CAM311A: Detailed Clinical Study and Analysis of PMS Symptoms

This report presents a clinical study on Premenstrual Syndrome (PMS), focusing on a case study approach. It includes a mind map outlining a holistic approach to the condition, acknowledging its impact on physical, mental, and emotional health. The report delves into the biomedical understanding of PMS, exploring etiological factors, differential diagnoses, and detailed analysis of diet, examination, and investigations. Treatment aims, both short-term and long-term, are outlined, including prescription recommendations such as dietary changes, exercise, and medication. The report considers various aspects of the patient's condition, including family history, psychological health, and medical conditions, providing a comprehensive analysis and proposing a multi-faceted approach to managing the symptoms of PMS. The study suggests a combination of lifestyle modifications, nutritional supplements, and, where necessary, pharmaceutical interventions to improve the patient's quality of life.

Running head: A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
Student Name
University name
Student Notes

1A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
MIND MAP

2A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
HOLISTIC APPROACH
Premenstrual syndrome is a very common condition that occurs in women, which affects the
overall physical, mental and emotional health, before the commencement of her menstrual
period. This has been known to affect almost 80% of the menstruating female population.
The typical duration of this disease can range from five to eleven days before menstruation.
During this period of time, women tend to show symptoms like extreme irritability, anxiety,
bloating, abdominal pain, food cravings, depression, emotional outbursts, and constipation or
diarrhea (El‐Gizawy & O'Brien, 2018).
She (Tayna) is found to be irritable, stressed, and anxious over trivial things, which is mainly
caused by the increase in the level of progesterone and estrogen, during the time of ovulation.
Thus, a holistic approach towards this condition would be the monitoring of diet plan of the
person, physical exercise regime and incorporating other lifestyle changes. Dietary intake
should have enough iron and calcium content. People suffering from hypertension have been
seen to have a tendency to suffer from Premenstrual syndrome, thus they are often advised to
reduce their intake of food items with high fat and sodium content (Farasati, 2018).
BIOMEDICAL UNDERSTANDING
Even though researches indicate that this condition is mainly triggered by the increase in the
levels of the hormones like progesterone, prolactin and estrogen, the definitive and
conclusive cause of the disease is unknown. Serotonin is believed to affect the hormonal
changes leading to severe mood swings. It is also believed that abnormal ovarian functions
are behind the symptoms of PMS instead of deviation of hormone levels in the body. Some of
the recent research papers provide different etiological factors like serotonin deficiency,
magnesium and calcium deficiency, increased levels of endorphins, hyppoprolactinemia, and
alterations in the GABA system (Yonkers, O'Brien & Eriksson, 2008).

3A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
The most effective way to diagnose this medical condition, is to record the premenstrual and
menstrual pattern of the individual. The patient would also need to document the duration of
the premenstrual syndrome symptoms to help monitor her condition as well as thoroughly
understand the reason behind it (Hofmeister & Bodden, 2016).
In case of Tanya, the etiological factors include her extensive family history of hypertension,
ovarian cyst, diabetes type II, and bowel cancer, psychological health – anxiety, depression,
mood swings, irritability, and also medical conditions like hypertension, and diabetes.
Symptoms like severe muscle cramps in her lower abdomen can be due to the high levels of
leukotriene in the menstrual blood. Her cramps can also be caused by the vasoconstrictions of
the endometrial vessels by increased production of prostaglandins in the body (Hapangama &
Bulmer, 2016).
DIFFERENTIAL DIAGNOSIS
Before confirming that Tanya was suffering from premenstrual syndrome, the differential
conditions that should be considered include dysmenorrhea, hypothyroidism, irritable bowel
syndrome, inflammatory bowel disease, urinary tract infection, pelvic inflammatory disease,
endometriosis, ovarian cyst formation and even depression (Rue & Kim, 2015).
According to Dr. Abraham’s classification, considering the symptoms portrayed by Tanya
she can be considered to fall under PMS –A (A= anxiety) as well as PMS-C (C=
carbohydrate craving).
PMS-A: She is anxious and irritable. This is considered to be strongly linked with increased
levels of estrogen and reduced levels of progesterone.

4A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
PMS-C: She has also been seen to portray severe carbohydrate cravings like her increased
chocolate and fried food intake. The reason behind this symptom is linked with decreased
prostaglandin levels, and amplified hormone regulation due to the surge in insulin binding.
Differential Diagnosis Evidence to support Dx
Dysmenorrhea Painful menstruation, cramps, heavy periods, diarrhea,
and fatigue (Morrow& Naumburg, 2009).
Endometriosis Pelvic pain, excessive bleeding, bloating, fatigue,
diarrhea, abdominal cramps, emotional distress
(Lemaire, 2004).
Ovarian cysts Lower abdomen pain, bloating, and hormonal problems
(Jermy, Luise & Bourne, 2001).
Irritable bowel syndrome Depression, diarrhea, bloating, cramping, and
abdominal pain (Hungin et al., 2005).
Inflammatory bowel disease Abdominal stools, diarrhea, nausea, and abdominal
cramps (Haplin & Ford, 2012).
Urinary tract infection Fatigue, pain and pressure in lower abdomen, nausea
and fever (Sheffield & Cunningham, 2005).
Pelvic inflammatory disease Pain in lower abdomen and pelvis, bowel discomfort,
and nausea (Peipert, 2001).

5A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
ANALYSIS OF DIET
The dietary factors can play an important role in PMS. For an adult belonging to the age
range of 20 – 60 years, 1.5 -2 liters/ day is the ideal water intake. Thus, Tanya has been seen
to drink enough amounts of water daily, given her age and weight, which can help her with
her digestion, but also reduce her abdominal cramps and bloating. Considering her daily meat
intake, her average protein intake of 68g/day, this can lead to inflammation. Thus, Tanya
needs to incorporate more lean meats like fish, egg and lesser red meat or processed meat
items. However, the increase in the iron intake can also reduce the menstrual cramps and
other symptoms. She usually incorporates cereals like brown rice in her breakfast, which can
help boost the serotonin levels in the brain, decrease of which can trigger emotional
abnormalities like irritability, depression and anxiety.
She has been observed to consume dairy products in large quantities, thus more calcium
intake can decrease the severity of the symptoms of Premenstrual syndrome.
She is observed to religiously eat fruits and vegetables 2-3 times and 3-4 times a day,
respectively. These are rich in vitamin B, iron and fiber, which can help with her lethargy.
Before and during her menstruation, she has been noted to have extreme food cravings and
seen to eat loads of dark chocolate and ice creams daily. She has been seen to drink white
wine daily, which is considered as one of the risk factors for this condition.

6A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
ANALYSIS OF EXAMINATION AND INVESTIGATIONS
Observations Sources
Slight abdominal tenderness Premenstrual syndrome is known to cause lower abdominal
cramps and tenderness,
Fingers and hands feel cold
Considering that Tanya is suffering from Premenstrual
Syndrome, she is experiencing increased blood loss due to
heavy menstrual flow, which starts from day 2. This can cause
anemia and also cause a deficiency in the iron content of the
blood. Tanya might be suffering from hypothyroidism, which
can lead to slower metabolism rates and an overall drop in the
body temperature (Stöllberger et al., 2001).
Tongue thin, pale, covered in strawberry
spot.
Nails: wears fake nails but advised strong.
Hair: quite oily around the time of her
period
The condition of her tongue either suggests an allergic reaction
or might be due to vitamin deficiency. However, in her case it is
most likely to be due to low vitamin intake, mainly low vitamin
B-12 levels in her diet (Erriu et al., 2016). This can also be due
to the inflammation caused by the increased consumption of red
meat.
Nails are healthy indicating sufficient amount of calcium intake.
Hair becomes oily, due to the increase in the levels of estrogen,
which in turn triggers oil secretion in the body (Nikam, Chavan
& Sharma, 2014).
Investigations and examinations
LDL
The optimal low-density lipoprotein level is less than 2 mmol/L
(Department of Health & Human Services, 2018).
Tanya’s LDL has been recorded 2.7 mmol/L, which can be due
to her being on the verge of being overweight and because of
her increased intake of fried and sugary food items.

7A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
BP
Tanya’s blood pressure reading is 129/85mm/Hg, which
indicates a slightly higher blood pressure. Vitamin D can be
prescribed to maintain normal cardiovascular function and
blood pressure. Thus, reducing hypertension can help in
improving the muscle health and thus reducing muscle cramps
(Mehta & Agarwal, 2017).
Anthropometrics
BMI Tanya’s BMI reading suggests a healthy weight (Nrv.gov.au,
2019).

8A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
TREATMENT AIMS
Four Short Term Treatment Aims:
PRI
ORI
TY
WHAT/
GOAL
WHERE HOW OUTCOME ACTION MODALITY
1 Diet
control
Digestive
system
Plan a nutrition
intake chart.
Follow the chart
properly.
Better
digestive
health and
sleeping
pattern.
Nutritive Food,
vitamin
supplement
s like
Vitamin
B6, calcium
and
magnesium,
nutrition
supplement.
2 Balance
mood
Endocrine
Reproductiv
e and
Nervous
system
Supporting
GABA
neurotransmitte
rs to balance
HPA axis.
Reduce cortisol
levels.
Stress coping
activities.
Anxiety
prevention,
Stable
emotional
state,
improved
stress.
Nutritive
Relaxant
Herbal
medicine,
Vitamins,
food in
medicine,
lifestyle and
stress
coping
activities
3 Improve
sleep
NS Increase
precursors of
neurotransmitte
rs
Restorative
sleep to
increase
energy
levels and
prevent
fatigue
Sedative
Nutritive
Vitamins
supplement
s like
Vitamin D,
Iron, and
stress
coping
activities,
and
lifestyle,
education.

9A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
4 Decrease
discomfort
or pain.
Decrease
inflammati
on.
Reproductiv
e
Nervous
system and
GIT
Prevent alcohol
consumption.
Analgesics to
relieve pain.
High meat
decreases
inflammation.
Reduce
prostaglandin
Reduced
tenderness
in lower
abdomen.
Reduced
inflammatio
n and
bloating.
Reduced
menstrual
pain.
Hormon
al
modulati
on, anti-
inflamm
atory
Nutritive
Herbal
medicines,
nutrient
supplement,
vitamins
like
Vitamin
D,E and
magnesium
, Food in
medication.
Lifestyle.
One Long Term Treatment Aim:
PRIORIT
Y
WHAT/
GOAL
WHERE HOW OUTCOM
E
ACTIO
N
MODALITY
1 Physical Exercise,
Blood glucose
reduction,
Maintain TSH
levels and routine
HbA1C tests to
detect Diabetes.
Systemi
c
Physical Improve
her physical
health and reduce
the severity of her
menstrual
symptoms.
This will also
maintain her
blood glucose
levels, and can
help with
reducing her
symptoms of cold
hands and feet.
TCM along with
acupuncture can
be used to help
maintain the body
temperature by
the proper
regulation of
Better
digestive
health and
sleeping
pattern.
Lower
blood
glucose
levels,
leading to
the lower
susceptibi
lity to
different
diseases.
Nutritiv
e
Aerobic
exercises
like
walking and
jogging,
nutrition
supplement.

10A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
blood.
PRESCRIPTION
To balance her mood by modulating the HPA axis and providing GABA with cofactors like
glutamine, in order to support the GABA neurotransmitters (De Bondt, 2015). Selective
serotonin reuptake inhibitors (SSRIs) can help significantly reduce her depressions and
anxiety (Dimmock, 2017).
Considering her daily meat intake, especially the increased amount of red meat, contributes to
the significant increase in the average protein intake of 68g/day, which can lead to
inflammation. Thus, Tanya needs to incorporate more lean meats like fish, egg and lesser red
meat or processed meat items.
Upon testing her oral glucose tolerance test showed a reading of 15mmol/L, when the normal
is 7.8mmol/L. this indicates that she has diabetes. This abnormal reading suggests that the
body is susceptible to trauma, increased stress and even stroke.
For the pain and cramps in the lower abdomen, medications like diuretics, analgesics, oral
contraceptives can be prescribed (InformedHealth.org, 2013).
Diuretics can help reduce the excess fluid in the kidneys and relieve the individual from
symptoms like bloating, increased food cravings and swelling (Wang, 1995).
The most effective and holistic approach towards this disease includes dietary changes,
physical exercise, and mental support from family and friends (Dickerson, Mazyck & Hunter,
2003). Tanya can be recommended the Traditional Chinese methods including not only
dietary changes, but also regular exercising, massages and acupuncture, to ensure increased
in the release of endorphins which help reduce the pain in the body. TCM also has a

11A CLINICAL STUDY ON PREMENSTRUAL SYNDROME (PMS)
significant effect on the serotonin levels present in brain, which can be used to regulate
positive mood change (Coutaux, 2017).
Tanya’s BMI was recorded to be 23, which is on the verge of being overweight. Thus, she
should avoid eating excessive sugary and fried food items as well as reduce the amount of
alcohol consumption, as these can aggravate the symptoms further and cause severe
discomfort. Thus, to reduce the severity of the cramps and other symptoms, intake of low-fat
diets is to be done (Houghton, 2017).
Studies show that supplements like vitamin C, D and E, as well as magnesium and calcium
and carbohydrate supplements can help reduce the severity of the symptoms, where the most
effective is calcium supplements (Bendich, 2000).