Premenstrual syndrome

Premenstrual syndrome (PMS) is the name given to the set of physical, psychological and emotional symptoms that appear in the days leading up to a woman's monthly period. It's also known as premenstrual tension (PMT). Usually, the symptoms improve when the woman's period starts and disappear a few days afterwards.

Nearly all women of child-bearing age have some premenstrual symptoms, but those between their late 20s and early 40s are most likely to experience PMS. A small number of these women will have symptoms severe enough that they disrupt their daily lives. PMS usually improves after the menopause.

The exact cause of PMS is not fully understood. However, it's thought to be linked to the changing levels of hormones in the body during a woman's menstrual cycle.

There is no cure for PMS, but there are treatments available and changes that can be made to help women manage their symptoms.

There are many different symptoms of premenstrual syndrome (PMS), and they can vary from person to person. Most women only experience a few symptoms each month, but these may differ over time. For example, you may find that you have similar symptoms every month but that they vary in intensity. Equally, you may find that you have slightly different symptoms every few months. PMS tends to be different for every woman.

As many as 150 different symptoms of PMS have been recorded, but the most common are:

• feeling irritable and bad tempered,
• fluid retention and feeling bloated,
• mood swings,
• changes to your skin and hair,
• feeling upset or emotional,
• insomnia (trouble sleeping),
• difficulty concentrating,
• backache,
• muscle and joint pain,
• breast tenderness,
• tiredness,
• some weight gain (up to 1 kg), and
• appetite changes, or food cravings.

You may also find you have a faster than usual heartbeat, swollen hands or feet, and are disinterested in sex.

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 then disappear until your cycle starts again.

While most women with PMS find their symptoms uncomfortable, a small percentage find that they are severe enough to stop them living their normal lives. This is due to a more intense type of PMS known as premenstrual dysphoric disorder (PMDD). The symptoms of PMDD tend to be similar to those of PMS, but more exaggerated. They can also include:

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

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

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

Hormonal changes

During your menstrual cycle, levels of hormones such as oestrogen and progesterone rise and fall. Hormonal 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

Like your hormone levels, certain chemicals in your brain, such as serotonin, fluctuate during your menstrual cycle. Serotonin is known to help regulate your mood and make you feel happier, and so it is possible that women with low levels of serotonin are particularly sensitive to the symptoms of PMS. Low levels of serotonin may also contribute to symptoms such as

• tiredness,
• food cravings, and
• insomnia (difficulty sleeping).

Stress

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

Diet

Eating too much of some foods, and too little of others, may also contribute to the symptoms of PMS. For example, too much salty food may add to fluid retention and make you feel bloated, and alcohol and caffeinated drinks can disrupt your mood and energy levels. Low levels of vitamins and minerals may also make your symptoms of PMS worse.

There is no test or procedure that can diagnose premenstrual syndrome (PMS), but if you are finding your symptoms difficult to deal with, you should see your GP.

In order to pinpoint exactly what symptoms you have and how severe they are, your GP may ask you to use a diary or chart to record how you are feeling each day in the run up to your period. You may have to do this for at least two months so that your GP can monitor any symptom patterns that may show up.

Alternatively, you can record your symptoms yourself. You should note when your symptoms first appear and disappear, and when your period starts and finishes. This will help you to clearly identify which symptoms you have so that you can try to treat them.

If you think you may have premenstrual dysphoric disorder (PMDD), see your GP. They may carry out a medical examination to determine whether or not you have PMDD, or some other condition. They may also be able to suggest specific treatments to relieve your symptoms.

A cure for premenstrual syndrome (PMS) does not currently exist, but the aim of treatment is to help you manage your symptoms so that they do not interfere with your daily life.

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

If your PMS is severe, or you have premenstrual dysphoric disorder (PMDD, you may wish to try a medical treatment. However, there is no single treatment that will work for everyone. A wide range of treatments are available, and you may have to try several before you find one that suits you. Your choice of treatment will be influenced by the symptoms you are having and how severe they are, what treatments are available, and their possible side effects. You should always discuss any treatment that you wish to take with your GP.

The different types of treatment for PMS are detailed below.

Non-steroidal anti-inflammatory drugs (NSAIDs)

You can take NSAIDs, such as ibuprofen and aspirin, to ease stomach cramps and sore breasts. They may also relieve headaches, muscular pain and joint pain, but they can make fluid retention worse. Children under 16 years of age should not take aspirin, and if you have asthma do not take ibuprofen.

Oral contraceptives including Yasmin pill

As well as being prescribed for contraceptive purposes, oral contraceptives, often known as 'the Pill', can be prescribed to regulate symptoms of PMS. They stop ovulation (when an egg is released from your ovaries) and stabilise hormone levels, which can help to combat mood swings.

There is a brand of oral contraceptive, known as the Yasmin pill, which can be prescribed to help with acne, fluid retention and other symptoms of PMS, and it may even be effective in improving symptoms of PMDD. However, oral contraceptives do not work for all women with PMS, and they can have side effects. These can be similar to the symptoms of PMS and may include, for example, fluid retention and irritability.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) may be the most effective treatment if you have severe PMS or PMDD. SSRIs, such as fluoxetine and sertraline, are a kind of antidepressant which can be taken daily to relieve tiredness, food cravings and sleep problems, as well as combating feelings of depression. However, like oral contraceptives, they may have negative side effects that may outweigh their benefits.

Diuretics (water tablets)

Diuretics (water tablets) are available over the counter (OTC) at pharmacies. They can help you feel less bloated and relieve sore breasts, by reducing the levels of fluid in your body.

If your GP prescribes you a treatment for PMS, they may ask you to record any changes to your symptoms so that you both know how effective it is for you. However, if the treatment does not help to ease your symptoms, your GP may prescribe an alternative.

If your premenstrual syndrome (PMS) is not too severe, there are several things you can do that may help to ease your monthly symptoms. These self-help methods are detailed below.

Diet

• Eat smaller meals more frequently to help reduce bloating.
• Avoid eating salty foods to limit bloating and fluid retention.
• Drink lots of water (the recommended daily amount is 1.2 litres, which equates to between six and eight glasses). Being dehydrated can make headaches and tiredness worse.
• Eat lots of complex carbohydrates, which can be found in foods such as fruit, vegetables and wholegrains.
• To improve physical and psychological symptoms of PMS, eat calcium-rich foods such as cheese, milk and other dairy products. If you cannot eat dairy products, try calcium fortified soya alternatives, such as yoghurts.
• Avoid caffeine and alcohol, which can affect your mood and energy levels.
• Eat plenty of fruit and vegetables, which are rich in vitamins and minerals, as these may help to ease your symptoms of PMS. You should aim to eat at least five portions a day.

Exercise

• Exercise for half an hour, at least five times a week (this is the minimum recommended amount for most adults). 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 medicines

There are many non-prescribed alternative treatments and supplements available for PMS, and many women find that they are helpful in easing their symptoms. However, there is little research to back up their effectiveness, and of the studies that do exist, most show mixed results. You should always see your GP before taking any complementary medicine, or supplement.

• Magnesium - this may help to reduce fluid retention, bloating, and breast tenderness. You should not take more than 400mg daily.
• Vitamin B6 - this may improve overall symptoms of PMS, particularly depression. Do not take more than 50 to 100mg a day.
• Vitamin E - this may help to ease stomach cramps and breast tenderness. Take no more than 400IU (international units) daily.
• Evening primrose oil - this can be taken to improve general symptoms of PMS but there is no medical evidence to prove that it is effective.
• Agnus castus (chasteberry) - some European studies have shown that, taken daily, this may be effective in easing general symptoms of PMS.
• Black cohosh, ginger, raspberry leaf, dandelion - some women take herbal remedies such as these to ease their symptoms of PMS, but there is no medical evidence to prove that they work.

If after talking to your GP, you do decide to take a complementary treatment, only take one at a time so that you know if it works for you. If you have had no change to your symptoms after three months, go back to see your GP who may recommend trying another treatment.