Hormonen Anhang P.M.S.

 

[Carrie-Ann Laister]

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 praemenstruum 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

Dysmenorrhea, change in bowel habits, frequent urination, hot flushes or cold sweats, general aches or pains, nausea, acne, allergic reactions, upper respiratory infections

           

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

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.

Carcinosin

 

4

Sepia officinalis

4

Calcarea carbonica

3

Arsenicum album

2

Natrum muriaticum

6

Ignatia amara

2

Sulphur

1

Nux vomica

1

Silica

1

Phosphorus

1

Pulsatilla nigrans

1

Lachesis mutas

1

 

 

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.

Natrum muriaticum (sea salt) was the most prescribed remedy with 12 prescriptions being Natrum muriaticum 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 the Natrum muriaticum women. Natrum muriaticum 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. Natrum muriaticum is averse to consolation or company and may have periods of involuntary and hysterical weeping. Natrum muriaticum 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 Natrum muriaticum:

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.