In mid 19th century the word Dysphoria originates from the Greek word
‘Dusphoria’ which means ‘hard to bear.’ Severe unhappiness, especially a person’s
feeling of being very uncomfortable in their body or of being in the wrong body. Premenstrual dysphoric disorder (PMDD), a severe mood illness that affects
millions of women globally, is characterized by cognitive-affective and somatic
symptoms in the week preceding menstruation.
According to ICD -11 Code GA34.41, in premenstrual dysphoric disorder a
pattern of mood symptoms (depressed mood, irritability), somatic symptoms
(lethargy, joint pain, overeating), or cognitive symptoms (concentration difficulties,
forgetfulness) that develops several days before the onset of menses, improves a few
days after the onset, and then diminishes or disappears about one week after the
onset of menses has been observed during the majority of menstrual cycles in the
past year.
In 2012, the American Psychiatric Association DSM-5 Executive Committee
received a review of the latest research on PMDD from a committee of international
experts on the pathophysiology and treatment of PMDD. The committee
recommended that PMDD be included as a full diagnostic category in the DSM-5.
According to recent epidemiological studies PMDD prevalence values
generally population between 2-8% worldwide.
The definite contributing factors of PMDD is still not clear, but some
documents and discoveries have helped to unfold few of the mysteries of this
disease. Deferent level of evidences variety of contributing factors to get a pathway
to explore the neumerous causes of the disease.
It is unknown to experts why certain people develop PMDD. Symptoms may
be brought on by declining estrogen and progesterone levels following ovulation
and prior to menstruation.
Another possible factor is serotonin, a brain neurotransmitter that controls
mood, appetite, and sleep. Similar to hormone levels, serotonin fluctuates during the
menstrual cycle.
Mitigating the physical and mental symptoms that adversely affect an
individual’s quality of life during the luteal phase of their menstrual cycle is the
main objective of treating premenstrual dysphoric disorder (PMDD). Strategies for
treatment aim to promote general well-being, improve everyday functioning, and
lessen the intensity and duration of PMDD symptoms.
In Homoeopathy the innermost core of philosophy allows treating patient on the
idea of individualization. Homoeopathy provides a holistic approach to the patient as it is solely based on the principles of similarity, simplicity, and minimalism.
Homoeopathy acts both as a preventive moreover as a curative mode of treatment
because it relies on the totality of prescribing symptoms regardless of the name of
disease.
JUSTIFICATION OF THE STUDY :
Premenstrual dysphoric disorder (PMDD) is the severe form of premenstrual
syndrome (PMS). Most young women have some degree of premenstrual issues,
particularly in the early years of their reproductive lives. According to
epidemiologic surveys, up to 80% of women of reproductive age report having
symptoms related to the premenstrual period of the menstrual cycle. According to
World Health Organization In India, almost one-fourth (27.7%) of the female
populace is between the 15-29 age bracket are more likely to experience depression,
anxiety, low self-esteem, and decreased vitality. This age represents a turning point
in life linked to a surge in social, mental, emotional, and physical growth. Despite
of conventional treatment with Antidepressent called SSRIs (selective serotonin
reuptake inhibitors) and Contraceptive pills they are having various side effects
including anxiety, dizziness, insomnia, sedation, nausea and headache. Large
population of female of reproductive age group are visiting Mahesh Bhattacharyya
Homoeopathic Medical College, with many of them are suffering from PMDD. The
incidence of PMDD is drastically increasing due to stress, anxiety, work load, socio
economic status, sedentary lifestyle and irregular food habits. Kent repertory is
being used because of its ample content of general rubrics along with medicines, its
ingenuity easy accessibility and usefulness worldwide.
Premenstrual Dysphoric Disorder is an example of a disorder that lacks a particular
targeted therapy in conventional medicine. Homoeopathy has been a popular choice
among the patients for the treatment of such illnesses. Unfortunately, there haven’t
been substantial evidence of research published on Premenstrual Dysphoric
Disorder , which justifies our quest to work on this topic,
➢ A case report published in PubMed titled with “Semi-standardised
homeopathic treatment of premenstrual syndrome with a limited number of
medicines: feasibility study†on July 2010; showed With help of an expert
panel, 11 homeopathic medicines were selected, as well as predictive
symptoms and characteristics (keynotes) for each medicine for treatment of
PMS. The medicines selected (in rank order) were Sep, Nat-m, Lach, Cimic,
Lac-c, Puls, Calc, Lil-t, Mag-p, Mag-c, Phos. 33 patients completed 3 months
follow-up. Premenstrual symptom scores dropped by 50% or more in 12
patients and by 30-50% in 6 patients; scores dropped by less than 30% or
increased in 12 patients.
➢ Effects of homeopathic treatment in women with premenstrual syndrome: a
pilot study showed the efficacy of homeopathic treatment in relieving
symptoms associated with premenstrual syndrome (PMS). Two months
baseline assessment with post-intervention follow-up for 3 months was
conducted at Hadassah Hospital outpatient gynaecology clinic in Jerusalem in
Israel . The subjects were 20 women, aged 20-48, suffering from PMS.
Homeopathic intervention was chosen individually for each patient, according
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to a model of symptom clusters. The main outcome measure was scores of a
daily menstrual distress questionnaire (MDQ) before and after treatment.
Mean MDQ scores fell from 0.44 to 0.13 (P<0.05) with active treatment, and
from 0.38 to 0.34 with placebo (NS).Improvement >30% was observed in
90% of patients receiving active treatment and 37.5% receiving placebo
(P=0.048). Homeopathic treatment was found to be effective in alleviating the
symptoms of PMS in comparison to placebo.
➢ Another study published in ‘Thieme Homoeopathy’ e-journal titled with “A
Placebo-Controlled Double-Blind Randomized Trial with Individualized
Homeopathic Treatment Using a Symptom Cluster Approach in Women with
Premenstrual Syndrome†in August 2019 showed that in an outpatient
department of a university clinic in Jerusalem, Israel (1996–1999), women
with PMS, aged 18 to 50 years, entered a 2-month screening phase with
prospective daily recording of premenstrual symptoms by the Menstrual
Distress Questionnaire (MDQ). A total of 105 women were included. 43
women in the active medicine group and 53 in the placebo group received the
allocated intervention with at least one follow-up measurement and their data
were analyzed. Significantly greater improvement of mean PM scores was
measured in the active medicine group. Individually prescribed homeopathic
medicines were associated with significantly greater improvement of PM
scores in women with PMS, compared to placebo.
A combined analysis of all of these research yields a good result demonstrating
the potential of homoeopathic medications to cure PMDD; in addition,
investigations have revealed that homoeopathy has played a significant role in
improving patients’ quality of life. To further understand the extent and limitations
of homoeopathic medications in the treatment of PMDD, more high-quality,
unbiased observational studies are needed. Patients commonly attend to Mahesh
Bhttacharyya Homoeopathic MedicalMCollege and Hospital’s OPD and IPD with a
variety of gynaecological conditions, and utilising the available infrastructure it
could be an ideal set up for this study.
RESEARCH QUESTION:
• Does individualized homoeopathic medicine is efficacious in treating
premenstrual dysphoric disorder?
HYPOTHESIS:
NULL HYPOTHESIS (HO):
• There is no role of individualized homoeopathic medicine in the treatment of
premenstrual dysphoric disorder.
ALTERNATIVE HYPOTHESIS (HA):
• Individualized homoeopathic medicine has significant role in the treatment of
premenstrual dysphoric disorder.