Premenstrual sendromda beslenme yaklaşımı

Öz

Premenstrual sendrom PMS , menstrual siklusun luteal fazında görülen ve menstruasyonun başlamasıyla düzelen fiziksel, davranışsal ve duygusal bozukluklardır. Türkiye’de PMS prevalansının %5,9 –76 gibi geniş bir aralıkta değiştiği rapor edilmektedir. PMS, tüm dünyada bireylerin günlük yaşamını, kişiler arası ilişkileri olumsuz etkilemekte ve iş veriminde düşüş ile ilişkilendirilmektedir. Kesin etiyolojisi tam olarak bilinmemekle birlikte gonadal steroidler ve nörotransmitterler arasındaki dengeyi sağlayan bazı değişikliklerin PMS’ye neden olabileceği görüşü ön plandadır. Tiroid disfonksiyonu, sıvı retansiyonu, psikolojik etmenler, hipoglisemi gibi nedenlerin de etkili olabildiği bilinmektedir. PMS’nin ortaya çıkışında sadece hormonal değişikliklerin değil, ait olunan kültür, annenin çalışma ve eğitim durumu gibi sosyokültürel etmenler ile şekillenen menstruasyona ilişkin tutum ile dismenore gibi menstrual problemler yaşama durumunun da PMS etiyolojisinde rol oynadığı belirtilmektedir. PMS’de en yaygın görülen belirtiler, kızgınlık, depresif ruh hali, anksiyete, şiddete eğilim, yalnız kalma hissi, göğüslerde büyüme ve hassasiyet, vücutta ödem, vücut ağırlığında artış, baş ağrısı, bulantı, kusma, ishal, iştah artışı, ciltte akne oluşumu veya artışı, aşırı susama, kas ve eklem ağrısı ve yorgunluktur. Bu semptomların aşırı çay, kahve, kolalı veya alkollü içecekler, çikolata, şeker içeriği zengin atıştırmalıklar ve yetersiz süt tüketimi ilişkili olabileceği gösterilmiştir. Ayrıca PMS’ye bağlı enerji ve karbonhidrat alımlarında bir artış olduğu, kalsiyum, magnezyum, sodyum, potasyum, çinko mineralleri ile tiamin, riboflavin, B6, D vitaminlerinin ve fitoöstrojenlerin diyetle alım miktarlarının PMS semptomları ile ilişkili olabileceği gösterilmiştir. PMS ile beslenme arasındaki ilişkiyi bütüncül bir yaklaşımla incelemek ve bu sayede gerek PMS insidansını azaltmak gerekse semptom şiddetini hafifletmek için beslenme protokolleri geliştirmeye yardımcı olacak araştırmalara ihtiyaç vardır. Bu derlemede, güncel literatür taranarak elde edilen yayınlar doğrultusunda, beslenme durumunun PMS gelişim ve semptom şiddetlerine etkisi ele alınmıştır

Anahtar Kelimeler

• premenstrual sendrom, beslenme, diyet örüntüsü

Nutritional approach in premenstrual syndrome

Abstract

Premenstrual syndrome PMS is defined as physical, behavioral and e motional disorders seen in the luteal phase of the menstrual cycle. It is reported that the prevalence of PMS changes in a wide range such as 5.9-76% in Turkey. PMS affects interpersonal relations negatively and it is associated with decreased productivity. The approach which of some changes in the balance of gonadal steroids and neurotransmitters may cause PMS is in the foreground although the etiology of PMS is not clearly known. Thyroid dysfunctions, fluid retention, psychological factors, hypoglicemia also may affect it. Not only hormonal changes, but also sociocultural factors such as the culture in which the person belongs, mother occupational and educational status, attitude towards to menstruation or dysmenorrhea have a role in the etiology of PMS. The most common symptoms in PMS are irritability, depressive mood, anxiety, tendency to violence, fatigue, feeling alone, enlargement and sensitivity in breast, edema in body, headache, nausea, vomiting, diarrhea, increased appetite, acne formation or increasing, excessive thirst, pain in muscles and joints. It has been shown that the symptoms are associated with excessive consumption of tea, coffee, coke and alcohol beverages, chocolate, snacks rich in simple sugar, and inadequate milk consumption. Furthermore, an increase in energy and carbohydrate intake related to PMS and dietary calcium, magnesium, sodium, potassium, zinc and also thiamine, riboflavin, vitamin B6 and vitamin D and phytoestrogens intake is shown to be associated with PMS symptoms. Further studies on the nutritional status of individuals in premenstrual period are needed to determine the relationship between PMS and nutrition with a holistic approach, and to develop nutrition protocols both decreasing the incidence and alleviating the symptoms. In this review, the effect of nutritional status on the development and symptom severity of PMS has been discussed using the recent literature.

Keywords

• premenstrual syndrome, nutrition, dietary pattern

Kaynakça

1. 1. 1.Rodin M. The social construction of premenstrual syndrome. Soc Sci Med, 1992; 35 (1):49-56.
2. 2. Avila C. The effect of nutritional supplementation on premenstrual sydnrome. PhD Thesis. Southern Cross University, 2009.
3. 3. Frank R. The hormonal basis of premenstrual tension. Arch Neurol Psychiatry, 1931; 26:1053- 7.
4. 4. Eke AC, Akabuike JC, Maduekwe K. Predictors of premenstrual syndrome among Nigerian university students. Int J Gynaecol Obstet, 2011; 112 (1): 63-4.
5. 5. The American College of Obstetricians and Gynecologists Frequently Asked Questions Gynecologic Problems. http://www.acog.org/ Patients/FAQs/Premenstrual-Syndrome-PMS. (2015). Erişim Tarihi: 22.01.2016.
6. 6. Türkçapar AF, Türkçapar MH. Premenstruel Sendrom ve Premenstruel Disforik Bozuklukta Tanı ve Tedavi: Bir gözden Geçirme. Klinik Psikiyatri, 2011;14 (4): 241-53.
7. 7. Tanaka E, Momoeda M, Osuga Y, Rossi B, Nomoto K, Kokubo K et al. Burden of menstrual symptoms in Japanese women - an analysis of medical careseeking behavior from a survey-based study. Int J Womens Health, 2013; 6, 11-23.
8. 8. Ashraf Direkvand-Moghadam, Sayehmiri K, Delpisheh A, Sattar K. Epidemiology of Premenstrual Syndrome (PMS)-A Systematic Review and Meta-Analysis Study. J Clin Diagn Res, 2014; 8 (2): 106-9.

9. 9. Adiguzel H, Taskin EO, Danaci AE. Manisa İlinde Premenstrüel Sendrom Belirti Örüntüsü ve Belirti Yaygınlığının Araştırılması. Turk Psikiyatri Derg, 2007; 18 (3):215-22.
10. 10. Derman O, Kanbur NO, Tokur TE, Kutluk T. Premenstrual syndrome and associated symptoms in adolescent girls. Eur J Obstet Gynecol Reprod Biol, 2004; 116 (2):201-6.
11. 11. Işgın K. Premenstrual Sendromda Beslenme Durumu ve Yeme Tutumunun Değerlendirilmesi. Yüksek Lisans Tezi, Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü, 2014.
12. 12. Işgın K, Ede G, Büyüktuncer Z. Premenstrual Sendromda Risk Faktörü Olarak Yaş ve Beslenme Durumunun Değerlendirilmesi. Bes Diy Derg, 2016; 44 (2): in press
13. 13. Johnson SR. Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners. Obstet Gynecol, 2004; 104 (4):845-59.
14. 14. Pearlstein TB, Halbreich U, Batzar ED, Brown CS, Endicott J, Frank E, et al. Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. J Clin Psychiatry, 2000; 61 (2):101-9.
15. 15. Erbil N. Diet and eating changes in premenstrual syndrome. In: Martin CH, Caroline, Akker O, Martin C, Preedy VR, editors. Handbook of diet and nutrition in the menstrual cycle, periconception and fertility. 1st ed.The Netherlands: Wageningen Academic Publishers, 2014:109-20.
16. 16. Daley A. Exercise and premenstrual symptomatology: a comprehensive review. J Womens Health (Larchmt), 2009; 18 (6):895-9.
17. 17. Salamat S, Ismail KMK, O’Brien S. Premenstrual syndrome. Obstetrics, Gynaecol Reprod Med, 2008; 18 (2):29-32.
18. 18. Wihlback AC, Sundstrom-Poroma I, Backstrom T. Action by and sensitivity to neuroactive steroids in menstrual cycle related CNS disorders. Psychopharmacology (Berl) 2006; 186 (3):388- 401.
19. 19. Giugliano D,Torella R. Prostaglandin E1 inhibits glucose-induced insulin secretion in man. Prostaglandins Med, 1978; 1 (2): 165-6.
20. 20. Halbreich U, Tworek H. Altered serotonergic activity in women with dysphoric premenstrual syndromes. Int J Psychiatry Med, 1993;23 (1):1- 27.
21. 21. Sule ST, Umar HS, Madugu NH. Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria. Ann Afr Med, 2007; 6 (2), 68-72.
22. 22. Vichnin M., Freeman EW, Lin H, Hillman J, Bui S. Premenstrual syndrome (PMS) in adolescents: severity and impairment. J Pediatr Adolesc Gynecol, 2006;19 (6):397-402.
23. 23. Perkonigg A, Yonkers KA, Pfister H, Lieb R, Wittchen HU. Risk factors for premenstrual dysphoric disorder in a community sample of young women: the role of traumatic events and posttraumatic stress disorder. J Cl in Psychiatry, 2004; 65 (10):1314-22.
24. 24. Kendler KS, Karkowski LM, Corey LA, Neale MC. Longitudinal population-based twin study of retrospectively reported premenstrual symptoms and lifetime major depression. Am J Psychiatry, 1998; 155(9):1234-40.
25. 25. Bertone-Johnson ER, Hankinson SE, Willett WC, Manson JE. Adiposity and the development of premenstrual syndrome. J Womens Health (Larchmt), 2010; 19 (11): 195.
26. 26. Bianco V, Cestari AM, Casati D, Cipriani S, Radici G, Valente I. Premenstrual syndrome and beyond: lifestyle, nutrition, and personal facts. Minerva Ginecol, 2014; 66 (4):365-75.
27. 27. Deuster PA, Adera T, South-Paul J. Biological, social, and behavioral factors associated with premenstrual syndrome. Arch Fam Med, 1999;8 (2):122-8.
28. 28. Hormes JM, Rozin P. Perimenstrual chocolate craving. What happens after menopause? Appetite, 2009;53 (2):256-9.
29. 29. Zellner DA, Garriga-Trillo A, Centeno S, Wadsworth E. Chocolate craving and the menstrual cycle. Appetite, 2004;42 (1):119-21.
30. 30. Bertone-Johnson ER, Hankinson SE, Bendich AJ, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med, 2005;165 (11):1246-52.
31. 31. Cross GB, Marley J, Miles H, Willson K. Changes in nutrient intake during the menstrual cycle of overweight women with premenstrual syndrome. Br J Nutr, 2001; 85 (4): 475-82.
32. 32. Cheikh Ismail LI, Al-Hourani H, Lightowler HJ, Aldhaheri AS, Henry CJ. Energy and nutrient intakes during different phases of the menstrual cycle in females in the United Arab Emirates. Ann Nutr Metab, 2009; 54 (2):124-8.
33. 33. Reed SC, Levin FR, Evans SM. Changes in mood, cognitive performance and appetite in the late luteal and follicular phases of the menstrual cycle in women with and without PMDD (premenstrual dysphoric disorder). Horm Behav, 2008; 54 (1), 185-93.
34. 34. Murakami K, Sasaki S, Takahashi Y, Uenishi K, Watanabe, Kohri T et. al. Dietary glycemic index is associated with decreased premenstrual symptoms in young Japanese women. Nutrition, 2008; 24 (6): 554-61.
35. 35. Rocha Filho EA, Lima JC, Pinho Neto JS, Montarroyos U. Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reprod Health, 2011; 8:2.
36. 36. Delion S, Chalon S, Guilloteau D, Besnard JC, Durand G. Alpha-Linolenic acid dietary deficiency alters age-related changes of dopaminergic and serotoninergic neurotransmission in the rat frontal cortex. J Neurochem, 1996; 66 (4):1582- 91.
37. 37. Sohrabi N, Kashanian M, Ghafoori SS, Malakouti SK. Evaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: “a pilot trial”. Complement Ther Med, 2013;21(3):141-6.
38. 38. Nagata C, Hirokawa K, Shimizu N, Shimizu H. Soy, fat and other dietary factors in relation to premenstrual symptoms in Japanese women. Bjog, 2004; 111 (6): 594-9.
39. 39. Chocano-Bedoya PO, Manson JE, Hankinson SE, et al. Intake of selected minerals and risk of premenstrual syndrome. Am J Epidemiol, 2013; 177 (10):1118-27.
40. 40. Chocano-Bedoya PO, Manson JE, Hankinson SE, Johnson SR, Chasan-Taber L, Ronnenberg Ag, et al. Dietary B vitamin intake and incident premenstrual syndrome. Am J Clin Nutr, 2011;93 (5): 1080-6.
41. 41. Bertone-Johnson ER, Chocano-Bedoya PO, Zagarins SE,Micka AE, Ronnenberg AG. Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population. J Steroid Biochem Mol Biol, 2010;121 (1-2):434-7.
42. 42. Dadkhah H, Ebrahimi E, Fathizadeh N. Evaluating the effects of vitamin D and vitamin E supplement on premenstrual syndrome: A randomized, double-blind, controlled trial. Iran J Nurs Midwifery Res, 2016;21(2):159-64.
43. 43. London RS, Sundaram GS, Murphy L, Goldstein PJ. Evaluation and treatment of breast symptoms in patients with the premenstrual syndrome. J Reprod Med, 1983; 28 (8):503-8.
44. 44. London RS, Sundaram GS, Murphy L, Goldstein PJ. The effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. J Am Coll Nutr, 1983;2 (2):115-22.
45. 45. London RS, Murphy L, Kitlowski KE, Reynolds MA. Efficacy of Alpha-Tocopherol in the treatment of the Premenstrual syndrome. J Reprod Med, 1987; 32(6):400-4
46. 46. Thys-Jacobs S. Micronutrients and the premenstrual syndrome: the case for calcium. J Am Coll Nutr, 2000;19 (2): 220-7.
47. 47. Walker AF, De Souza MC, Vickers MF, Abeyesekera S, Collins ML, Trinca LA. Magnesium Supplementation Alleviates Premenstrual Symptoms of Fluid Retention. J Women’s Health, April 2009, 7(9): 1157-1165. doi:10.1089/ jwh.1998.7.1157.
48. 48. Abraham GE. Nutritional factors in the etiology of the premenstrual tension syndromes. J Reprod Med, 1983 Jul;28(7):446-64.
49. 49. Kia S, Amani R, Cheraghian B. The Association between the Risk of Premenstrual Syndrome and Vitamin D, Calcium, and Magnesium Status among University Students: A Case Control Study. Health Promot Perspect, 2015; 5(3):225-30.
50. 50. Sunar F, Baltaci AK, Ergene N, Mogulkoc R. Zinc deficiency and supplementation in ovariectomized rats: their effect on serum estrogen and progesterone levels and their relation to calcium and phosphorus. Pak J Pharm Sci, 2009; 22 (2):150-4.
51. 51. Halbreich U, Petty F, Yonkers K, Kramer GL, Rush AJ, Bibi KW. Low plasma gamaaminobutyric acid levels during the late luteal phase of women with premenstrual dysphoric disorder. Am J Psychiatry, 1996; 153(5):718-20.
52. 52. British Dietetic Association Food Fact Sheet Premenstrual Syndrome. https://www. bda.uk.com/foodfacts/pms. Erişim tarihi: 10.12.2016.
53. 53. Bryant M, Cassidy A, Hill C, Powell J, Talbot D, Dye L. Effect of consumption of soy isoflavones on behavioural, somatic and affective symptoms in women with premenstrual syndrome. Br J Nutr, 2005;93 (5):731-9.
54. 54. Lee SY, Bae YJ, Lee SY, Choi MK, Choe SH, Sung CJ. The effect of soy isoflavone on sex hormone status and premenstrual syndrome in female college students. Korean J Nutr, 2005; 38(3): 203-10.