Premenstrual Syndrome is a frequent topic raised in the family planning and sexual health clinics where I work. A client is very often well-read on the subject. ‘I have the most dreadful PMS’ she will say, ‘and I’ve tried all the vitamins and diet supplements they recommend. Can I be referred to a specialist for hormone treatment?’ Sometimes it turns out that, in fact, she has not tried the simplest changes of routine such as taking small frequent, starchy meals or limiting her salt and caffeine intake. Sometimes there appear to be problems in her life which are not related to her PMS, but her premenstrual condition may be held responsible. However, the reverse is more likely to be true, her PMS symptoms are probably exacerbated by the stress in other areas of her life.
In contrast, other clients are like the young Somali mother attending clinic for a check of her intra-uterine device. She was very intelligent and a expressed her anxieties in perfect English. ‘This coil is making me put on weight and is giving me headaches’, she said ‘and it makes me so irritable – I get cross with my little boy when he hasn’t really been naughty and then I cry. It is unlikely that the coils was the source of these particular symptoms. In fact the scales showed that her weight had not changed. She thought that had because she felt so bloated, but not all the time. On questioning her about her headaches, she realised that they only happened just before her period started. She found keeping a menstrual diary extremely tedious and out of character, but it did convince her that her complaints arose every month within the four days before her period. She had a marked Premenstrual Syndrome, but had not recognised it as such.
Cultural and ethnic communities
In Southall, where I work, the wide range of races and cultures represented is unusual even for London. The population includes Polish, Irish, Greek, Armenian, Ukranian, Punjabi, Gujerati, Bengali, Pakistani, Afghani, Caribbean and Chinese as well as people from all parts of Africa and South America. Even the staff speak at least 14 separate languages and belong to eight different major religious groups. We are well aware that cultural differences affect attitudes towards contraception and the menopause. There are evsen physical characteristics that need to be considered. To give one example, women of central and southern African origin rarely suffer from severe post menopausal bone loss. Another example is that certain racial groups may be prone to inherited blood disorders which affect the way they react to some drugs. However it had not occurred to me until recently that there might be significant ethnic/cultural differences in women’s experience of PMS.
Cross-cultural prevalence of PMS
Although there have been no scientific studies, we can attempt to look at some of the questions that arise. I have begun to ask opinions from clients and staff including as many different cultural backgrounds as possible. What has already emerged is that PMS is universal. Don’t believe anyone who says that women in Asia or Africa do not experience it. Many of them do but, like the Somali mother, they may not recognise it or they may feel that the symptoms are part of a woman’s lot. If nothing can be done, why complain? They may be unwilling to confide in a male doctor about something so vague yet so personal. This appears to be a common feeling, whether in rural Ireland or in Punjab. Stress makes the mood change in PMS less easy to bear so, for some refugees, it only becomes a problems when they find themselves in hostile environment.
Remedies and treatments
On questioning colleagues and clients on the subject, it appears that certain remedies are used in different communities. West African women used to use purgatives, whereas Asians can choose from several vegetable dietary supplements such as linseed, which has oestrogenic effect and is thought to ease bloating and depression, anjwan (carom ) seeds which have an antispasmodic (possibly an antiprostaglandin) effect, or onion seeds. The Chinese have used the herbal remedy dong qui, which is now most often taken in liquid form and ginseng root, which is known to have an oestrogenic effect. It would be interesting to find out about the native American and South American experience.
People who have ethnic origins in Asia and Africa seem to be ready to adopt their own traditional measures or complementary therapies such as acupuncture and homeopathy. Homeopathic practitioners point out that their treatment of PMS is directed by the profile of the individual regardless of ethnicity. (They probably use several treatments, for instance, natrum muriaticum or pulsatilla, taken from a number of treatments in their pharmacopoeia, but the choice of these would vary according to personality) However different countries show differences in prescribing habits, which could reflect practitioner bias but, equally, may show different cultural influences at work.
Social and religious factors
Fasting is a vexing issue. Many traditional therapists accept that taking small frequent, starchy meals can improve PSM. But what is the effect of fasting for example during Lent and Ramadan especially if the latter falls during the summer and devout Moslems are requested to fast during the hours of daylight?
Menstruating women, as well as those who are pregnant or breast feeding are exempt from religious fasting, so extending the time of exemption to include premenstrual signs could prevent undue stress.
Two close distinctive patterns emerge from this overview. One is that there appears to be a universal trend to resort to seeds, roots and other plant foods containing ingredients which act like female hormones. The other is that there is an established idea that the flow of menstrual blood is purifying as some traditions hold that it rids the female body of noxious substances. It is suggested that, like the ancient Greek system, which has had an influence on medicine in Europe and Asia, menstruation is needed to restore the natural balance of humours, qualities or energy flow. Unpleasant symptoms or antisocial behaviour experienced by a premenstrual woman must be due to a build-up of toxic substances or blockage causing imbalance. As a result, many traditional PMS remedies such as an elixir of dock root, popular in early modern Britain, are intended to ‘cleanse the blood’. Regardless of the treatment used, the variety and origin of remedies clearly shows that PMS is a condition acknowledged, openly or covertly, across the cultural spectrum.
Jeanette Cayley MSc MB Bs MFFP
Member of the Institiute of Psyschosexual Medicine