Premenstrual syndrome, or PMS, refers to the range of physical and emotional symptoms that many women experience in the lead up to a period (menstruation). Symptoms resolve during the woman’s period and there is usually at least one symptom-free week before the symptoms return.
It is thought that most women who menstruate have premenstrual symptoms, ranging from relatively mild (in 75 per cent of women) to severe (in 20 to 30 per cent of women). For eight per cent of women with severe symptoms, PMS is associated with reduced quality of life.
PMS is a complex condition that includes physical and emotional symptoms. The latest research shows that:
- women with PMS are hypersensitive to their own normal cyclic hormones (progesterone and progestogens) during a menstrual cycle
- ovulation is required with release of oestrogen and progesterone hormones
- oestrogen related genes are involved
- brain chemicals (specifically the neurotransmitters serotonin and gamma butyric acid) play a role
- symptoms do not occur during pregnancy or after menopause.
Although the cause isn’t conclusively known, PMS can be managed with medication and other strategies.
Symptoms of PMS
PMS differs from one woman to the next. The wide range of PMS symptoms can include:
- abdominal bloating
- depression and lowered mood, which may include suicidal thoughts
- difficulties in concentration, memory lapses
- digestive upsets, including constipation and diarrhoea
- drop in self-esteem and confidence leading to social isolation
- drop in sexual desire, or (occasionally) an increase
- feelings of loneliness and paranoia
- fluid retention
- food cravings
- headache and migraine
- hot flushes or sweats
- increased appetite
- increased sensitivity to sounds, light and touch
- irritability, including angry outbursts
- mood swings, weepiness
- sleep changes, including insomnia or excessive sleepiness
- swollen and tender breasts.
Factors contributing to PMS
The cause of PMS is unknown. Factors that may contribute to PMS symptoms include:
- psychological state
- poor physical health
- overweight and obesity – women with a BMI higher than 30 are three times more likely to have PMS than those with a normal weight
- smoking – smokers are twice as likely to have severe PMS symptoms compared to non-smokers
- genetic makeup
- cultural and social environment.
Incorrect theories about the causes of PMS have included oestrogen excess, progestogen deficiency, vitamin B6 deficiency, abnormal glucose metabolism and electrolyte imbalances.
Premenstrual dysphoric disorder (PMDD)
Between three and eight per cent of menstruating women suffer from seriously debilitating PMS, which is sometimes known as premenstrual dysphoric disorder (PMDD). The symptoms may have a serious impact on a woman’s mental health state and can be so severe that an affected woman is unable to carry out her normal activities.
Diagnosis of PMS
There are no specific diagnostic tests for PMS, as hormone levels are within the normal range. Diagnosis relies on an examination of the woman’s medical history and a description of the symptoms.
In most cases, it is recommended that you keep a daily symptoms diary to help identify whether you have PMS. Include the details of your menstrual cycle – for example, the first and last days of your menstrual period. Keep this daily diary for at least two menstrual cycles. If the symptoms don’t resolve at menstruation, other causes may be suspected and would need to be investigated.
If you are not sure whether you are suffering from PMS, or if you need help understanding your symptoms, talk to your doctor.
While there is no cure for PMS, the symptoms may be successfully managed with lifestyle changes, dietary modifications, supplements, hormone treatments and other therapies. You may have to experiment to find the balance of treatments that works best for you.
It’s a good idea to continue your PMS diary and record any symptoms while you try out these therapies and treatments. Consult with your doctor or healthcare professional during this trial period.
Lifestyle changes and PMS
Recommended lifestyle changes include:
- Exercise regularly, at least three times a week – try to exercise daily as the increased endorphins will help.
- Don’t smoke.
- Cut back on caffeine and alcohol in the two weeks before menstruation.
- Make sure you get enough sleep.
- Manage your stress in whatever way works for you – for example, counselling, cognitive behaviour therapy (CBT), tai chi or meditation, mindfulness, walking or gardening.
Dietary changes for PMS
Women experiencing PMS symptoms may crave high-fat and high-sugar foods like chocolate, biscuits and ice cream, and may consequently increase their food intake significantly.
You can manage your weight and help reduce your PMS symptoms by making a few dietary changes. You might like to try:
- eating smaller meals more often – for example, have six ‘mini-meals’ instead of three main meals
- reducing your intake of salty foods
- including more fresh fruits and vegetables, and wholegrain foods in your daily diet
- boosting your dairy food intake, but switching to reduced-fat or non-fat versions
- not keeping high-fat and high-sugar foods in the house
- making sure you always have tasty and healthy snack alternatives on hand
- recording your food choices in your PMS diary – charting your food intake may help you become more aware of high-fat and high-sugar snacking.
Supplements for PMS
Check with your doctor before taking any type of supplement, including herbal supplements, and make sure that you follow instructions on dosage. Complementary therapies should be viewed as a medicine and should be treated with the same respect.
Therapies that can help reduce PMS symptoms include calcium, vitamin D and vitex castus agnus. Gingko biloba, evening primrose oil, lemon balm, curcumin, vitamin B6, isoflavones, St John’s wort and wheatgerm have been shown to provide some benefit.
Medication and hormone treatments for PMS
A range of medications and hormone treatments are available to help you manage your symptoms. There are different types available.
Treatments that have been proven to relieve symptoms include:
- SSRIs (selective serotonin reuptake inhibitors) fluoxetine, sertraline, paroxetine and escitalopram – these medications are mood stabilisers and antidepressants, which can improve PMS symptoms significantly by boosting brain chemicals (neurotransmitters). They may be prescribed just in the premenstrual phase or taken continuously
- agents that suppress ovulation – including GnRH analogues and danazol
- oral contraceptive pill containing drospirenone and ethinyloestradiol – sold in Australia as Yaz
- alprazolam – considered a second-line treatment for PMS. Due to its addictive potential, it is used only in the last two weeks of the menstrual cycle.
Treatments that might improve symptoms include:
- other oral contraceptive pills
- spironolactone, which has not been shown to be consistently of any advantage, but may help if there is fluid retention
- oestradiol patches or implants.
Treatments that have not been proven to relieve symptoms include progesterone and progestogens (such as intrauterine devices (IUD), intrauterine devices (Implanon) and Depo-Provera (injection).
Complementary medicine and PMS
Many women feel they benefit from a variety of natural therapies, such as cognitive behaviour therapy, and complementary therapies such as vitex castus agnus.
If you would like to use complementary therapies, it is important to seek advice from a qualified professional and to let your doctor know about any herbal or complementary therapies you are using.
Many herbal or complementary medicines can have side effects, so make sure you are well informed about them before you and your doctor decide on your treatment.
Where to get help
This page has been produced in consultation with and approved by:
Jean Hailes for Women's Health
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