The Unspoken Malady

THROUGH with every other article conceivable on premenstrual syndrome (PMS), a British glossy splashed yet another cover on the subject: 'Tips to Help Men Cope with PMS'! Stretching the story too much you think? There's more. An episode of popular American serial Picket Fences actually had the judge pardoning a murderer because she committed the crime while suffering the agonies of PMS! Yes, the West does seem to have been overindulging in the subject for the last 10 years at least—spilling out with medicines, feel-good creams, therapies, counselling techniques, books, support groups on the Internet to cope with PMS. In fact, the syndrome that manifests itself both with physical and psychological symptoms beginning anywhere between two to 14 days before menstruation, is at the centre of a controversy in the West with some advocating it be categorised as a clinical disorder and others defining it as a bio-psycho-socio disease.

Back home, however, there's little controversy on the subject. Little hype. Little awareness. And now, a recently launched little pill called Efarelle, the first natural product to help Indian women cope with the pangs of PMS. Developed by the Dabur Research Foundation and currently marketed as a "nutritional supplement for PMS", the capsules will be available to women off the counter without prescription. At last there's an option for women shy of allopathy.

"Research has shown that the lack of Gamma Linolenic Acid (GLA), an essential fatty acid which is not manufactured by the human body, causes PMS. The richest source of GLA is an oil extracted from the seeds of Evening Primrose flower: and Efarelle contains this oil," says D.B.A. Narayana, deputy general manager at the Dabur Research Foundation. Narayana emphasises that the capsule is not a mere problem solver but a preventer of the PMS pains.

Whether the capsule delivers the relief it promises remains to be seen, but it certainly is a step forward in helping thousands of women in the country who have silently been suffering the PMS, some without even understanding it.

"Many callers describe the depression and pain they go through before they menstruate without quite knowing that there is a medical term for their suffering," says Radhika Chandiramani, director of a Delhi-based sexual health helpline called Tarshi. These callers are then given "practical tips" like going slow on sugar and reducing stress among others on coping with PMS. "We advise professional help only when callers complain of severe physical symptoms or become dysfunctional," Chandiramani says.

Significantly, over 150 symptoms have been attributed to PMS. The most common complaints, according to expert claims, however, are feeling "out of control", anxiety, depression and having uncontrollable crying spells, followed by headache and fatigue. Symptoms may vary month to month and there may be symptom-free months. Though years of research has revealed that about 40 per cent of women suffer from these marked mood and behavioural changes and physical distress, the exact cause of PMS is still unknown. Why some women suffer severe PMS symptoms, some mild, while others have none has still not been explained.

It is generally believed that PMS, migraine and depression stem from neurochemical changes within the brain. Hormonal factors such as estrogen levels had not been appreciated until recent studies. The female hormone estrogen starts to rise after menstruation and peaks around mid-cycle during ovulation. It then rapidly drops, only to slowly rise and then fall again in the time before menstruation. Estrogen holds fluid and hence the increase in water retention and weight gain. And because the hormone has a central neurological effect, it can contribute to increased brain activity and even seizures.

"I feel so unwanted during the PMS phase. I know it's PMS and yet my tears seem out of control. The slightest teasing by my brother, one harsh word by a colleague in office...just about anything can start me sobbing. It's most embarrassing but it's uncontrollable," says Uttama Dasgupta, 26-year-old teacher at a private music school in the Capital. At 30-something and after two children, housewife Rachna Gupta complaints of excruciating pain in her upper thighs and her stomach before her menstruation. "The pain drives me crazy and I become irritable. Snapping at my children, hollering at the domestic help and picking up fights with my in-laws," Gupta observes.

Despite their intense suffering, neither of the two women have gone to the doctors for a cure. Delhi-based neuropsychiatrist Dr Avdesh Sharma, who presents Mind-watch, a serial dealing with psycho-social problems on Doordarshan, doesn't find it surprising: "All problems regarding periods are—even in the metro-culture—perceived as part of a monthly punishment that is a woman's lot. It is something that women talk about amongst themselves. Perhaps because the very first bit of information

about menstruation is handed down to them by their girlfriends or mothers and by teachers or doctors." Gynaecologist Alka Dhal's professional experience leads her to believe that PMS is underrated as a problem till it manifests itself as physical pain. "Mostly it's mothers bringing in daughters because severe pain causes absenteeism in school," the doctor says.

And even in these cases, many seem to be coping with the situation by popping painkillers indiscriminately. Says Dr Achal Bhagat, psychiatrist at Delhi's Apollo Hospital: "Self-medication up to a point is okay but if PMS is manifesting itself as recurring depressive disorder then it has to be treated through prescribed medicines. It has to be seen as something that might not be curable but is definitely preventable."