Sikh Women's Health Initiative

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are conditions that many women experience in the days before their menstrual period. There is a range of physical and emotional symptoms, from mild to severe. Understanding these conditions and how they might affect you is important for managing them effectively.

What Are PMS and PMDD?

PMS: symptoms that can happen in the days before your period starts. These can include mood swings, irritability, anxiety, depression, bloating, breast tenderness, and headaches. They are uncomfortable but usually manageable for most women.

PMDD: more severe form of PMS. The same symptoms may be more intense in PMDD and interfere with daily life. Also, PMDD can have more emotional symptoms that may be more extreme.

Symptoms to Watch Out For

• Physical Symptoms: Bloating, breast tenderness, headaches, fatigue, changes in sleep patterns, changes in appetite.
• Emotional and Behavioral Symptoms: Mood swings, anxiety or tension, irritability or anger, feelings of sadness or hopelessness, tension, difficulty concentrating.
• Both PMS and PMDD can cause the physical symptoms, but in PMDD, there is at least one emotional/behavioral symptom.

Symptoms usually start 1-2 weeks before your period and go away a few days after it begins. If you notice that your daily activities or relationships are affected, it may be more than just simple PMS.

Unique Considerations for Punjabi and Sikh Women

There are cultural, familial, and lifestyle factors that might impact your experience of PMS or PMDD.

1. Cultural expectations and family dynamics: In many families, women often carry the responsibility of managing the household, caring for children, and cultural traditions. This can increase stress, which can make PMS/PMDD symptoms worse. Also, talking about periods openly is not done in most families, so women can sometimes suffer in silence.
2. Diet: Traditional Punjabi diets have a lot of carbohydrates, dairy, and spices. These foods can nourish you, but they can also sometimes make symptoms (like bloating) worse. Before and during periods, it is very important to also eat fruits, vegetables, and whole grains, which can help with symptoms.
3. Stress related to immigration and culture: Immigrants may have more stress from adjusting to a new culture, language problems, or feeling isolated from extended family and community. These stressors can worsen the emotional symptoms of PMS or PMDD.
4. Religious and cultural responsibilities: Community and religious involvement is central to many women’s lives in our community. But, the expectation to be fully involved, even if you don’t feeling well, can add to the pressure women face. It is very important to prioritize taking care of yourself and know when it is okay to step back for your health.

What Can You Do About It?

1. Have open communication in a way that makes sense:
   • Choose the right moment: Start by finding the right time and setting to talk about what you’re going through to someone you trust. It might be easier to have these conversations when things are calm, maybe over a cup of cha or during a quiet moment at home. Explain how your symptoms are affecting you and focus on how managing them better can also help you keep supporting the people around you.
   • Involve key family members: See who might be more supportive, such as your spouse, sibling, or parent. They can convey your needs to others in the family and support you when you need a break. Sometimes, just telling people who love you that you’re going through something can help them start to understand.
   • Use cultural references: Have the conversation in a way that makes sense to whoever you’re talking to. For example, you might say that taking care of your menstrual health helps you fulfill your family responsibilities by being there for others, or allows you to actively be part of religious activities.
2. Use stress management strategies:
   • Mindfulness and meditation: Most of us know about meditation with practices like Naam Simran (repeating the name of God). Try to add mindfulness or deep breathing exercises – this can reduce stress and manage symptoms. Even 5-10 minutes can make a difference!
   • Find support in your circle: Connecting with other women who might be going through the same experience can be very helpful – even just to share how you feel and share ways that others deal with the same thing. Try joining up with women you trust (Gurdwara community members, friends, family, etc).
   • Avoid or reduce stressful/emotional triggers: If possible, try to avoid or reduce activities that cause stress or emotional problems, especially arguments or discussions about topics that may be difficult for you (finances, relationship problems, family issues, religious problems, community conflict, etc).
   • Physical activity: Do regular physical activity that fits your lifestyle. This could be a morning walk, yoga, or even dancing to your favorite music at home. Physical activity is very important to help with some symptoms of PMS and PMDD and is also very helpful for mood.
3. Diet and lifestyle changes
   • Regular exercise: can manage PMS symptoms (mentioned in Tip #2)
   • Reduce caffeine use, alcohol, and smoking: can help reduce PMS/PMDD symptoms
   • Proper sleep: important for PMS/PMDD symptoms
4. Prioritize self-care during your responsibilities
   • Take small, manageable breaks: If you are responsible for taking care of elders, children, and the house, it can be hard to find time for yourself. Start with small breaks. Even 10 minutes of quiet time alone, a short walk, or listening to your favorite music can help lower stress.
   • Delegate work when possible: Look for ways to share tasks, even if temporary. If you live with family, you can explain that you might need more help some weeks. For example, older children may help with small chores, and elders might help with light activities or watch young children while you step away for a moment. This can lower your load, especially during difficult days.
   • Incorporate self-care into your daily routines: Try to include self-care into your existing routines. For example, while driving, do deep breathing or paath; or while cooking, practice “mindfulness” by focusing on colors, smells, and textures of ingredients. This can make routine tasks feel more like breaks and help lower stress, instead of adding to your long list of work.
5. Balance your social or community obligations when you are having difficult symptoms:
   • Be flexible: If taking part in religious or social activities is overwhelming during certain times, let yourself step back or participate in a way that feels manageable. You can always be fully involved when you feel better, but it doesn’t need to be all the time.
   • Care for yourself: Remember, taking care of your health is also a form of honoring your body, which is deeply respected in Sikh teachings.
   • Educate and engage your circle: Over time, you can gently educate people around you about PMS/PMDD symptoms, to help to make a more understanding environment. When more people are aware of these issues, it can get easier for women to speak up and find support when they need it.
6. Talk to your doctor if you are experiencing PMDD – there are treatments available for these difficult symptoms.
   • Birth control pills: can help reduce physical and emotional symptoms.
   • Antidepressants: there are many different types that work well. Taking them all month or only for a short time each month can reduce fatigue, emotional symptoms, food cravings, and problems with sleep.
   • Supplements and herbal remedies: these are not regulated by the Food and Drug Administration. Calcium, Vitamin B-6, Magnesium, and L-tryptophan can help with overall symptoms. Chasteberry (Vitex agnus-castus) may help with some physical and emotional symptoms. Before starting anything, talk to your doctor, especially if you have other health issues or take other supplements or medications (including over-the-counter), to make a safe decision.

Final Thoughts

PMS and PMDD can be hard to deal with, but understanding the conditions and their effect on your life is the first step to manage it. Balancing cultural, family, and personal needs can make it harder. But, you can take control of your health by talking openly about your symptoms, finding help, and making mindful lifestyle choices.

Self-care, managing stress, and having open communication are important, especially because women in our community may feel responsible for everyone around them. Please remember that your health is important not just for you, but so you can be there for your loved ones also. With small changes, you can manage PMS and PMDD in a way that respects your values and well-being.

Your health matters, and it’s okay to prioritize it. You are not alone in this experience – don’t be afraid to ask for help.

References

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2. American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS). Retrieved from https://www.acog.org/womens-health/faqs/premenstrual-syndrome.
3. Singh, A., Kaur, M. (2011). Impact and awareness about menstruation and menstrual hygiene among women of reproductive age group of Patiala district. Anthropologist, 13(4), 221-225.
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9. Vitex agnus-castus. Natural Medicines. https://naturalmedicines.therapeuticresearch.com.