PREMENSTRUAL SYNDROME (PMS)

Premenstrual syndrome (PMS) is the name given to the physical, psychological and behavioral symptoms that can occur in the two weeks before a woman’s monthly period. It is also known as premenstrual tension (PMT).

There are many different symptoms of PMS, but typical examples are bloating, breast pain, mood swings, feeling irritable and loss of interest in sex.

These symptoms usually improve when your period starts and disappear a few days afterwards.

Nearly all women of childbearing age have some premenstrual symptoms, but women in their late 20s to their early 40s are most likely to experience PMS.

Around 1 in every 20 women have symptoms that are severe enough to stop them living their normal lives. This is often the result of a more intense type of PMS known as premenstrual dysphoric disorder (PMDD).

Symptoms of premenstrual syndrome (PMS) 

There are many different symptoms of premenstrual syndrome (PMS), which can vary from person to person and change slightly every month.

For example, you may find that you have similar PMS symptoms every month, but they vary in intensity, or you may have slightly different symptoms every few months. PMS tends to be different for every woman.

The symptoms of PMS usually happen at the same time in your menstrual cycle each month, which can be up to two weeks before your period starts. They usually improve once your period has started and disappear until your cycle starts again.

Common symptoms of PMS

More than 100 different symptoms of PMS have been recorded. Some of the most common are listed below.

Physical symptoms

  • Feeling bloated
  • Pain and discomfort in your abdomen (tummy)
  • Headaches
  • Backache
  • Muscle and joint pain
  • Breast pain
  • Trouble sleeping (insomnia)
  • Nausea
  • Weight gain (up to 1kg)

Any chronic (long-term) illnesses, such as asthma or migraines, may get worse.

Psychological and behavioral symptoms

  • mood swings
  • feeling upset or emotional
  • feeling irritable or angry
  • crying
  • anxiety
  • difficulty concentrating
  • confusion and forgetfulness
  • clumsiness
  • restlessness
  • tiredness
  • decreased self-esteem
  • loss of libido (loss of interest in sex)
  • appetite changes or food cravings

Premenstrual dysphoric disorder

While most women with PMS find their symptoms uncomfortable, a small percentage have symptoms that are severe enough to stop them living their normal lives. This is the result of a more intense type of PMS known as premenstrual dysphoric disorder (PMDD).

The symptoms of PMDD are similar to those of PMS, but are more exaggerated and often have more psychological symptoms than physical ones. Symptoms can include:

  • feelings of hopelessness
  • persistent sadness or depression
  • extreme anger and anxiety
  • decreased interest in usual activities
  • sleeping much more or less than usual
  • very low self-esteem
  • extreme tension and irritability

As depression is a common symptom of PMDD, it is possible that a woman with PMDD may have thoughts about suicide.

PMDD can be particularly difficult to deal with as it can have a negative effect on your daily life and relationships.

When to see your Doctor

It’s normal to experience mild PMS symptoms in the two weeks before your period starts. However, you should see your Doctor if the symptoms are making everyday life difficult.

Your Doctor may ask you to use a diary to record how you’re feeling each day in the run-up to your period. You may have to do this for at least two or three months so your Doctor can spot any patterns in your symptoms.

PMDD is only diagnosed when your mood symptoms seriously affect your relationships and stop you from functioning properly at work or school. Your Doctor may refer you to a mental health specialist for further assessment and treatment if they think you have PMDD.

Causes of premenstrual syndrome (PMS) 

The exact cause of premenstrual syndrome (PMS) is not fully understood, but there are a number of things that may contribute to the symptoms.

 Hormone changes

During your menstrual cycle, levels of hormones such as estrogen and progesterone rise and fall. Hormone changes are thought to be the biggest contributing factor to many of the symptoms of PMS.

The fact that PMS improves during pregnancy and after the menopause, when hormone levels are stable, supports this theory.

 Chemical changes in the brain

It has also been suggested that the changes in hormone levels during the menstrual cycle may affect the levels of certain chemicals in your brain, such as serotonin.

Serotonin is known to help regulate your mood and make you feel happier, so a reduction in the level of serotonin caused by changes in hormone levels may explain the mood changes often associated with PMS.

It may also explain why a type of antidepressant medication that increases serotonin levels (known as selective serotonin reuptake inhibitors, or SSRIs) helps some women with PMS.

 Lifestyle factors

There are also a number of lifestyle factors that can increase your risk of PMS. These are outlined below.

 Weight and exercise

Research has shown that you are more likely to have PMS if you are obese (with a body mass index of more than 30) and if you do little exercise.

 Stress

You may find that your symptoms of PMS get worse as you become more stressed. While it is not a direct cause, stress can aggravate the symptoms of PMS.

 Diet

Eating too much of some foods and too little of others may also contribute to PMS symptoms. For example, too much salty food may make you feel bloated.

Alcohol and caffeinated drinks can disrupt your mood and energy levels.

Low levels of vitamins and minerals may also make your PMS symptoms worse.

 Treating premenstrual syndrome (PMS) 

There is no cure for premenstrual syndrome (PMS), but there are treatments that can help you manage your symptoms so they do not interfere with your daily life.

If your PMS is mild or moderate, you may want to make changes to your diet and lifestyle before resorting to medical treatment. This is because many of the medical treatments can have side effects that may be worse than your PMS symptoms.

Lifestyle changes

Diet

The following tips can help you maintain a healthy balanced daily diet, and may help control the symptoms of PMS:

  • eat smaller meals more frequently to help reduce bloating
  • avoid eating salty foods to limit bloating and fluid retention
  • drink plenty of water to avoid dehydration – being dehydrated can make headaches and tiredness worse
  • eat lots of complex carbohydrates, which can be found in foods such as fruit, vegetables and whole grains
  • eat calcium-rich foods such as cheese and milk to improve the physical and psychological symptoms of PMS – if you can’t eat dairy products, try calcium-fortified soya alternatives
  • eat plenty of fruit and vegetables, which are rich in vitamins and minerals and may ease your PMS symptoms – aim to eat at least five portions a day
  • avoid caffeine and alcohol, which can affect your mood and energy levels

Exercise

If possible, aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of activities include walking, swimming and cycling.

Exercise improves your overall health and can help alleviate depression and tiredness.

Stretching and breathing exercises, such as Yoga and Pilates, can help you sleep better and reduce your stress levels.

Complementary treatments

There are many non-prescribed alternative treatments and supplements that claim to help treat PMS that some women may find helpful in easing their symptoms.

However, many complementary therapies and supplements have either not been tested or have not been proven to be effective.

Always see your Doctor before taking any supplements, as taking them alongside certain medications or in excessive amounts can be harmful.

If you decide to take a complementary treatment, take one at a time so you know it works for you. Go back to your Doctor if your symptoms don’t change after three months, as another treatment may be recommended.

Psychological therapy

If you have psychological symptoms, such as feeling depressed or emotional, it may help to talk to a health professional.

Cognitive behavioral therapy (CBT) is the term for a group of therapies designed to help solve problems such as anxiety and depression. A cognitive behavioral therapist can help you learn new ways of managing some of your symptoms.

Medical treatment

You may wish to try a medical treatment if your PMS is severe or you have premenstrual dysphoric disorder (PMDD). However, there is no single treatment that works for everyone.

A wide range of treatments is available. You may have to try several before you find one that suits you. Your choice of treatment will be based on your symptoms and how severe they are, and the possible side effects of the medication.

If you are prescribed treatment for PMS, you may be asked to record any changes to your symptoms so that you know how effective it is for you. If the treatment doesn’t ease your symptoms, you may be prescribed an alternative.

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