Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) is a collection of physical and mental symptoms which women experience to a greater or lesser degree before their menstrual period each month.

A working definition of premenstrual syndrome (PMS) from the Royal College of Obstetricians and Gynaecologists is ‘a condition which manifests with distressing physical, behavioural and psychological symptoms, in the absence of organic or underlying psychiatric disease, which regularly recurs during the luteal phase of each menstrual (ovarian) cycle (this is the two weeks before a woman's period) and which disappears or significantly regresses by the end of menstruation’.

  • As many as 40% of women have symptoms fitting this definition. The combination of symptoms ,how long they last and how severe varies from woman to woman.
  • Symptoms of PMS are distinguished from 'normal' because" they cause significant impairment to daily activity." Symptoms usually disappear when the period starts.
  • Approximately 5% of women experience severe premenstrual symptoms which include depression, anxiety, irritability and loss of confidence, and physical symptoms including bloating and mastalgia and this can be known as premenstrual dysphoric disorder (PMDD).
  • There is no clear agreement on the best management of PMS. A wide range of treatment options are promoted with varying levels of evidence.

Causes

No one knows for sure what causes PMS. As the symptoms start mid-cycle after ovulation (when the egg is released) it is thought that the hormonal changes which normally occur during each menstrual cycle may produce a variety of symptoms.

These hormonal changes (the main hormones are called oestrogen and progesterone) affect women differently and can be further altered by lifestyle, hereditary factors, nutritional status, and the emotional state of the woman at the time when PMS symptoms appear. That is why some women have very mild symptoms and other women have severe symptoms impacting them for days at a time. 

More studies are being carried out to determine the cause of PMS. Many of the symptoms are similar to those experienced by women during pregnancy, and in the years before and during menopause.

PMS is not usually due to a lack of a particular hormone or because you have 'too many' hormones.

Symptoms

The symptoms of PMS are not the same for every woman. The most common are:

Other less common symptoms include:

  • sleep disturbances
  • food cravings
  • skin problems such as pimples
  • joint pain
  • hot flushes
  • mild to severe personality changes
  • feeling hostile towards others
  • irregular heartbeat and palpitations
  • feeling indecisive
  • those who have asthma sometimes find it gets worse at this time.

PMS is diagnosed by your symptoms and by excluding other illness. Blood tests for hormonal levels are of little value as symptoms can occur at any hormonal level.

Treatment

A symptom diary

Treatment aims to relieve your particular symptoms. Keeping a daily record will help you clarify what your main symptoms are and when they occur. This information will help you and your doctor decide what treatment may suit you best. Make a note of things such as:

  • whether you are taking an oral contraceptive
  • what and when you eat
  • whether you smoke, drink or take other recreational drugs, and if so, how much
  • your stress levels at work or home
  • at what stage of your menstrual cycle you first notice symptoms of PMS
  • the amount and type of exercise you do
  • see - symptom diary -Healthwise USA

Medication

Prescription medicines: Prescription medicines can also be helpful for women who have not been able to control their symptoms with lifestyle changes. Diuretics (water pills) have been given in the past to reduce the bloated feeling. This is not such a popular choice now, but is still prescribed occasionally. Some doctors prescribe hormones in the form of tablets.

Antidepressants: Antidepressants are another form of medication. Any medication requires regular medical supervision, so remember to have a six-monthly check with your doctor. If your symptoms do not improve or if they get worse, seek further assistance from your doctor.

Calcium or vitamin B6: Some women find calcium or vitamin B6 useful in controlling PMS symptoms. Calcium can be taken every day and vitamin B6 can be taken a few days before PMS symptoms start and continued until your period commences. Evidence from studies suggests the effective dose of calcium supplementation for PMS symptoms is about 1000mg per day; there is also some evidence that a calcium-rich diet may be beneficial for symptoms, e.g. four servings of low-fat dairy products a day.

Calcium and vitamin B6 do not require a prescription and can be bought from pharmacies, supermarkets and health food shops. Remember to read the instructions on the bottle for the correct dosage – check with your pharmacist if unsure. Let your doctor know if you are taking either of these supplements, particularly if you are on prescribed medicines or are at higher risk of heart disease.

Complimentary health measures

Other choices such as acupuncture, massage or yoga to relax you or relieve your symptoms are proving to be very beneficial for many women.

Self care

  • Make sure you eat regularly and sensibly, including plenty of fresh fruit and vegetables each day. Avoid salt, caffeine, alcohol and excessive fluids.
  • Exercise regularly. Exercise helps in a number of ways. A daily walk at least five times a week for 30 minutes is relaxing and releases natural antidepressants (endorphins) into the system which, in turn, reduces your stress levels. It also gives you time to think on your own. As a weight-bearing exercise it will often help to reduce any joint pain you may have.
  • Get a good night's sleep.

Learn more

Premenstrual syndrome (PMS) Office of Women's Health - U.S. Department of Health and Human Services
Slideshow: A Visual Guide to Premenstrual Syndrome (PMS)  WebMD, 2014
Premenstrual syndrome (PMS) Medline Plus - U.S. Department of Health and Human Services National Institutes of Health, 2014

References

Premenstrual Syndrome, Management (Green-top Guideline No. 48) Royal College Obstetricians & Gynaecologists, UK

Credits: Written by Anna Mickell RCpN. Reviewed by Dr Helen Roberts, University of Auckland, May 2011. Reviewed By: Editorial team Oct 2015