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Prementrual syndrome (PMS)

What is PMS?

Premenstrual syndrome (PMS) is a collection of symptoms associated with monthly periods (menstruations). The symptoms of PMS usually arise 1–2 weeks before your period starts and subside after you start bleeding.1 Premenstrual syndrome typically goes away when you get pregnant or go through menopause.

Premenstrual syndrome can affect menstruating women of any age and the effect varies from woman to woman.1 Most of the symptoms are mild, but for some women, PMS may be so severe and painful that makes it hard for them to get through the day.

What causes PMS?

The exact cause of PMS is unknown. However, it seems to be related to the fluctuating levels of female hormones (oestrogen and progesterone) that occur in preparation for monthly periods.2 Certain lifestyle factors, such as lack of exercise, unhealthy diet, consumption of alcohol and caffeine, and stress may aggravate the symptoms of PMS.

What are the symptoms of PMS?

The symptoms of PMS are diverse and the severity is different for each woman. Common PMS symptoms include1,2:

  • Joint or muscle pain
  • Tiredness
  • Mood swings, anxiety or depression
  • Appetite changes
  • Acne
  • Swollen or tender breasts
  • Upset stomach, bloating, constipation or diarrhoea
  • Headache or backache
  • Trouble with concentration or memory

How common is PMS?

The American Congress of Obstetricians and Gynecologists reports that almost 85% of menstruating women experience some sort of PMS symptoms as part of their monthly cycle.3 Most of the symptoms are mild and thus, do not require clinical treatment. However, some women (about 3–8%) may have a more severe form of PMS, called premenstrual dysphoric disorder (PMDD) that requires medical attention.3

In general, PMS is more prevalent in women who1:

  • Are between their late 20s and early 40s
  • Have at least one child
  • Have a family history of depression
  • Have a past medical history of either postpartum depression or a mood disorder

How is PMS diagnosed?

Your doctor may diagnose PMS based on which symptoms you have, when they occur, how long they last and how much they affect your life. By keeping a PMS symptoms diary, you can observe if your symptoms correspond to a certain trend in your monthly cycle.1,2

You have PMS if2:

  • Your symptoms occur during the last 2 weeks before your period and affect your quality of life
  • Your doctor has excluded other conditions with similar symptoms (eg, thyroid disease, depression, irritable bowel syndrome)

Can PMS be prevented?

Premenstrual syndrome itself cannot be prevented, but through appropriate treatment options (eg, lifestyle changes, medications, supplements and natural remedies, and psychological therapy), most women can find relief from the symptoms.1,2,4

How to treat PMS

Due to the diversity of PMS symptoms, there is no single treatment for every woman. You may need to try several options to see which one works for you. Common treatment options include4:

  • Lifestyle changes
  • Medications
  • Supplements and natural remedies
  • Psychological therapy

Lifestyle changes

If your PMS is not so severe until you need to see a doctor, the following lifestyle changes may help to manage the symptoms.1,4
  • Exercise
    • Aim to do 2.5 hours of moderate-intensity physical activities every week, which include walking, swimming or cycling. These activities improve your overall health and help to alleviate depression and tiredness
    • Try to practice stretching and breathing exercises, such as yoga and pilates. These activities help to reduce your stress levels and enable you to sleep better at night
  • Healthy diet
    • Eat foods that are rich in complex carbohydrates, vitamins and minerals, such as whole grains, fruits and vegetables
    • Eat smaller meals more frequently to help reduce bloating
    • Avoid eating salty and sugary foods to limit bloating and fluid retention
    • Drink plenty of water to avoid dehydration
    • Avoid consuming caffeine and alcohol that can affect your mood and energy levels
  • Rest and sleep
    • Get enough rest during the day
    • Get around 8 hours of sleep each night
  • Stress management
    • Talk to your friends
    • Exercise
    • Relaxation therapy
  • Avoid smoking
Medications
You may want to seek medical treatment if you have a severe PMS, also known as premenstrual dysphoric disorder (PMDD). Your doctor will decide the type of medications for you based on your symptoms and how severe they are. There is no single treatment or medication that works for everyone.

Supplements and natural remedies
There are several supplements and natural remedies that may ease the symptoms of PMS. For instance, supplements of folic acid, calcium, vitamin B, vitamin D, vitamin E and magnesium. In terms of natural remedies/herbs, black cohosh, chasteberry and evening primrose oil could be used to manage PMS symptoms.1

Remember to talk to your doctor before taking any supplements or natural remedies. Some supplements and natural remedies have not been proven to be effective. Moreover, taking them alongside certain medications or in excessive amounts can be dangerous.

Psychological therapy
If your PMS involves psychological symptoms, such as feeling emotional, anxious or depressed, it is advisable to talk to your doctor. Cognitive behavioural therapy is a group counselling practice designed to help patients to manage psychological problems such as anxiety and depression.

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS.1 A brain chemical called serotonin plays an important role in this condition. The major symptoms, which can be dangerous, include1:

  • Panic attacks
  • Feelings of sadness or despair that may lead to thoughts of suicide
  • Feelings of intense tension or anxiety
  • Prolong irritability or anger that affects other people
  • Lack of interest in daily activities and relationships
  • Trouble thinking or focusing
  • Extreme tiredness or low energy
  • Food cravings or binge eating
  • Trouble sleeping
  • Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain


If you have five or more of these symptoms, it is advisable to see a doctor as you may have PMDD. Symptoms of PMDD are more severe and typically occur 1–2 week before your period and subside after bleeding starts.1
Certain lifestyle changes, medications, supplements and natural remedies, and psychological therapy may help to ease the symptoms of PMDD. See “How to treat PMS?” above to understand more.

References

  1. US Department of Health and Human Services. Premenstrual syndrome (PMS) fact sheet. Available at: http://www.womenshealth.gov/publications/our-publications/
    fact-sheet/premenstrual-syndrome.html. Accessed 28 October, 2015.
  2. WebMD. Your guide to premenstrual syndrome, or PMS. Available at: http://www.webmd.com/women/guide/premenstrual-syndrome?page=2. Accessed 28 October, 2015.
  3. The American Congress of Obstetricians and Gynecologists. Women's Health Stats & Facts; 2011.
  4. NHS Choices. Premenstrual syndrome - Treatment. Available at: http://www.nhs.uk/Conditions/Premenstrual-syndrome/Pages/Treatment.aspx. Accessed 28 October, 2015.