PMS is the name given to the physical and emotional symptoms that can affect your life in the 2 weeks before you have your period.
These symptoms typically resolve once your period starts.
Nearly all women have some premenstrual symptoms. Each woman’s symptoms are different, but the most common include:
- Physical symptoms such as:
- Headaches
- Fluid retention and feeling bloated
- Changes to skin or hair
- Sore or tender breasts.
- Psychological symptoms such as:
- Mood swings
- Feeling depressed, irritable or bad-tempered
- Tiredness or having trouble sleeping
- Changes in appetite and food cravings
- Feeling clumsy
Symptoms can vary from month to month, although they tend to form a pattern over time.
Between 2 and 4 in 100 women get PMS that is severe enough to prevent them from getting on with their daily lives.
A very small number of women get an even more intense form of PMS known as premenstrual dysphoric disorder (PMDD), which can make it difficult to work, socialise and have healthy relationships. In some cases, it can also lead to suicidal thoughts.
Here is a run-down of what premenstrual syndrome is, and what can be done to help!
Cause of PMS
The exact cause of PMS is not known. Throughout your menstrual cycle your hormone levels change, mainly of progesterone and oestrogen.
Some women are more sensitive to these hormonal changes, which can lead to the symptoms described.
PMS has also been linked to a changes in chemical substances in your blood called neurotransmitters, such as serotonin and gamma-aminobutyric acid (GABA).
Diagnosing PMS
Keep a symptom diary, for a minimum of 2 months, documenting each symptom that you experience and when. You can do this through many period tracker apps, or by using a paper chart such as this one.
When you show your chart to your doctor, they will be looking to see which symptoms are most common for you, and to confirm they preceed your period during the ‘luteal phase’, ie after ovulation. This will help them decide which treatment option is best.
If there is any uncertainty, you may be given a course of medication called GnRH analogues for 3 months. If your symptoms improve, this confirms the diagnosis of PMS.
What treatment is available?
1.First line
Exercise, diet and stress reduction are all shown to be beneficial for symptoms
Psychological – CBT has been shown to be effective. This involves discussing your symptoms with a therapist. It can help you learn new ways of managing some of your symptoms to reduce their impact on your daily life.
Complementary treatments – Supplements of calcium, vitamin D, Vitex agnus-castus (a herb known as chasteberry) or Ginkgo biloba may be helpful. Evening primrose oil can reduce breast tenderness.
Hormonal – the combined contraceptive pill (particularly those containing the hormone drospirenone eg Yasmin) have been shown to be really helpful. This can be taken to mimic your cycle, or continuously depending on your preference.
Non-hormonal eg antidepressants like SSRIs eg sertraline can be helpful but have side effects that are important to be aware of
2. Second line
If those options dont work, your doctor can adjust the doses of medication or consider GnRH analogues which cause a temporary and reversible menopause, so you will not release eggs and you will not have any periods.
3. Third line
Finally, if the symptoms dont improve then removal of your uterus along with both ovaries and fallopian tubes can help to improve severe PMS symptoms by making you menopausal. Of course such extensive surgery has benefits and also disadvantages so should be discussed at length with your own doctor.