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Premenstrual syndrome (PMS)

Key facts

  • Symptoms of premenstrual syndrome (PMS) start in the second half of your menstrual cycle and stop after your period starts.
  • Symptoms can be emotional, such as depression, mood swings or irritability, and/or physical, such as breast tenderness, bloating and spots.
  • Eating a well balanced diet and taking regular exercise may help to improve PMS symptoms.

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.

About PMS

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.

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.

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.

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 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.:

  • 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.

Reviewed by Dylan Merkett, Bupa Health Information Team, January 2014.

Find out more about our health editors

For answers to frequently asked questions about premenstrual syndrome (PMS), see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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