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Global Health Africa Decoded aims to demystify global health concerns, health systems, and policies for all healthcare beneficiaries in Africa.

Writer's pictureAchieng' Aling'

Failing Women: Oversimplification of PMS and its Far-Reaching Impacts

Updated: Aug 8, 2023



Introduction


Premenstrual Syndrome (PMS), often dismissed as an inconvenient fact of life, represents an overlooked global health issue. With more than 150 identified symptoms ranging from bloating to mood swings, PMS affects approximately 75% of menstruating women, according to the Office on Women's Health. Yet, our understanding and categorization of PMS is disappointingly rudimentary, often lumped into two broad categories: physical and psychological symptoms. This outdated and overly simplistic view fails to capture the complexity of the syndrome and leaves many women feeling dismissed and misunderstood. The urgent need for more nuanced research and a deeper societal understanding of PMS is evident.

Beyond Physical and Psychological – The Multifaceted Nature of PMS


The World Health Organization recognizes the complexity of PMS symptoms, yet we persist in our binary classification. This reductionist view doesn't reflect the individuality of women's experiences or the extensive symptomatology. By acknowledging the depth and breadth of symptoms associated with PMS, we can help those who suffer from it feel seen, heard, and validated.


It's clear that the experiences of PMS extend far beyond the realms of the physical and psychological. It also impacts women's relationships, productivity, and quality of life. Consider the woman who misses work each month due to incapacitating cramps or the mother struggling to manage mood swings while caring for her children. These stories highlight the significant societal and economic implications of PMS and underscore the need for a more comprehensive and nuanced approach to understanding and treating this complex syndrome.


The Environmental Equation – How Modern Living Influences PMS


Consider the effects of modern living on our bodies. We're constantly bombarded with a slew of toxins and pollutants from the air we breathe, the water we drink, and the food we consume. This relentless exposure has sparked concerns about the potential health implications, including its influence on hormonal balance and menstrual health.


Microplastics, for instance, are pervasive pollutants found in everything from bottled water to seafood. A study in Environmental Science & Technology noted that these tiny particles could release chemicals like bisphenol A (BPA) and phthalates, known endocrine disruptors, into our bodies. Could this constant exposure be exacerbating PMS symptoms? These compounds can mimic or interfere with the body's hormones, potentially contributing to menstrual irregularities and exacerbating PMS symptoms.


Furthermore, genetically modified foods (GMOs) have become a staple in many diets. While their long-term effects on human health are still under investigation, a study in the International Journal of Environmental Research and Public Health suggested a potential link between GMOs and endocrine disruption.


From a hormonal perspective, these environmental exposures could feasibly contribute to the severity and variability of PMS symptoms. Therefore, our categorization of PMS must evolve to include these considerations, guiding research into potential environmental interventions.


The Lifestyle Impact on PMS


Our environment and lifestyle have a profound effect on our overall health, including menstrual health. This influence extends from the air we breathe, the food we consume, to the stress we encounter in our daily lives. The advent of industrialization has led to increased exposure to various environmental chemicals, pollutants, and endocrine disruptors, like Bisphenol A (BPA) and phthalates, found in many personal care products that mostly target women.


In the realm of climate change, a less direct but nonetheless significant factor comes into play: dietary changes. With changing climate patterns, the availability and quality of certain foods are affected. This can lead to shifts in dietary habits, potentially impacting nutritional intake, which plays a critical role in hormonal balance and menstrual health. For instance, a diet low in calcium and vitamin D has been associated with more severe PMS symptoms.


In addition, the tangible stressors of climate change, such as extreme weather events, economic instability, and forced migration, undoubtedly affect our mental health. However, their impact may reach even deeper, possibly influencing hormonal balance and exacerbating PMS symptoms. The growing body of research linking stress and PMS underscores this theory. A study published in the Journal of Women's Health found a significant correlation between perceived stress and the severity of PMS symptoms. As the stressors associated with climate change mount, it's plausible to suggest that we may see an increase in PMS severity globally.


However, the relationship between these environmental and lifestyle factors and PMS symptoms is complex and remains under-researched. This further underscores the need for a comprehensive approach to understanding and categorizing PMS, taking into account the multifactorial nature of this condition. As we unravel these complex interconnections, we can develop more targeted strategies for managing PMS, improving the quality of life for countless women worldwide.

Genetic Predisposition, PMDD, and PMS - A Growing Field of Research


We're all unique, and our bodies react differently to internal and external factors. This individuality may explain why PMS symptoms and their severity vary so widely among women. It's a spectrum that even extends to a severe form of PMS known as Premenstrual Dysphoric Disorder (PMDD), which affects between 2 to 5% of women of reproductive age.


Recent research has started to uncover the complex interplay of genes and hormones that might predispose some women to more severe PMS symptoms or even PMDD. A study published in the Journal of Molecular Psychiatry identified specific gene variants associated with PMDD. These breakthroughs underscore the importance of genetic factors in our understanding of PMS and PMDD.


Furthermore, PMDD not only affects the individual but also has broader socioeconomic implications. Women with PMDD often experience significant impairments in work productivity, social functioning, and quality of life. The economic burden of lost work productivity and healthcare costs is considerable, underscoring the imperative to enhance our understanding and management of PMDD.


Moreover, epigenetic factors, which refer to changes caused by the modification of gene expression, might also play a role in how PMS manifests in different individuals. Changes in lifestyle, environment, diet, and stress levels can all influence epigenetic modifications.


Consequently, the broad categorization of PMS symptoms into physical and psychological compartments fails to consider these crucial genetic and epigenetic differences. There is an urgent need to incorporate genetic research into our understanding and treatment of PMS. Genetic profiling could potentially help predict symptom severity and guide more personalized treatments. By doing so, we can empower women to better manage their symptoms and enhance their overall well-being.


The Diet Factor - Food and PMS


We've all heard of the phrase "You are what you eat," but could our diet be influencing our PMS symptoms? Various studies suggest a correlation between dietary habits and the severity of PMS symptoms. For instance, a study in the journal Reproductive Biology and Endocrinology found that a high intake of dairy products and calcium was linked to a reduced risk of developing PMS.


Conversely, a diet high in sugar and fats might worsen PMS symptoms. A study published in the American Journal of Clinical Nutrition showed that women who consumed a diet high in thiamine and riboflavin from food sources had a significantly lower risk of PMS than women with low intakes.


However, the role of diet in PMS management is still a nascent field, warranting more extensive research. In an era where personalized nutrition is gaining momentum, could a tailored diet plan be the key to managing PMS symptoms? This premise poses an exciting prospect and underscores the need for a more nuanced understanding and categorization of PMS symptoms.


Broadening Our Perspective - The Urgent Need for Change


We must view the categorization of PMS symptoms as more than just a linguistic or academic exercise. It's about recognizing and validating the diverse experiences of millions of women worldwide. It's about shedding light on the multifaceted nature of PMS and empowering women with knowledge and solutions that match the complexity of their experiences.


As we move forward, let's ask ourselves: Can we continue to ignore the extensive and nuanced range of PMS symptoms? Can we afford to overlook the potential impacts of modern living, genetics, diet, and climate change on PMS? The answer is a resounding no.


It's time to broaden our perspective and deepen our understanding of PMS. We must rally for more extensive research, educate our societies, and ultimately, reclassify PMS symptoms in a manner that genuinely mirrors women's lived experiences. Doing so can create a future where PMS is no longer minimized or stigmatized but understood and effectively managed.


Dr. Achieng' Aling' is an obstetrician gynaecologist and global health professional with a strong focus on health system strengthening and menstrual health. Passionate about advancing global health, she is committed to knowledge sharing to drive positive change in the sphere menstrual health.

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