Libido bei Frauen.
Cori-s: Eine östrogenartige Wirkung wird schon lange vermutet, bislang fand man noch keine verantwortlichen Stoffe.
Puls: Das Füttern von Pulsatilla an Tiere führte laut Madaus zu verfrühter Brunst. Pulsatilla C30 zeigte im Tierversuch progesteronartige Wirkung.
Leguminosen (Pueraria mirifica): Thailänd. Sexualtonikum; enthält Miröstrol.
Meli: Wirkt mild östrogenartig und antithyreotrop.
Agn: Aufgrund der dopaminergen und prolaktinsenkenden Wirkung tritt ein relativer Gestageneffekt ein (siehe Text).
Ruta: Die östrogenartige Wirkung; dämpft ähnlich wie Hopfen den Geschlechtstrieb der Männer und steigert den der Frauen.
Rheum rhaponticum: Bei Wechseljahrsbeschwerden in Form von Phytoestrol bewährt (enthält Diäthylstilböstrol Rhaponticin; teilsynthetisch; rezeptpflichtig).
Rosm: Regt die Keimdrüsentätigkeit an, wirkt mild aphrodisierend, fördert Eisprung (= östrogenisierend) und Menstruation.
Salbei (Salvia officinalis): Wirkt östrogenartig und schweißhemmend.
Con: Hemmt die Aktivität endokriner Drüsen (siehe Text).
Cimic: Östrogenartiger Wirkung.
Mill: Wirkt laut Réquena gestagenartig.
Heli-a: In den Blüten fand man östrogenartige wie auch gestagenartig wirkende Substanzen (Madaus).
Lithospermum officinale: Indianisches Verhütungsmittel; enthält antigonadotrope und prolaktinsenkende Lithospermsäure.
Lil-t: Die frischen Brutknospen zeigten antiöstrogene Wirkung (Madaus); die relative Gestagenwirkung wird in Form von Mastodynon z.B. bei PMS genutzt.
Lycp-e u. Lycp-v: Enthält Lithospermsäure mit antithyreotroper und prolaktinsenkender Wirkung (z.B. in Form von Mutellon von Klein).
Dios: Enthält das Steroidsaponin Diosgenin, das früher für die Pille isoliert wurde. Dioscorea zählt zu den ayurvedischen Heilmitteln bei Sexual- und Hormonproblemen. Bei durch Gelbkörpermangel bedingten
Leiden (z.B. Dysmenorrhoe) wird Natural Progesteron Salbe empfohlen (halbsynthetisch; verschreibungspflichtig).
Sambucus vs. Hormones: A Natural and Preventive Approach to Female
Health
[Bertram von Zabern]
From adolescence on are women subject to treatment with hormones in
order to regulate the menstrual cycle, to protect against pregnancy, and to
eliminate various effects of menopause. Unfortunately, prolonged treatment with
oestrogen (such as Premarin) and progesterone, or their combinations (= birth
control pills) have side-effects. Manufacturers list the enormous number of 50
to 60 different side-effects caused by contraceptive pills (myocardial
infarct/thromboembolism/cerebral haemorrhage/cancer). Conditions, like
osteoporosis, that can not be prevented by exercise and diet, in which hormone
treatment becomes a necessity with risks to be considered. However, the
terrifying list clearly shows that in most cases hormone medication has a
negative impact on longterm health. No doubt they are prescribed too often, as
for routine treatment of hot flashes, while natural approaches offer a much
better alternative.
Hormones are primarily the result of life processes, not their cause. A
healthy female body will produce the amount of oestrogen best suited to her
constitution. The timing from the onset of the first menstrual cycle, as well
as the interval of the monthly rhythm and the timing of menopause is tailored
by nature to be part of the health of the individual woman. There may be a
benefit for a young woman not to have her menstrual period naturally for a few
months while under stress and other conditions.
Equally, the change of life is a very important healthy transition. Therefore
the indiscriminate prescribing of birth-control pills and menopausal estrogens
are an artificial interference with the wisdom of the body and of nature.
In anthroposophic medicine, we try to understand the workings of nature.
The female cycle is an example that shows how cosmic rhythms work in our lives.
Since antiquity, doctors have been aware of the similarity of the 28-day moon
phase with the average menstrual rhythm. Even the average gestation of an
embryo comes amazingly close to 10 x 28 days. There are other obvious cosmic
effects in our lives, most prominently: the sun-bound sleep-wake cycle, the
seasons of the year, and the effects of the full moon, new moon, solstice, etc.
These cosmic rhythms are received differently and modified by each individual
to suit their being.
Due to the imperfection of human life, the interaction with cosmic
rhythms and their energies can become irregular and discomforting. At the point
of illness we need help from a being purely devoted to, and in harmony with, the
cosmos: a plant. Elderberry is such a plant. Its flowers, given as a tea, make
us feel hot and induce perspiration.
As a homeopathic preparation, Sambucus (= Elder flowers) have the
opposite effect; they become an excellent medication for menopausal hot
flashes.
Let us observe some details of this plant. Its umbrella of tiny flowers
reflects the dome of the sky. The flowers produce a peculiar scent and taste
that reveal an active chemistry. Such a flowery chemistry was called
"sulfuric" by the alchemists, because the chemistry of sulfur is
connected with the heat processes in nature.
R.S.: gives new insights into the remedial relationship of human and
plant life. The flower's chemistry works in human metabolism, where heat
processes are most active. That is especially true for Elder flower; its
sulfuric strength is of a gentle, nutritious nature. Just smell the delicious
aroma of the elder flower tea, or taste the peculiar gourmet flavor of a soup
of the berries, made with apples and lemon peel!
It would not be the best approach to tell a patient that hot flashes are
common and healthy, so she should suffer them through. But it would be worse in
most cases to "rebalance" her hormones with estrogens. Heat reactions
are known to activate the immune system and they work as a preventive against
cancer. Therefore, hot flashes should not just be suppressed. Mother Nature has
wisely designed the change of life to free the mature woman from the monthly
preparation for childbearing, and to strengthen her constitution for many
years to come.
Based on insights by R.S., homeopathic preparations of elder flowers
have been developed, enhanced by the spongy core of the twigs, also a
significant part of the plant, and larch resin. This medicine is available from
Weleda as Flores Sambuci comp. When a patient reports that the hot flashes have
become much less, we have done more than "manage the discomfort." We
are led to admire the wisdom of a plant that can uniquely transform sun heat
into nutritious heat in its plant life and, as a medicine, transform the
metabolic heat of hot flashes into the inner strength of keeping energy in
balance and order.
Editor's Note: Hot flashes are like lightning, divine flashes that
vitalize and warm you towards a new self. Recognize them for what they are and
you will greet them with awe. Hot flashes quicken, while night sweats cast off
the old. The editor is for sure a man!
[Joop van Dam/Bob C. Witsenburg]
THE EFFICACY OF HOMOEOPATHIC SIMILLIMUM IN THE
TREATMENT OF PMS (PMS).
ABSTRACT This study was intended to evaluate
the efficacy of homoeopathic simillimum in the treatment of PMS
(PMS). The sample group consisted of women between 18 - 40, living in the
greater Durban area.
PMS: a condition characterized by
nervousness, irritability, anxiety, depression, and possibly headaches, oedema,
and mastalgia, occurring during the 7 - 10 days before and usually disappearing
a few hours after the onset of menses (Beers and Berkow, 1999:1932-1933). 75%
of all women suffer from PMS to some degree (Hayman, 1996). A total of 39
participants with PMS were selected for the study on the basis of inclusion and
exclusion criteria.
Participants were randomly divided
into 2 groups (treatment and placebo) according to the randomisation sheet.
There were 12 withdrawals from the study. 27 of the participants completed the
study of which, 14 were on placebo treatment and 13 on active treatment. The
treatment followed the initial consultation, which consisted of 3 powders
containing either active ingredient (i.e. simillimum) or matching placebo and a
20ml bottle of liquid containing either active ingredient or placebo. Each
participant was required to take one powder daily for three days from day 10 of
their menstrual cycle followed by liquid treatment daily till onset of menses.
Each participant had 3 consultations with the researcher over a 3 month period;
each consultation a month apart. Menstrual Distress Questionnaires (Appendix A)
were completed by the participants at each consultation.
The data accumulated via the questionnaires was evaluated using
non-parametric tests and analyzed statistically using the Wilcoxon’s Signed
rank test and the Kruskal Wallis test. The results were analysed at a 95%
confidence rating with p ≤ 0.05. Data was analysed using the SPSS
(version 15.1®) for Windows® statistical software suite. The intra-group
analysis showed statistically significant changes in the subgroups of water
retention (p=.020) and appetite changes (p=.010) in the Treatment Group. The
Placebo Group showed statistical significant changes in the subgroups of
concentration (p=.029), autonomic reaction (p=.013) and appetite changes
(p=.035). The inter-group analysis failed to reveal any statistical
significance. Therefore, the conclusion is that homoeopathic simillimum was not
effective in the treatment of PMS (PMS). There were clinical
improvements noted by participants during the study which suggest that more
research into the treatment of PMS should be conducted. Studies with a larger
sample group over a longer time frame with daily outcome measures would give a
better indication of the efficacy of the homoeopathic simillimum on PMS.
For thousands of years - up to and including decades of the present century
- very little, if anything, was done to alleviate the unpleasant symptoms which
the vast majority of women experience while they are menstruating, nor the
whole complex (or syndrome) of problems, mental and physical, which affect far
more women than is generally realized during the premenstrual phase of their
cycle (Sheeve, 1992:14-15). PMS (PMS) is a condition characterized
by nervousness, irritability, anxiety, depression, and possibly headaches,
oedema, and mastalgia, occurring during the 7 to 10 days before and usually
disappearing a few hours after the onset of menses (Beers and Berkow,
1999:1932-1933). There are over 150 symptoms that have been attributed to PMS
(Lichten, 2005). PMS was first identified as a true medical disorder by Dr
Robert T Frank in 1931 in his paper called “Hormonal Causes of Premenstrual
Tension” (Dixie Health, 2006). According to some studies, 75% of all women
suffer from PMS to some degree (Hayman, 1996). Of the estimated 40 million
sufferers, more than 5 million require medical treatment for marked mood and
behavioural changes (Litchen, 2000). Approximately 2% to 5% of women have
severe PMS but many have only mild or moderate symptoms. PMS is most common in
women in their 20’s and 30’s, and ceases entirely at menopause (as cited by
Sarawan, 2001).
In a study conducted to assess the impact of premenstrual symptomatology
on functional and treatment-seeking behaviour for a community-based sample of
women in the U.S., U.K. and France it was found that functional impairment tended
to be highest at home, followed by social, school, and occupational situations.
Among working women, over 50% reported their occupational functioning being at
least somewhat affected. Of women who ever missed work because of symptoms, 1-7
days were missed in the past year. Almost ¾ of the women had never sought
treatment, and symptom severity was an important factor in treatment-seeking
behaviour (Hylan, et al. 1999). A study conducted in a UK women’s
prison showed that half the inmate’s offences had been committed in the
praemenses time (4 days prior to the start of the menses and first 4 days of
menses) (Hayman, 1996). Homoeopathy, based on the „law of similars’
is a system of medical therapeutics that subscribes to fundamental laws of
nature. This allows homoeopathic remedies to utilise and enhance the body’s
curative powers. Homoeopathy is a curative system of medicine as it restores
the patient to health and balance, both mentally and physically (Eizayaga,
1991: 11, 37). The simillimum is the medical potency capable of producing a set
of symptoms which are the most similar to those in the case of disease to be
cured (O’Reilly, 2001). Homoeopathy is considerably cheaper than
conventional medicine, making it a desirable alternative to allopathic medication
(Ullman, 1991: 49). Homoeopathic treatments have no harmful side effects and
are safe to treat during pregnancy, menopause and for babies to take. The
remedies work gently to stimulate the body’s own natural defences
with results that may be powerful and long lasting (Traub, 2006). Menstrual
disorders at all ages and stages can be treated effectively with homoeopathy
(Bloch and Lewis, 2003).
The purpose of this double-blind placebo controlled study was to
evaluate the efficacy of homoeopathic simillimum in the treatment of
Premenstrual 3 syndrome in terms of patient’s perception of the
treatment using the Moos Menstrual Distress Questionnaire (Moos, 1968).
Premenstrual ailments are some of the most common disorders suffered by
women today. It has been shown that women can have radical behavioural,
emotional and physical reactions to the hormonal changes occurring in the
premenstruum that can impact all aspects of their lives (Hayman, 1998).
Although extensive research is still being done, medical science has not yet
come up with the perfect solution (Kirtland, 1995). PMS (PMS) is a
recurrent luteal phase condition characterized by physical, psychological, and
behavioural changes of sufficient severity to result in deterioration of
interpersonal relationships and normal activity (Moreno, 2006).
Up to 80% of women experience mood and physical symptoms associated with
menstrual cycle. Commonly reported symptoms are irritability, anger, fatigue,
physical swelling or bloating and weight gain (Hylan, et al. 1999).
More than fifty years ago premenstrual tension was methodically
investigated and described by Dr. Robert T. Frank of New York, although, at the
time he referred to PMS as “premenstrual tension". PMS is now
recognized the world over as being a widespread problem. In 1931 Dr. Frank read
his history making paper, "Hormonal Causes of Premenstrual Tension"
at a meeting of the New York Academy of Medicine.Scientists who were
investigating problems associated with menses were struck by the constant
appearance of what they labelled premenstrual tension (PMT). PMT was their
umbrella term for depression, extreme fatigue, and irritability. However as
research continued, it became clear that the "tension" evident during
the premenstrual time was only part of what had to be called a syndrome. There
were just too many other symptoms that constantly occurred prior to menses.
Important findings about the distressing symptoms of PMS, and in fact, the term
PMS came from the efforts of two English physicians, Dalton and
Greene. In 1953 they published "The PMS", which was the
first PMS
paper in medical literature in the British Medical Journal. (Dixie
Health, 2006). Dalton describes the PMS as the most prevalent of
endocrine disorders. The endocrine system consists of glands that secrete
substances into the blood. These substances have an action on a specific organ.
In her book, "The PMS", she says this title covers a wide
variety of cyclical symptoms which regularly recur at the same phase of each
menstrual cycle. The most common time for repeated symptoms is during the
premenstruum or early menses, but occasionally symptoms occur at ovulation. She
says that the onset of the full menstrual flow usually brings dramatic and
complete relief, but as there may be slight menstrual loss for a day or two
before the onset of full menses it is not uncommon to find symptoms continuing
through the first day or two of each cycle (Dixie Health, 2006). Symptoms of
PMS
have been reported to affect as many as 80% of women of reproductive age
some time during their lives. Recent studies indicate that 14-88% of adolescent
girls have moderate-to-severe symptoms. Another 3-5% of women meet the criteria
for Premenstrual Dysphoric Disorder (PMDD). PMS affects women with ovulatory
cycles. Older adolescents tend to have more severe symptoms than younger
adolescents. Women in their fourth decade of life tend to be affected most
severely. PMS resolves completely at menopause (Moreno, 2006). Singh, Berman,
Simpron and Annechild (1998) found that women were more frequently aware of
symptoms related to PMS rather than a recognition of a formalised medical
syndrome. Less than half the women reporting symptoms had taken either over-the
counter or prescription drugs. Women who tried complementary therapies generally
found them to be effective.
IMPACT OF PMS
A study conducted in the USA surveyed 1052 women (aged 21-64)
telephonically to find out the respondent demographics, respondent knowledge of
PMS, the incidence rate of common symptoms and remedies being used to control
symptoms. This study concluded that 41% of the women indicated that they
suffered from PMS, and an additional 17% indicated that they experienced
symptoms prior to their menstrual cycle commonly associated with PMS, including
pain, bloating, feeling more emotional, weight gain and food cravings, although
they did not associate these symptoms explicitly with PMS. Of those women
reporting PMS symptoms, about 42% took either prescription or over-the-counter
medications for relief of symptoms. The conclusions drawn from the study were
that women are more frequently aware of symptoms related to PMS rather than a
recognition of a formalised medical syndrome. Women who tried complementary
therapies generally found them to be effective (Singh et al., 1998).
Economic impact
Dean and Borenstein (2004) conducted a study to investigate the
relationship between work productivity and impairment due to PMS.
They took a sample group of women aged between 18 to 45 years of age who, for
two consecutive menstrual cycles, completed a “daily rating of severity of
problems” form to record daily symptoms. In the workplace, women with PMS
reported higher absenteeism rates (2.5 days vs. 1.3 days) and more
workdays with 50% or less typical productivity per month (7.2 days vs.
4.2 days). Women with PMS in one of two menstrual cycles reported a greater
number of days with impairment in routine work, school, and household
activities in comparison with women without PMS. The results indicated that PMS
leads to substantial decrease in normal daily activities and occupational
productivity and significantly increased work absenteeism.
Hylan, Sundell and Judge (1999)
conducted a study to assess the impact of premenstrual symptomatology on
functional and treatment-seeking behaviour for a
community-based sample of women in
the U.S., U.K. and France.
A sample of 1045 menstruating women
(aged 18-49) completed a telephonic questionnaire that measured, at a point in
time, premenstrual symptoms, impact on functioning, and treatment-seeking
behaviour. Results were
generally consistent across the 3
countries. Irritability / anger, fatigue, and physical swelling / bloating, or
weight gain were among the most commonly reported symptoms (approximately 80%).
Functional impairment tended
to be highest at home, followed by
social, school and occupational situations. Among working women, over 50%
reported at least somewhat affected occupational functioning. Of women who ever
missed work because of symptoms, 1-7 days were missed in the past year. Almost
three quarters of the women had never sought treatment, and symptom or symptoms’
severity was an important factor in treatment-seeking behaviour.
Social impact
A UK Medical Committee conducted a study on women involved in car
accidents and found that 48% of these accidents occur during the premenstruum.
The expected result would have been for 25% of accidents to occur as
premenstruum accounts for one in four weeks. Another study revealed that
accidents are far more common during the premenstruum than at any other time,
based on increased hospital administrations and visits to doctors’
surgeries. These findings indicated how in the premenstruum a woman is far more
accident prone and so can be more hazardous to have in the work place (Sheeve, 1992).
A study conducted in a UK women’s prison showed that half the
inmate’s offences had been committed in the premenstruum time - the
three or four days before a period begins, when the symptoms of PMS would be at
their peak
(Hayman, 1996). Cases have been
heard in the courts of women who temporarily “lose their minds” during the
premenstruum due to PMS and they have received lighter sentences. One case in
point was Mrs. Christine English
who had no criminal record but in a
fit of rage drove her car over her lover and killed him. Her intention was not
to kill him she stated that she „just snapped’ and jammed her foot
on the accelerator, intending to bump into him
and hurt him and shut him up. The
courts accepted her claim and she was given a conditional discharge for twelve
months and banned from driving for the same period (Sheeve, 1992).
TYPES OF PMS
The most common symptoms during menses can be
divided into 5 subgroups: |
Symptoms |
PMS-A, anxiety |
Difficulty sleeping, tense feelings, irritability,
clumsiness, mood swings |
PMS-C, craving |
Headache, cravings for sweet foods, cravings
for salty foods, cravings for other types of food |
PMS-D, depression |
Depression, angry feelings for no reason, feelings
that are easily upset, poor concentration or memory, feelings of low
self-worth, violent feelings |
PMS-H, hydration |
Weight gain, abdominal bloating, breast
tenderness, swelling of extremities |
PMS-O, other |
|
Type A
Characterised by anxiety: irritability, crying without reason, verbal
and sometimes physical abuse, feeling “out of control”, or Dr. Jekyl-Mr Hyde
behaviour changes (Lichten, 2001). This type of PMS is the most common subtype
affecting 65-75% of PMS sufferers (Lockie and Geddes, 1992:67). In some women
the anxiety is followed by depression. The symptoms get worse in the days
before the menstrual period and are relieved by its onset.
The cause of type A is most likely due to excessive levels of oestrogen
and inadequate levels of progesterone circulating in the body (Lark, 1984:27);
however there is no scientific evidence to confirm this theory (Sheeve, 1992).
Type C
Characterised by cravings: food cravings, usually for sweets or chocolates;
dairy products including cheese, and on occasion, alcohol or food in general
(Lichten, 2001). This subtype also includes symptoms like headaches, fatigue
and palpitations. This affects 24-35% of premenstrual women (Lockie and Geddes,
1992:67). Many women note an increased craving for refined carbohydrates
(sugar/chocolate/pastries) and eat larger quantities of these foods before
their period than they normally would. This craving is made worse by stress. A
few hours after indulging in these foods, many women experience fatigue,
headaches, shaking and dizziness (Lark, 1984:29).
Type D
Characterised by depression: confusion, clumsiness, forgetfulness,
withdrawal, fearfulness, paranoia, suicidal thoughts and rarely, suicidal
actions (Lichten, 2001). This affects 23-35% of women and is more commonly
found in combination with PMS type A. The PMS type A occurs first and is
followed by type D symptoms a few days before the onset of the period (Lockie
and Geddes, 10 1992:67). In these women oestrogen levels are found to be
abnormally low, and the depressant effects of high or normal progesterone are
not counterbalanced by oestrogen (Lark, 1984:30).
Type H
Women complain of heaviness or headaches: fluid retention leading to
headaches, breast tenderness, abdominal bloating and weight gain (Lichten,
2001). This affects 65-72% of sufferers (Lockie and Geddes, 1992:67).
These women tend to retain excess salt and fluid, caused by an excess
production of the pituitary hormone adreno-corticotrophic hormone (ACTH). The
ACTH is then circulated via the blood to the adrenal glands (Lark, 1984:30).
Aldosterone release causes the kidneys to retain water and salt so less urine
is excreted (Lockie and Geddes, 1992:67).
Type O
For all the other symptoms not accounted for in the first 4 subgroups.
Complaints: dysmenorrhoea, change in bowel habits, frequent urination, hot
flashes or cold sweats, general aches or pains, nausea, acne, allergic
reactions, upper respiratory infections (Moreno, 2006). The above shows exactly
how multifaceted PMS is, with 5 different problem entities often coexisting in
the same women (Lark, 1984:30).
SIGNS AND SYMPTOMS
Most women experience some symptoms which are related to the menstrual
cycle. In many, women the symptoms are not disabling and are of short duration,
while others may experience a broad range of symptoms that disturb normal
ability to function (Hayman, 1996).
The most common physical symptoms are:
Headache
Swelling
of ankles, feet, and hands
Backache
Abdominal - cramps or heaviness/pain/fullness, feeling gaseous
Muscle spasms
Breast tenderness
Weight gain
Recurrent cold sores
Acne aggravations
Nausea
Bloating
Constipation or diarrhoea
Decreased coordination
Food cravings
Less tolerance for noises and light
Anxiety or panic
Confusion
Difficulty concentrating
Forgetfulness
Poor judgement
Depression
Irritability, hostility or aggressive behaviour
Increased guilt feelings
Fatigue
Slow, sluggish, lethargic movement
Decreased self-image
Sex drive change, loss of sex drive
Paranoia or increased fears
Low self-esteem
(Thompson, 2004)
POSSIBLE AETIOLOGY
For many years, PMS was dismissed as a psychological problem. We now
know that this is a physiological problem and not purely a psychological one.
However it is still far from clear what causes all the symptoms. It is
possible that there is more than one cause of PMS and that there may be
different causes of symptoms in different people. One of the reasons for PMS
may be hormonal imbalance - excessive levels of oestrogen and inadequate levels
of progesterone –
as well as sensitivity to fluctuating hormones. Diet may be an important
contributing factor for some women. Unstable blood sugar levels are an
important factor as well. PMS has also been linked to food allergies, changes
in carbohydrate metabolism, hypoglycaemia, and malabsorption. Other suspected
causes of PMS symptoms include erratic levels of beta-endorphins (a narcotic
like substance produced by the body).
All these play a part in PMS. (Balch and Balch, 2003).
Hormonal imbalance
Oestrogen and progesterone imbalance
PMS occurs when there is oestrogen dominance. Depression, loss of sex
drive, sweet cravings, heavy periods, weight gain, breast swelling and water retention
can all be attributed to oestrogen dominance. Oestrogen dominance can be due to
excessive exposure to oestrogenic substances, or a lack of progesterone, or a
combination of both (Holford, 2004: 27-8). The variation of oestrogen and
progesterone levels coincides with the onset and relief of PMS. However the
evidence is inconsistent and is still inconclusive (Hayman, 1996).
Prolactin
Some studies have shown that there is an increase in prolactin during
the luteal phase. Halbreich found that women with PMS had higher prolactin
levels than women who did not have PMS symptoms. Prolactin is produced in the
pituitary gland and its function is to stimulate the development and growth of
breast tissue. If the pituitary produces too much prolactin this will lead to
breast tenderness, lumpiness and enlargement, and it may also alter the amount
or balance of oestrogen and progesterone produced in the body, and affect mood
(Hayman, 1996).
Prostaglandins.
A diet-related explanation concerns the role of prostaglandins in PMS.
These are essential fatty acids that are made by the body and which are
nutritionally important for growth and health. The most important of these is
linoleic acid, a polyunsaturated fatty acid found in cereals, legumes and
vegetables. If most of the fat in a woman’s diet is obtained from
animal fat she may have a diet that is low in linoleic acid. Prostaglandins are
responsible for inflammation and pain in response to tissue damage. They also
have a regulating effect on hormones such as oestrogen, progesterone and
prolactin. A deficiency in prostaglandins may lead to the imbalance in hormones
that causes PMS symptoms. The dietary deficiency of essential fatty acids which
leads to a deficiency in prostaglandins would cause PMS. Some studies have
indicated that prostaglandins increase during the luteal phase and decline
during menses as a normal and natural part of the menstrual cycle (Hayman,
1996).
Opiods
One argument is that PMS is linked to opium-like substances which are
produced in the brain (endogenous opiod peptides or endorphins). These are
produced to control body temperature, bowel function and whether one feels
tired, hungry, happy or sad. PMS symptoms mimic the symptoms of narcotic
withdrawal e.g. nausea, cramps and depression. (Studies show that these opiods
are not only produced by the brain but some are also affected by chemicals
produced by the ovaries, so the levels may change throughout the menstrual
cycle.) If, in common with other ovarian hormones, the levels are low in the
premenstruum, this may account for the drop in mood. Further studies are needed
to substantiate this theory (Hayman, 1996).
Nutritional
Blood sugar
Another theory is that PMS is related to low blood glucose. Glucose is
the body’s chief source of energy and is carried by the blood to all
tissues. If one did not eat for a long period, there would be a decrease in
blood glucose levels. However, usually the level is kept within fairly narrow
limits by the action of various hormones such as insulin, glucagon and
adrenaline. Glucose can be stored in the liver and muscles so that if these
levels begin to drop these reserves can be released. However the release of
adrenaline to stimulate this effect has the side effect of causing stress
symptoms, making one tired and jittery. People have 15
been noted to experience sweet
cravings boost energy levels by eating chocolates and sweets, which can
actually make the situation worse. There is a quick increase in blood glucose
levels followed by an immediate “rebound” reaction where the levels fall. The
decrease in blood glucose causes the release of more adrenaline which has a
positive feedback effect aggravating the situation. Adrenaline releases glucose
from the cells causing water uptake, which causes the bloating experienced by
PMS sufferers (Hayman, 1996).
Dietary deficiencies
Another diet-related argument is that PMS is linked to vitamin and
mineral deficiencies. The symptoms of various dietary deficiencies can be shown
to be similar to those of PMS, a lack of vitamin B6, E, zinc and magnesium,
and others. Modern diets are frequently lacking in these essential
dietary factors (Hayman, 1996). In the premenstruum, women often have cravings
for the B vitamins, which is similar to a craving for sugar. Instead of ingesting
the vitamins, sugar is eaten such as cakes and chocolates and the
craving is satisfied. These cravings should be dealt with by taking vitamins
rather than sugars (Sandler, 1991). The deficiency of the essential fatty acids
(EFAs)
has come to light in recent years as a likely cause of PMS as EFAs are
essential to the production and regulation of hormones. The deficiency of EFAs
leads to the hormonal imbalance that results in premenstrual symptoms.
The efficacy of Vitamin B6 (pyridoxine) in the treatment of PMS
has been attributed to its role in metabolising EFA rather than a direct action
on the hormones (Sheeve, 1992).
Calcium supplementation has been shown to reduce many symptoms of PMS by
as much as 30%. The deduction from this is that calcium deficiency is a cause
of PMS (Balch and Balch, 2003). Magnesium deficiency has been linked with
breast pain, water retention, cravings, tension headaches, depression and
anxiety (truestarhealth.com).
DIAGNOSTIC CRITERIA
According to Dalton (1984) the diagnostic criteria for PMS
are:
- Symptoms must occur exclusively during the second half of the
menstrual cycle.
- Symptoms increase in severity as the cycle progresses.
- Symptoms must be relieved by the onset of full menstrual flow.
- There must be an absence of symptoms in the postmenstruum.
- Symptoms have to be present for at least 2 consecutive cycles.
OUTCOME ASSESSMENT TOOL
The Moos Menstrual Distress Questionnaire (MDQ) (Moos, 1968) (Appendix A)
is one of the methods of assessing premenstrual symptomatology. Other methods
include the Premenstrual Assessment form and the Daily Menstrual Charts. There
are 45 symptoms in the MDQ and these are divided into nine sub-scales. These
sub-scales are: pain, water retention, control, negative affect, autonomic
reaction, concentration, behavioural changes, appetite changes and arousal. The
subjects are asked to assign numerical weight according to their experience of
each of the 45 symptoms (Hawes, 1992). The MDQ was the main assessment tool
used in this study. The Moos Menstrual Distress Questionnaire (MDQ) was
selected for this trial due to its usage in all previous PMS research seen by
the researcher.
In a study to test the efficacy of the MDQ it was concluded that the
Moos factors effectively represent the structure of the menstrual cycle
symptoms. The aim of the study was to determine whether Moos’
factors could be replicated based on daily and prospective completion of the
MDQ in women who were unaware of the study’s aims. One hundred and
87 women from the general community (mean age 30 years) completed a modified
version
of the MDQ daily for 70 days. Principle components analysis of the
modified MDQ items during the follicular, late luteal and menstrual phase
indicated that a six-factor solution similar to that derived by Moos, best
summarised the data. A number of symptoms, however, loaded highly on more than
one factor. This created some instability in the solution and may explain the
discrepancies in previous research (Ross, et al. 2003). A study
published in the British Journal of Psychiatry found the Moos MDQ to be a
useful method for assessing menstrual distress. Nineteen volunteers completed a
MDQ daily for a period exceeding one menstrual cycle. The data were analysed,
using a least mean square method of fitting sine waves. The fact that the
results obtained on this group are essentially those found by other researchers
looking at the menstrual cycle suggests that this may be a useful method of assessing
menstrual distress (Sampson and Jenner, 1977). An assessment of the Moos
MDQ was done by the American Psychosomatic Society which found the MDQ to be
consistent and highly reliable in reporting symptoms of the menstrual cycle.
The MDQ was analysed for split-half and test-retest reliability. The
experimental group was given neutral instructions to determine if the knowledge
of the purpose of the questionnaire would affect the symptom rating. The
results indicated that the MDQ is internally consistent and does have high
test-retest reliability (Markum, 1976).
DD.:
Cyclic Pelvic Pain
Premenstrual Dysphoric Disorder (PMDD)
A condition associated with severe emotional and physical problems that
are linked closely to the menstrual cycle. Symptoms occur regularly in the 2nd
half of the cycle and end when menses begins or shortly thereafter. PMDD is not
just a new name for PMS (PMS), a condition that affects as many as
75% of menstruating women. It is, considered to be a very severe form of PMS that
affects about 5% of menstruating women. Both PMDD and
PMS share symptoms in common that include depression, anxiety, tension,
irritability and moodiness. Women with PMDD experience severe PMS that disrupts
their everyday lives to the point that they can no longer function effectively
(Madison Institute).
Dysmenorrhoea is a painful menstrual period (Dox et al., 1993).
This can be classified into congestive or spasmodic dysmenorrhoea. Spasmodic
dysmenorrhoea is not part of PMS. It is related to the uterine contractions
which cause shedding of the endometrial lining. The pain is due to the
interruption of the normal blood flow to the muscle fibres caused by to the
strong sustained contraction of the muscle which results in an accumulation of
chemical metabolites in the muscle causing pain. Spasmodic dysmenorrhoea occurs
most often in young women and girls in the time following menarche, before the
uterine muscles have received sufficient oestrogen to complete their
development. The pain experienced with spasmodic dysmenorrhoea is spasmodic and
occurs in the lower abdomen and small of the back and is a heavy, bloated,
dragging feeling sometimes accompanied by dull or shooting
pain in the genital area. This is not a premenstrual symptom as it
occurs during the period. However it can occur in a person with PMS and so the
distinction between PMS and Dysmenorrhoea for the patient is difficult to
distinguish. Congestive dysmenorrhoea is not true dysmenorrhoea as it occurs
before the onset of menses. It is due to the congestion of blood in the vessels
in the pelvis. The pain is in the pelvic and genital regions and is a dull
persistent pain in contrast to period pain which is cramp-like. Congestive
dysmenorrhoea is a symptom of PMS (Sheeve, 1992).
Mittelschmertz Phenomenon
Mittelshmertz Phenomenon refers to a frequently occurring unilateral
lower abdominal pain that occurs mid-cycle due to ovulation. Rupture of the
follicle and subsequent irritation of the peritoneum may produce pain.
The pain, although sometimes severe, resolves spontaneously (Beers and
Berkow, 1999).
Endometriosis
Endometriosis is an abnormal condition in which the uterine mucous
membrane invades other tissues in the pelvic cavity (Dox et al., 1993).
The cyclical engorgement of this ectopic endometrial tissue results in pain,
bleeding, diarrhoea, constipation and lower back pain. The onset of
endometriosis is usually in females between the ages of 20-45 (Haslett, et
al. 2002). In the early stages of endometriosis pain is caused which starts
several days before
the menses and continues through the first few days. This disorder
becomes chronic and pain commonly occurs at various times unrelated to the
menstrual period (Beers and Berkow, 1999).
Affective disorders/ Mood disorders
Depression
Symptoms of major depression include feelings of sadness, loss of
interest in normally pleasurable activities, changes in appetite and sleep,
loss of energy, and problems with concentration and decision-making. Women are
twice as likely as men to experience major depression. Depression can
also cause a wide variety of physical complaints, such as gastrointestinal
problems (indigestion, constipation or diarrhoea), headache and backache. Many
people with depression also have symptoms of anxiety (International Society for
Affective Disorders, 2006).
Seasonal Affective Disorder
Seasonal Affective Disorder (SAD) is a pattern of depression related to
changes in seasons and a lack of exposure to sunlight. It may cause headaches,
irritability and a low energy level (Mayo Clinic, 2006).
Dysthmia
A chronic depression of mood which does not currently fulfil the
criteria for recurrent depressive disorder in terms of either severity or duration
of individual episodes. The balance between individual phases of mild
depression and intervening periods of comparative normality is very
variable. Sufferers usually have periods of days or weeks when they describe
themselves as well, but most of the time they feel tired and depressed;
everything
is an effort and nothing is enjoyable. They brood and complain, sleep
badly and feel inadequate, but are usually able to cope with the basic demands
of everyday life (World Health Organisation, 2007).
Adjustment Disorder
Adjustment Disorder is when the response to a stressful or traumatic
event is signs and symptoms of depression or anxiety. The disorder can be acute
(lasting less than six months) or chronic. An adjustment disorder can develop
following a single stressful event or as result of an accumulation of stress.
The behavioural changes found in Adjustment Disorder are not restricted to the
premenstruum but the behaviour could be misdiagnosed as PMS (Mayo Clinic,
2006).
Other conditions
Peri-menopause
It may be difficult to distinguish peri-menopause from PMS in certain
instances. If one is over 40, symptoms such as joint pain, depression, anxiety,
forgetfulness, increased urge to pass urine and cystitis may actually be caused
by the climacteric (Hayman, 1996:65). In addition one should consider
the possibility of premature menopause in those women who are under the age of
40 (Beers and Berkow, 1999).
Chronic Pelvic
Inflammatory Disease (PID)
PID is widespread infection in the reproductive and pelvic organs. When
chronic, there may be discharge, pain and general ill health (Beer and Berkow,
1999). PID may become worse before a period begins (Hayman, 1996:66).
Hypothyroidism
The signs and symptoms of hypothyroidism vary widely, depending on the
severity of the hormone deficiency. In general, problems tend to develop
slowly, often over a number of years. At first there are symptoms such as
fatigue and sluggishness. The metabolism continues to slow; more obvious
signs and symptoms of hypothyroidism develop, including: increased sensitivity
to cold; constipation; pale, dry skin; a puffy face; hoarse voice; an elevated
blood cholesterol level; unexplained weight gain; muscle aches, tenderness and
stiffness; pain, stiffness or swelling in the joints; muscle weakness; heavier
than normal menstrual periods and depression. Forgetfulness
and slowing of comprehension are additional symptoms of hypothyroidism
(Mayo Clinic, 2006). 22
TREATMENT OPTIONS
Non-pharmacologic
Therapy
The most extreme form of treatment for PMS is a
hysterectomy with a bilateral oophorectomy. This is only considered in cases of
severe PMS where the women has had children and does not wish to have any more.
This option is not viable to young girls or
women due to the finality of the surgery in relation to being able to have
children (Moreno, 2006). Lifestyle changes can play a big part in curbing
symptoms of PMS. Eating properly
and getting adequate exercise and rest are the simplest
steps to help relieve PMS. Reducing the intake of sodium during the
premenstruum will help reduce water retention. Avoiding caffeine assists as
caffeine has been linked
to symptoms of breast tenderness and anxiety.
The intake of caffeine also contributes to the
depletion of important nutrients due to its diuretic action.
Women who exercise regularly have been shown to
have less PMS symptoms than women who don’t so getting regular
exercise is a good way to control PMS (Balch and Balch, 2003).
Yoga has been found to help in the control of
PMS for three reasons. Firstly the postures and breathing technique are
designed to instil a peaceful and tranquil state which will calm the physical
and mental tension associated
with PMS. It decreases tension in the body and
so decreases muscular and joint aches and pains. Yoga teaches the maintenance
of an upright and balanced posture which relieves fatigue, lethargy and lower
back pain. Thirdly
some of the yoga postures have been attributed
to directly helping with congestive dysmenorrhoea (Sheeve, 1992).
Acupuncture: A placebo controlled study was conducted to test the
effectiveness. The participants were classified as having severe symptoms and
some were on medication (progestin and fluoxetine). The treatment group showed
a 77.8% improvement of symptoms in comparison to the 5.9% improvement
found in the placebo group. The positive result was attributed to the serotonin
and opiod releasing effects of the acupuncture treatment (Habek, et al.
2002). A randomised clinical trial was conducted to determine the efficacy of
chiropractic therapy on PMS. In this trial 54 subjects diagnosed with PMS
(using the Moos PMS questionnaire plus daily symptom monitoring) and
30 subjects with no diagnosable PMS were recruited. The PMS group had a
higher positive response for each of 12 measured spinal dysfunction indexes
except for range of motion of the lower back. The indexes where the increases
were statistically significant (P<.05) were cervical, thoracic, and lower back
tenderness, lower back orthopaedic testing, lower back muscle weakness, and the
neck disability index. An average of 5.4 of the 12 indexes were positive for
the PMS group compared with 3.0 for the non-PMS group. This study proved that
there is a relatively high incidence of spinal dysfunction in PMS sufferers
compared with a comparable group of non-PMS sufferers. This research suggests
spinal dysfunctions as a possible aetiological factor for PMS and that
chiropractic manipulation may offer a good alternative approach to treating PMS
(Polus and Walsh, 1999). A study was conducted to see the effect of
consuming soy isoflavone on the behavioural, somatic and affective symptoms in
women with PMS. The study used 23 women with diagnosed PMS and took place over
a seven menstrual cycle time frame. It was a double-blind placebo-controlled,
crossover intervention study. The study proved that isolated soya protein
containing soy isoflavones may reduce specific premenstrual symptoms but on the
totality of the premenstrual symptoms there proved to be insignificant
difference between the placebo and active groups (Bryant, et al. 2005).
A systemic review was done on 27
randomised controlled trials conducted to show the efficacy of various
complementary therapies in the treatment of PMS. (7 Herbal trials, 13 dietary
supplement trials and 1 trial of each of the following disciplines:
homoeopathy, biofeedback, chiropractic, massage, reflexology, relaxation.) This
review showed that despite positive findings in some of the trials reviewed
there is very little evidence to prove that complementary medicines are
effective for the treatment of PMS (Ernst and Stevinson, 2001). The trials that
were reviewed all had a small sample size. The good clinical findings would be
more indicative of the efficacy of the therapies if conducted in a larger group
because a larger sample size yields more statistically significant results than
a small sample. Psychological treatment has also been found to relieve symptoms
of PMS.
Education about PMS and using a
diary to monitor symptoms has been noted to help women feel more in control and
reduce symptoms. Teaching women how to relax by the use of the relaxation
response, biofeedback and
guided imagery helps to relieve
tension and so help the PMS. Cognitive behavioural therapy has also been
clinically noted to help symptoms of PMS (Moreno, 2006).
Dietary Supplementation
Dietary supplements that have been evaluated in women with PMS include
vitamins (A,E, and B6), calcium, magnesium, multivitamin/mineral supplements,
and evening primrose oil. Most studies have been small or poorly designed,
efficacy needs to be confirmed in large, well-designed clinical trial before
evidence-based recommendations can be made (Dickerson et al., 2003).
Pharmacologic Therapy
Over the Counter drugs (OTC) 2
OTC drugs that are useful to relieve symptoms of
PMS include drugs containing mild diuretics, analgesics, prostaglandin
inhibitors and anti-histamines. Caution must always be used when combining
products due to risk of inadequate dosing of some ingredients in the drugs and
excessive dosing of others. It is preferential to use a single product when
using OTC drugs to negate this issue (Dickerson et al., 2003). Herbal
preparations and vitamins (discussed in 2.8.2) are included as OTC.
Herbal
treatments for PMS:
Agn.: Brustschwellung, Depression und Akne vor der
Periode.
Dioscorea villosa. (Wild Yam) is known
historically to treat „women’s complaints’. It has been
used to relieve cramps and mood swings. Wild Yam contains the sterol,
diosgenin, with progesterone-like effects which is why it
has been attributed to relieve symptoms of PMS
(Dixie Health, 2006).
Agnus castus. (Chaste tree) has been
shown to help re-establish normal balance of oestrogen and progesterone during
the menstrual cycle. The action of re-establishing a normal hormonal balance
helps women whose PMS is
due to underproduction of progesterone or overproduction
of oestrogen. It has a calming soothing effect and relieves muscle cramps.
Chaste tree needs to be taken for at least four cycles to determine efficacy
(Balch and Balch, 2003).
Angelica sinensis. (Don Quai) is a
traditional Chinese medicine and is often referred to as female ginseng. It
helps promote normal hormonal balance and is useful for women suffering from
premenstrual cramping and pain
(Dixie Health, 2006). Don Quai acts as a mild
sedative, laxative, diuretic, antispasmodic and pain reliever along with
assisting the usage of hormones by the body (Balch and Balch, 2003).
Chamaelirium luteum (False Unicorn Root) is a Native American traditional
medicine which is useful in treating amenorrhoea, painful menses and other
menstrual irregularities (Dixie Health, 2006).
Psychotropic agents Anti-anxiety and anti-depressant drugs are often
utilised to treat the emotional symptoms of PMS (Hayman, 1997). Anti-anxiety
agents such as Alprazolam (Xanax) and Buspirone (BuSpar) have
been effective in helping the anxiety-related symptoms of PMS. The
Selective Serotonin Re-Uptake Inhibitors (SSRI), Fluoxetine (Prozac) and
Sertraline (Zoloft), are the first-line drugs for severe emotional symptoms.
They work best when taken throughout the month. Clomipramine (Anafranil)
given for the full cycle or half-cycle has been effective in treatment of
emotional symptoms. Nefazodone, an antidepressant that blocks serotonergic
and noradrenergic uptake, recently was shown to be effective in
relieving symptoms (Moreno, 2006).
Diuretics Many women complain of bloating and cyclical weight gain due
to fluid retention. Diuretics help to turn these excess fluids in the body into
urine, increasing the frequency and quantity of urine. Side effects
of nausea and dizziness are not uncommon. Some research suggests that
not only is premenstrual bloating a normal aspect of cyclical change, but that
it is not associated with an actual increase in girth. Fluid may shift around
the body, and there may be an increase in distension or pressure in the
abdomen, but the actual external measurements do not increase. If this is so
diuretics would not be an appropriate treatment (Hayman, 1998: 106). 27
Prostaglandin Inhibitors
Non-Steroidal Anti-Inflammatory (NSAIDS) are agents which are useful for
managing the general aches, pains, and dysmenorrhoea associated with PMS.
Commonly used drugs in the treatment of PMS are Ibuprofen and Mefenamic Acid
(Thompson, 2004). Agents used to alter the menstrual cycle The oral
contraceptive pill (OCP) has been used to regulate the menstrual cycle and
alleviate the symptoms of PMS. However in a study conducted in the Royal
Edinburgh Hospital where 276 women who considered themselves to have PMS were
studied, 171 of which were on the OCP, found that women on OCP experienced
delayed or more prolonged pattern of perimenstrual negative mood (Bancroft and
Rennie, 1993).
HOMOEOPATHY
Homoeopathic.
prescription of medicines is based on the “Law of Similars”. The idea is that
„like cures like’, that is, any substance which can produce a
totality of symptoms in a healthy human being can cure that totality of
symptoms in a sick human being. A homoeopathic remedy helps the body to heal
itself, by stimulating the body’s own energies or vital force. The
remedies initiate the vital force to rid the body of disease, helping the body
to return to health (Vithoulkas, 1998). Menstrual disorders at all ages and
stages can be treated effectively with homoeopathy (Bloch, 2003).
HOMOEOPATHIC TREATMENT OF PMS
Martinez (1990) conducted a double-blind placebo-controlled trial using
Foll. in potencies 9C and 15C
in 32 participants. A questionnaire was given to all the participants
prescribed Folliculinum at their first consultation, to
be collected at the subsequent consultation. The duration of the
treatment was 2 - 4 months. Of all the participants, 88% showed a satisfactory
response to the treatment according to the questionnaire. Most of the
participants (61%) noted an improvement from the second cycle after having
started the treatment. 93% of the participants felt that the treatment had
physiological effects while only 7% felt that the effects might be due to the
placebo effect. The most marked effect on particular symptoms was on breast
swelling, metorrhagia and menstrual irregularities.
Kirtland (1995) conducted a double-blind placebo controlled study
involving 31 women from the greater Durban area where she compared the effect
of Foll. 15CH to placebo. The
results were based on a subjective questionnaire filled in by the participants.
The test group (16 women) had 89% improvement, 4% unchanged and 7% worsening of
the premenstrual symptoms. The placebo group (15 women) had 7% improvement, 4%
unchanged and 89%
worsening of premenstrual symptoms.
The improvement ascertained during the trial was statistically significant. A
double-blind study of the homoeopathic treatment of PMS used a
complex, Premenstron® (= Agn D1 + Cham-er.
D3 + Lil-t. D3 + Caul. D4 + Equis-a. D4. +
Zinc-valer + Ign. D 6 + Kali-c. D6) was compared to placebo. Thirty participants were
randomly selected and divided into their respective groups. The statistical
results were overall 53.3% improvement in the placebo group while 46.7%
worsened. In the treatment group 86.7% showed improvement and 12.3 % worsened.
The improvement in the treatment group was not significant enough to verify
that the complex was effective when analysed statistically and in comparison
with the effect of the placebo (Sarawan, 2001). As the study was conducted as
part of a mini-dissertation the test sample was small which resulted in there
not being statistical significance
in the findings. However based on the clinical findings the homoeopathic
complex had significant improvement to merit further research.
A study was conducted in Israel to test the
efficacy of treating PMS with homoeopathic simillimum using the cluster method
to derive the remedy. The simillimum was selected by the subject filling in a
questionnaire which related to the keynote symptoms of 5 polychrest remedies
commonly used in the treatment of PMS:
Sep.
Nux-v.
Puls.
Nat-m.
Lach.
The prescription was made based on the cluster
of „yes’ answers relating to each remedy. The remedy with the most positive
response was considered the simillimum. The subject was then given a single
powder (which was either the placebo or the selected simillimum). The subjects
were then monitored for 3 months on a once monthly basis to see the effect of
their treatment. The study was a double-blind and placebo-controlled in which
the results were only correlated at the end of the study. They observed
improvements greater than 30% in 90% of participants receiving the active treatment and in 37.5% receiving
placebo (Yakir et al., 2001). The limitation of this study was
the restriction of homoeopathic remedies which could be prescribed for
PMS. The focus of the study was the efficacy of the method of prescribing
rather than the efficacy of a homoeopathic simillimum. Women were excluded
if their symptom profile did not correlate with the selected remedies.
However, simillimum prescribing is a holistic process taking the symptom
profile of the entire person rather than just the premenstrual symptoms.
Remedies were prescribed at the first consultation for each
participant, there was one remedy prescribed. |
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Intra-group analysis
Table 4.1 demonstrates that the Treatment Group showed a significant
difference in the reduction of symptoms in the subgroups of water retention
(p=.020) and appetite changes (p=.010) during the trial. Table 4.3 demonstrates
that the significant difference in regard to water retention occurred between
the first and third consultation (p=.034) and between the second and third
consultation (p=.018). Table 4.3 indicates the difference in appetite changes
occurred between the first and second consultation (p=.009) and between the
first and third consultation (p=.013). No significant difference was noted in
the subgroups of pain (p=.076), concentration (p=.052), behavioural changes
(p=.679), autonomic reactions (p=.197), negative affects (p=.168), arousal
(p=.690) or control (p=.313) in the Treatment Group.
Table 4.2 demonstrates that the Placebo Group
showed a significant difference in the reduction of symptoms in the subgroups
of concentration (p=.029), autonomic reactions (p=.013) and appetite changes
(p=.035) during the trial. No significant differences were noted in the
subscales of pain (p=.360), behavioural changes (p=.078), water retention
(p=.079), negative affects (p=.125), arousal (p=.572), and control (p=.175).
Table 4.4 indicates that the significant
difference in autonomic reactions occurred between the first consultation and the
second consultation (p=.013). The significant differences in concentration
(p=.050) and appetite changes (p=.008) occurred between the first and third
consultation.
Inter-group analysis
Inter-group analysis for all aspects of the MDQ questionnaire revealed
no statistically relevant results (table 4.5), and hence the null hypothesis
was accepted.
Conclusion - MDQ
The statistical evidence indicates that homoeopathic simillimum is
ineffective in the treatment of PMS.
LIMITATIONS OF THE STUDY DESIGN: A POST-HOC ANALYSIS
Participant Compliance
PMS is a chronic condition so the study should have been conducted over
a longer time period for the effect of homoeopathic simillimum to be adequately
examined. The researcher feels that the limited duration of the study would not
have effectively shown the efficacy of the treatment. The research should have
incorporated telephonic follow up consultations in the study design as this
would have combated a large number of participant withdrawals from the study
due to poor accessibility at the Homoeopathic Day Clinic due to various events
outside of the researcher’s control.
Sample Size
Due to participant non-compliance the researcher had to reduce sample
size. The initial sample size should have been larger to account for
non-compliance and withdrawals so that the final sample size would still be
large enough to make the study statistically viable. This would have indicated
a true reflection of the effect of homoeopathic simillimum on PMS.
Prescription
The study utilised three single unit
homoeopathic powders (active/ placebo) followed by 20ml homoeopathic liquid
(active/ placebo) remedies, which were given in drop form on a daily basis. The
powder medicines were
taken consecutively on a daily basis from day 10
of the menstrual cycle (10 days after onset on menses). The liquid medicine was
taken daily from day 13 of the menstrual cycle (13 days after the onset of
menses)
and continued daily till the onset of the
following menstrual cycle. The participants took the remedies for a single
menstrual cycle and then had no further treatment. The researcher believes a
daily remedy/placebo for the
duration of the study would have improved
overall compliance. Administration of medication (active/placebo) should have
taken place at each consultation as this would have given the researcher the
option to repeat
the simillimum if need be or to give placebo
treatment. This would have simply acted as a daily reminder of the research
being conducted which may have helped with overall compliance in the study. The
repetition of
prescription would negate the effect of life
stressors interrupting the study. The participants experienced great stress
over the research period, for example: examinations, marriage preparation,
pregnancy scares, crime and
others. All of which serve as interference to a
clear indication of the effect of homoeopathic simillimum.
Outcome measures
The use of a single outcome measurement tool was exceedingly limiting in
assessing the efficacy of the condition, especially since the questionnaire was
completed monthly post-menses and relied upon the participant’s recollection.
Participants were not always clear about the meaning of the different
categories of the questionnaire, which may have led to mis-information. The
researcher should have given clear definitions of the 66
categories in the pre-research
literature to prevent confusion with regards to meanings. In addition to the
MDQ the researcher should have elected to use a daily rating scale of symptoms.
The participants would then have completed a questionnaire daily and the
researcher would use the scores for the 7 days before the menstrual cycle to
indicate the premenstrual scores. The act of recording symptoms daily would
serve as a reminder that they are participating in a study and so would improve
compliance. It would also increase the accuracy of the results as the scores
are not based on recollection but at the time the participant experienced them.
The MDQ would still be
done at each consultation using the
scores for the 7-10 days before the menses. The use of a second outcome measure
would improve overall accuracy in recording efficacy of treatment.
Inexperience of the researcher
Implicit to the identification of the simillimum is the homoeopath.
Different practitioners vary in age, gender, expertise, experience and
approach. Thus the results of any trial involving the simillimum are as much an
evaluation of the practitioner as it is the modality (Bloch, 2002:59). Although
the researcher received clinical supervision, it must be noted that she is
relatively inexperienced. The relative lack of experience on the part of the
researcher may have accounted for the prescription of broader acting remedies,
such as Natrum muriaticum, because the case-taking skills of the
researcher were not as honed as an experienced homoeopath, and so the nuances
of smaller remedies would be missed during consultation. However, the remedies
prescribed during the trial were all well indicated based on the information
gained from the participant. In a homoeopathic case there is some information,
which is objective but the majority of the information is subjective or
qualitative which is where the homoeopath’s case-taking/counselling skills come
into consideration. The interpretation of the information gained is varied with
experience and skill level of the homoeopath. 67
Swayne (1998:41) and Scholten
(2002:825) state that the skill and experience of the individual homoeopath is
an important factor in determining the use of remedies, and application of the
simillimum method; consequently it will influence treatment outcomes. Even with
the inexperience of the researcher many participants noted an improvement in
general well being. Two of the women on active treatment noted a complete 180
degree turn around of symptoms with energy levels improving, sleep improving
and general motivation to improve their lives increasing. These improvements
were only noted during the month of treatment and not in the following
observational month. However the scores at the end of the trial were better
than at the beginning (only by a small margin).
PLACEBO EFFECT
Placebo is any therapeutic procedure (or component of therapeutic
procedure) which is deliberately given to have effect on, a symptom, syndrome
or disease, but which is without specific activity for a condition being
treated (Liggins, 2002). In this study the consultation itself is a placebo as
it brings about improvements non-specific to the complaint. Most of the
participants reported changes to their general well being other than that
relating to PMS irrespective of which group they were allocated to in the
trial. PMS has often reported high rates of positive response to placebo
(Freeman et al, 1999). The changes noted in both groups, even if not
statistically significant, did comply with the above statement. The act of
acknowledgement of PMS as a real complaint and the suggestion of receiving a
treatment for it was enough to cause a clinical change.
Placebo group
Sarawan (2001) found that in some aspects of his study the placebo
out-performed the complex. Kirtland (1995) found that in her study conducted to
compare placebo to homoeopathic preparation of Folliculinum 15CH, that the
placebo group only experienced a 7% improvement at the end of the trial in
comparison to the 89% improvement found in the Treatment Group. Intra-group
analyses revealed that concentration, autonomic response and appetite changes
all had significant improvement on placebo, which indicated a psychological
aspect of the condition. The case-taking process may account for the
improvements in the homoeopathic consultation, which allows the participants to
express themselves in a caring, quiet and empathetic environment, which causes
positive changes in their lives.
Treatment Group
If the therapeutic potential of the consultation played a role in the
placebo group there is a high likelihood that it had a possible influence in
the Treatment Group. Assuming this to be the case, the positive affects seen in
the Treatment Group could simply be due to the placebo effect, especially
considering how similar the overall changes were between the two groups.
Remedies most often prescribed in the research were: Natrum muriaticum, Carcinosin, Sepia officinalis and Calcarea carbonica.
Nat-m. (sea salt) was the most prescribed
remedy with 12 prescriptions being Nat-m.
of the total 39 prescriptions made up in the research. Of this group 6
completed the study. It was apparent that many of the women experiencing PMS
had to be “in control of themselves to protect themselves and keep their lives
together”. This is a common trend in Na-m.
women. Nat-m. women are
very sensitive and protect themselves by working through hurts and “walling
off” their feelings. Their bodies do not necessarily comply with this mentality
and, therefore, manifest physically what they refuse to manifest emotionally.
This occurs around the time of menses. Nat-m.
is averse to consolation or company and may have periods of involuntary
and hysterical weeping. Nat-m. is
also known for symptoms of water retention due to the very nature of sea salt
and its affiliation for attracting water. Some PMS symptoms experienced by Nat-m.:
Aggravation before menses
Involuntary and hysterical weeping
Depression
Headache before menses
Craving salt
Insomnia
Feeling trapped
Anaemia
Aversion to sex
Water retention
Fastidious
(Vermeulen, 2002:958-967)
Carcinosin was prescribed 4 times
out of the total 39 prescriptions. All 4 participants completed the study.
Sepia officinalis was prescribed 5 times
out of the total 39 prescriptions and of these, 4 completed the study and were
able to be used for statistical purposes.
Calcarea carbonica was prescribed 4 times
out of the total 39 prescriptions and of these, 3 completed the study.
CONCLUSION
There was an overall clinical improvement in both groups even though it
was not statistically significant. Therefore due to statistical parameters
homoeopathic simillimum was found to be ineffective in the treatment of PMS. 71
Vorwort/Suchen. Zeichen/Abkürzungen. Impressum.
Homö-opathi-kum |
Typ |
Zyklus |
Blut |
PMS |
Libido |
Sonstiges |
Ergänzungsmittel |
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Agn |
Deprimiert. erschöpft. frigide |
Hypo- + Oligo- |
Alle Variationen möglich |
Akne. Herpes. Mastodynie. depressive Verstimmung |
Abscheu vor Koitus |
Hautleiden + Zyklus- Steril infolge Gestagen- |
Phyt: Basilikum. Art-vg. Dam. Rosm |
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Apis |
hastig. hektisch. linkisch |
Amenorrhoe mit Nach-untenziehen. „Als ob Periode kommen wolle“ |
Meist hell mit Klumpen |
Unruhe |
Normal bis erhöht |
Hals + Bauch berührungs- |
Phyt: Hyper. Meli |
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Calc |
Fett. frostig. furchtsam. schlaff; oft blond |
Amenorrhoe (Regel zu früh. reichlich + lang) |
Membranös. intermittierend |
Mastodynie. Frost. Kopfschmerz. Kolik.
reizbar. Rücken- |
Schwäche nach Coitus |
Hypophyse- + Schilddrüs- |
Phyt: Art-vg. Fuc. Rosm. |
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Graph |
Fett. faul. frostig. frigide. verstopft |
A-. Hypo- + Oligo- |
wässrig. wund- |
Mastodynie. Fluor gussartig. Obstipation. Hautleiden |
Empfindungs- |
Hypothyreose. Hautleiden. Erkältlichkeit. Fettsucht. Anämie |
Phyt: Art-vg. Fuc. Lev. Rosm. |
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Mag-c |
Essstörung; Bulimie; launisch. erschöpft. empfindlich |
Hypo- (im Rücken) |
Dunkles Blut; braun. pechartig. klumpig. nachts |
Angina. Fresslust. Hautleiden.
Obstipation. Kopf- + Rücken- |
Verlangt Geborgenheit |
Folgen von FÜRsorge ( Heimweh);
Magen- |
Phyt: Basilikum. Meli. Sep |
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Nat-m |
Stress Kummer. verklemmt. oft magersüchtig |
Amenorrhoe (Notstand/ Flucht) Hypo- + Oligo- |
Membranös. Blass/ dunkel/dünn |
Alles schlimmer. Kopfschmerz. Depressiv/reizbar Trauer |
Schmerz beim Coitus |
Trockene Schleimhäute. Hitzeempfindlich Hyperprolaktinämie/-Hyperthyreoidismus |
Phyt: Basilikum. Dam.
Meli. Puls. Sep |
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Phos |
Furchtsam (Alleinsein. Gewitter,...). sensibel. leicht erschöpft. medial |
Amenorrhoe/Fluor statt Periode; Hypomenorrhoe. zu früh + zu lang; Zwischenblutungen |
Membranös; hellrot. wässrig |
Alles schlimmer vor der Regel; Harndrang. weinerlich |
auch Nympho- |
Leber- |
Phyt: Card-m. Meli |
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Puls |
Schwammig. frostig. launisch. weinerlich. oft blond. religiös; "Apriltag" |
A-. Hypo- + Oligo- |
Wechselt; blass. dick. braun. schwarz. Klumpig |
Depressiv/unruhig Stimmungs- |
Männer abgeneigt |
Wechselnde Beschwerden (Unterleib/Magen-Darm/Lunge) Akne bei Zyklusstörung |
Phyt: Art-vg.Fuc. Rosm. Hom: Agn. Calc. Graph. Phos. Hypophysis. Ovarium |
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