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Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) is a mixture of physical and emotional symptoms. Some women have them during the days, or sometimes weeks, leading up to their menstrual period.

Nine out of 10 women have some form of premenstrual symptoms. They start in the second half of your menstrual cycle and go away when your period starts, or just after. PMS is where these symptoms cause significant disruption to your daily activities and is most common in young and middle-aged women. Older teenage girls tend to have more severe symptoms than younger teenage girls, and women in their 40s tend to be affected most severely.

PMS can range in severity from mild to severe. Mild PMS causes some discomfort, but doesn’t interfere with your life. If you have moderate PMS, your symptoms interfere with your personal, social and working life. You’re still able to function each day, although maybe not to your usual level. If you have severe PMS, your symptoms are so severe that the condition affects your quality of life and relationships.

A more severe form of PMS is premenstrual dysphoric disorder. Emotional symptoms, such as mood swings, depression and irritability, are more common in premenstrual dysphoric disorder. The condition can interfere significantly with your everyday life. It affects between three and eight women in every 100.

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Details

  • Symptoms Symptoms of PMS

    There are many symptoms associated with PMS. The most common symptoms can be grouped into emotional and physical symptoms.

    Emotional and behavioural symptoms can include:

    • anxiety
    • mood swings
    • tiredness
    • irritability, anger or aggression
    • depression
    • a loss in confidence
    • clumsiness
    • difficulty sleeping

    Physical symptoms can include:

    • headaches
    • feeling bloated
    • increase in appetite or food cravings
    • pain in your joints
    • tender breasts
    • abdominal (tummy) pain
    • backache
    • spots

    These symptoms aren't unique to PMS – it's the timing of the symptoms that indicate if you have the condition. If you have PMS, your symptoms will:

    • appear during the two weeks leading up to your menstrual period
    • get better by the end of your period
    • come back each month

    If you have premenstrual dysphoric disorder, your symptoms will be similar to those for PMS, but more severe and will include significant emotional symptoms . The most significant symptom tends to be irritability.

    These symptoms may be caused by problems other than PMS and premenstrual dysphoric disorder. If you have any of these symptoms, contact your GP for advice.

  • Diagnosis Diagnosis of PMS

    If you think you have PMS, keep a diary of your symptoms for two or three menstrual cycles before you visit your GP. This will help to see if your symptoms are related to your menstrual cycle.

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    There are no specific tests that can diagnose PMS. Your GP will usually make a diagnosis based on your description of your symptoms and when they occur.

    It's important to distinguish between PMS and other problems that could be causing similar physical or emotional symptoms. Your GP may ask you to have some blood or urine tests to rule out other illnesses that could be causing your symptoms.

  • Treatment Treatment of PMS

    There isn’t a cure for PMS, but there are a number of treatments that can help relieve your symptoms. Continue to use a diary to record your symptoms to see if your treatment is effective.

    Self-help

    If you keep a symptom diary, you may find that your physical or emotional symptoms are linked with your period. You can then predict more accurately how you will feel at certain times of the month. This helps you plan your time so you can try to prevent being in stressful situations in the second half of your menstrual cycle.

    Regular exercise may help to improve your symptoms. Aim to do at least 150 minutes (two and a half hours) of moderate intensity physical activity during the week.

    Your GP may advise you to eat a diet, such as regular meals that include small amounts of low sugar, starchy carbohydrates. These include wholegrain carbohydrates such as wholemeal bread and porridge.

    Reducing the amount of salt you eat may minimise bloating and tender breasts that you may have with PMS. Limiting caffeine may also improve breast pain. But more research is needed to prove these effects on PMS – although these changes to your diet may benefit your overall health.

    At the moment, there is conflicting scientific evidence about taking vitamin B6 supplements for PMS. High doses may damage your small nerve endings so speak to your GP for advice before you start taking a supplement.

    Medicines

    If you have pain from premenstrual headaches, backache or other aches and pains, you can take over-the-counter painkillers, such as ibuprofen or paracetamol. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    If you have symptoms that disrupt your life, and don't improve with self-help measures or painkillers, contact your GP for advice. He or she may prescribe medicines, depending on the type of symptoms you have. Some of these are listed below.

    • The combined contraceptive pill, for example, one with drospirenone and oestrogen, prevents ovulation and may help with some symptoms, possibly by stabilising the levels of your hormones.
    • Medicines called selective serotonin re-uptake inhibitors (SSRIs), such as fluoxetine, can be effective. These are antidepressant medicines, but may help both the physical and behavioural symptoms of PMS.

    If your symptoms are still severe, your GP may refer you to a specialist. Your specialist may offer you further medicines, which may include the following.

    • A diuretic (water tablet), such as spironolactone, which may help to relieve symptoms, such as tender breasts and bloating, and improve mood.
    • An oestrogen patch plus progesterone, which may help to balance out fluctuating hormone levels. However, there isn't enough scientific evidence to know whether there may be long term side-effects from this treatment.
    • A medicine called a gonadorelin analogue. This is a synthetic form of the hormone, gonadotropin releasing hormone (GnRH), which helps to reduce the level of oestrogen produced by your body. Your specialist will only offer it to you if you have severe PMS as it can have harmful side-effects (such as osteoporosis).

    Talking therapies

    If you have severe PMS, cognitive behavioural therapy (CBT) is a treatment option. This is a short-term psychological treatment. It helps to challenge negative thoughts, feelings and behaviours and is often used to treat anxiety and depression. Ask your GP for more information.

    Surgery

    A hysterectomy (removal of the womb) with oophorectomy (removal of the ovaries) is a permanent solution to PMS as it stops your menstrual cycle completely. The procedure is only rarely carried out for PMS.

    If you're considering this operation, your specialist may suggest an injection of a gonadorelin analogue first to see if this improves your symptoms. If this makes no difference, it means your symptoms aren't linked to your menstrual cycle and therefore it's unlikely that surgery will help.

    Complementary therapies

    Research on whether complementary therapies, such as herbal remedies, can improve symptoms of PMS is conflicting and there is little scientific evidence. If you’re considering a complementary therapy for PMS, ask your GP or pharmacist for advice.

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  • Causes Causes of PMS

    The exact reasons why you may get PMS aren't fully understood at present.

    One theory is that getting PMS means you're particularly sensitive to the varying levels of hormones in your body at certain times of the month. It's possible that these hormones also interact with your brain's mood-controlling chemicals (such as serotonin).

    There are also certain factors that can make you more likely to get PMS. For example, if you’re obese and don’t exercise, you’re more likely to get PMS. If you smoke, you double your risk of having more severe PMS symptoms.

  • FAQs FAQs

    Are there any complementary treatments that I can try to relieve my PMS?

    Answer

    Some women find that complementary treatments can be helpful in easing symptoms of PMS. However, there is limited scientific evidence to say that they actually work.

    Explanation

    Complementary medicines used to treat symptoms of PMS include:

    • acupuncture
    • homeopathy
    • reflexology
    • Gingko biloba
    • Agnus castus
    • light therapy
    • chiropractic

    A lot of scientific studies have investigated how effective these treatments are in relieving PMS symptoms. As yet, there is no good evidence to confirm that they work.

    But some women do find that they help. Talk to your pharmacist or GP if you want to try complementary therapies because some interact with other medicines.

    I've heard that taking evening primrose oil can help ease the symptoms of premenstrual syndrome (PMS) - is this true?

    Answer

    Evening primrose oil is one of the most popular self-help remedies for PMS. However, there is currently little evidence to show that it can reduce symptoms.

    Explanation

    The exact reasons why some women get PMS aren't fully understood at present. Evening primrose oil has been used as a treatment for PMS because it contains essential unsaturated fatty acids. These are important for a range of reasons, one of which may be the production of chemicals involved in regulating your periods.

    Many studies have been carried out to see how effective evening primrose oil is in relieving symptoms of PMS. So far, none of the research has shown conclusively that it has any effect.

    My partner has PMS, which makes her irritable and moody every month before her period - what can I do to help her?

    Answer

    PMS can cause mood swings and irritability, putting a strain on your relationship. It's important to acknowledge that your partner is feeling unwell and to offer her any support she needs.

    Explanation

    Symptoms of PMS can affect a woman's emotional wellbeing, causing her to behave out of character. Some women become depressed and tired, whereas others become moody and irritable. It's important that you take her seriously and acknowledge her concerns without simply attributing everything to 'that time of the month'.

    Offering support can help a great deal. Ask your partner about how she's feeling and encourage her to talk about it. Reassure her by reminding her that she felt the same last month and that her symptoms passed. Try to make her feel more positive about herself. Taking charge of the household chores or childcare will give her some free time to herself and may also help her cope better.

    If your partner says or does things that upset you, try not to take them personally. It's important that you talk about how her PMS is affecting both your lives. But it's best to wait and do this after her period has started when she's feeling more herself again. Try not to be critical or blaming, remember that the symptoms she's having are out of her control. Work together to come up with an action plan to try and combat her monthly symptoms – this may include seeing her GP for more help.

    If you or your partner have any concerns about PMS, it's important to talk to your GP.

    What is the difference between PMS and premenstrual dysphoric disorder?

    Answer

    Premenstrual dysphoric disorder is the term used to describe a more severe form of PMS. This term is not used very much outside of the US. Severe PMS can cause major disruption to your life and to your relationships. It's far less common than PMS, affecting between three and eight women in every 100.

    Explanation

    Premenstrual dysphoric disorder can seriously interfere with your life and make the weeks before your period unbearable. You’re likely to have premenstrual dysphoric disorder if you have at least five different symptoms in the week before your period starts. You will also have had them for most months in the past year. The symptoms include:

    • a depressed mood or feeling hopeless
    • feeling sensitive and crying easily
    • irritability and anger
    • poor concentration
    • tension and anxiety
    • a loss of interest in your usual activities
    • altered eating habits or food cravings
    • disturbed sleep – sleeping a lot or being unable to sleep
    • lack of energy and extreme tiredness
    • feeling overwhelmed or out of control
    • headaches
    • tender breasts
    • gaining weight
    • feeling bloated

    If you think you have any of the symptoms listed above, speak to your GP. He or she will ask you to describe your symptoms and when they occur. Your doctor will ask you to keep a diary of your symptoms over the next two months. This will help to establish how severe your condition is and which treatment will suit you best.

    Treatment is usually a combination of self-help methods such as exercise and a healthy diet, along with medicines, such as selective serotonin re-uptake inhibitors (SSRIs). These are antidepressant medicines, but appear to have a positive effect on both the physical and behavioural symptoms of PMS. They can take several weeks to start working so it's important to keep taking your medicine. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    If you have any questions or concerns about premenstrual dysphoric disorder, talk to your GP.

  • Resources Resources

    Further information

    Sources

    • Premenstrual syndrome. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 21 December 2009
    • Premenstrual syndrome. Medscape. www.emedicine.medscape.com, published 21 March 2012
    • Premenstrual syndrome (PMS) – primary care. Map of Medicine. www.mapofmedicine.com, published 23 September 2013
    • Premenstrual syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2009
    • Premenstrual dysphoric disorder. Medscape. www.emedicine.medscape.com, published 4 November 2013
    • Anaemia. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk published February 2013
    • UK physical activity guidelines. Department of Health. www.gov.uk, published July 2011
    • Bayles B. Evening primrose oil. Am Fam Physician 2009.15;80(12):1405–08.
    • Koeppen BM and Stanton BA. Berne & Levy Physiology. 6th ed. St Louis: Mosby, 2009:775
    • Jones A. Homeopathic treatment for premenstrual symptoms. J Fam Plann Reprod Health Care. Jan 2003;29(1):25–8
    • Cognitive behavioural therapy. Royal College of Psychiatrists. www.rcpsych.ac.uk, published July 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 4 December 2013 (online version)
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    Reviewed by Dylan Merkett, Bupa Health Information Team, January 2014.

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