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Premenstrual syndrome (PMS)


Expert reviewer, Dr Raj Mathur, Consultant Gynaecologist
Next review due January 2020

Premenstrual syndrome (PMS) is the name given to a range of symptoms that a woman can get in the days or weeks before her monthly period.

Nine out of 10 women notice certain symptoms before their period, such as bloating, tender breasts and headaches. Called ‘premenstrual symptoms’, these can start in the two weeks before your period begins and go away around the time your period starts.

Mild premenstrual symptoms can be uncomfortable but won’t affect your daily activities. If you have more severe symptoms, it can have a huge impact on your work and social life. PMS tends to be worse in older teenage girls and women in their 40s.

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Symptoms

PMS is associated with many different symptoms. Every woman’s experience is different and may vary from month to month. However, if you have PMS, you’ll have both emotional and physical symptoms.

Emotional and behavioural symptoms include:

  • anxiety
  • mood swings
  • tiredness
  • irritability, anger or aggression
  • depression
  • reduced self-confidence
  • clumsiness
  • difficulty sleeping

Physical symptoms include:

  • headaches
  • feeling bloated
  • feeling more hungry than usual or craving certain foods
  • tender breasts
  • abdominal (tummy) pain
  • constipation or diarrhoea
  • general aches and pains
  • feeling or being sick
  • backache
  • spots

The timing and severity of your symptoms will indicate whether or not you have PMS. If you do have PMS, your symptoms will:

  • appear during the two weeks before your menstrual period
  • get better by the end of your period

Premenstrual dysphoric disorder is a more severe form of PMS. It affects between two and eight women in every 100. The symptoms are similar to those of PMS, but the mood swings, especially irritability, are likely to be much worse. See the FAQ on premenstrual dysphoric disorder for more information.

You may have some, or all, of these symptoms without having PMS. Some PMS symptoms are a sign of other long-term health problems.

If you have PMS, you will usually be able to manage your symptoms at home. But if you’re finding this difficult or your symptoms are affecting your daily life, speak to your GP.

Diagnosis

You may not need to see a doctor for a diagnosis of PMS, if you’re able to manage your symptoms yourself.

If you think you have PMS, keep a diary of your symptoms for two or three months before seeing a GP. This will help to you to see if your symptoms are related to your periods.

PMS can’t be diagnosed with any specific tests. So your GP will usually make a diagnosis based on your description of your symptoms and when they occur. They may need to rule out other underlying health conditions that could be causing similar symptoms, such as thyroid problems. You’ll need to have a blood test for this.

Self-help

PMS can’t be cured but there are certain things you can do yourself that may help your symptoms, especially if these are mild. It may take a while to find something that works for you. Keeping a diary of your symptoms will mean you and, if necessary, your GP can see if any particular treatments are helping.

Reducing your stress levels may help to ease your PMS. Make a note of when your next period is due. Then you can keep more stressful tasks for when you’re likely to be free from PMS symptoms. Try relaxation techniques, and make sure you get plenty of sleep.

Regular exercise may improve your symptoms, especially bloating, irritability, anxiety and insomnia. Some women find yoga helpful.

You may be able to ease your symptoms by making sure you eat regular meals (every two to three hours). Try to include small amounts of starchy carbohydrates with each meal, such as bread, pasta, rice and potatoes. Eat plenty of fruit and vegetables during the day and don’t eat sweet snacks between meals.

If you have tender breasts, cut down on saturated fat and caffeine. Switching to fennel tea or chamomile tea instead of caffeinated tea may help. Wearing a supportive bra, day and night, may also help.

Wearing support stocking or tights may help to ease aching legs.

If you suffer from bloating, cutting down on salt in your diet may help. You may also feel more comfortable if you wear loose clothing. Some women take natural diuretics, but there’s little research to show these work.

It’s still not clear whether or not specific food supplements can help PMS symptoms. Some research has found that vitamin B6, calcium and vitamin D, and magnesium supplements may help, but more research is needed. If you want to try vitamin B6 supplements, start off by taking 10mg a day. High doses of vitamin B6 may damage your small nerve endings, so don’t take more than 100mg a day. A pharmacist can give you advice before you start taking a dietary supplement.

If your PMS is associated with 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. If you have any questions, ask your pharmacist for advice.

Medicines

If your symptoms don't get better with self-help measures and over-the-counter painkillers, speak to your GP. They may be able to prescribe certain medicines to help ease certain PMS symptoms.

Your GP may suggest you try taking the combined contraceptive pill, especially if you need contraception as well as PMS relief. The combined pill prevents ovulation and affects your hormone levels. It may help with the breast pain and bloating of PMS, but not mood symptoms. Some women find the pill helps their PMS symptoms, and others don’t – it’s not possible to predict who will benefit.

If you have severe symptoms, medicines called selective serotonin re-uptake inhibitors (SSRIs), such as fluoxetine, may help. These are antidepressants, but they may help severe emotional and physical PMS symptoms. They may be especially useful for anxiety, irritability and other mood-related symptoms. They’re not suitable for anyone under 18. Your GP may be able to prescribe these medicines, but you often need to be referred to a consultant for this treatment for PMS.

If initial treatments don’t help, your GP may refer you to a consultant who specialises in PMS. Your consultant may offer you other medicines, which may include the following.

  • A diuretic (water tablet), such as spironolactone, to relieve tender breasts and bloating.
  • An oestrogen patch (usually with a progestogen) to balance out changing hormone levels.
  • Gonadotropin releasing hormone (GnRH) analogues to reduce oestrogen levels in your body. These can help with physical and emotional PMS symptoms. Your specialist will only offer these if you have severe PMS as GnRH analogues can have harmful side-effects (such as osteoporosis).

Talking therapies

If you have moderate to severe PMS, you could try cognitive behavioural therapy (CBT).

CBT is a type of talking therapy. It helps you change how you think, feel and behave in response to your PMS. You’ll learn how to recognise negative or unhelpful thinking patterns and replace them with positive or helpful ones.

Ask your GP whether CBT is available in your area. In some areas, your GP may be able to refer you to a suitable therapist.

Surgery

Surgery to have your ovaries removed (oophorectomy) is a permanent solution to PMS as it stops your periods completely. It’s used only as a last resort for PMS though, and only if you’re sure you don’t want any (or more) children.

If you're considering this operation, your specialist may suggest you have an injection of a GnRH analogue first to see if this helps your symptoms. A GnRH analogue reduces your oestrogen levels and stops your periods. If this makes no difference, it means your symptoms aren't linked to your periods so surgery’s unlikely to help.

Complementary therapies

There’s little scientific evidence to show that complementary therapies, such as herbal remedies, acupuncture or homeopathy, can improve PMS symptoms. However, some women do decide to give them a try. You can buy herbal and homeopathic remedies from a pharmacy, and you can ask the pharmacist for advice if you need it.

Causes

It’s not clear why some women get PMS and others don’t.

It’s possible that women who get PMS are particularly sensitive to changing hormone levels in their body at certain times of the month. These hormones interact with the brain's mood-controlling chemicals (such as serotonin).

Certain factors can make you more likely to get PMS. If your mother had PMS, you’re likely to experience it too. If you’re very overweight or smoke cigarettes, you’re also more likely to get PMS.

Frequently asked questions

  • There’s currently little evidence to show that evening primrose oil can reduce PMS symptoms. It’s no longer recommended by doctors as a PMS treatment. But some women find it can help with breast tenderness that occurs just before a period.

    Evening primrose oil contains an essential unsaturated fatty acid called gamolenic acid (GLA). GLA is converted in the body into chemicals called prostaglandins. Prostaglandins have anti-inflammatory action.

    If you try evening primrose oil, you may need to take it for four months before you notice any effect on your symptoms. Evening primrose oil can cause side-effects, including headache, nausea and diarrhoea. It may also cause seizures (fits) in people with epilepsy.

  • PMS often causes mood swings. It can make some women feel depressed and tired and others grumpy and irritable. Your partner may find it more difficult to deal with her usual day-to-day activities around this time, which may put a strain on your relationship. It can really help to offer your partner support if she’s feeling unwell and let her know you understand how she’s feeling.

    Encourage her to talk about her PMS. Think about any practical things you can do to give your partner more time to relax, which may help her to cope better.

    If your partner says or does things that upset you, try not to take them personally. It's important to 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 her symptoms are out of her control. Work together to come up with an action plan to try to combat her monthly symptoms. This may include your partner keeping track of her symptoms in a diary, and seeing her GP to discuss potential treatment options.

  • Premenstrual dysphoric disorder (PMDD) is the term used to describe a very severe form of PMS. It affects between two and eight women in every 100.

    If you have PMDD, your symptoms are similar to those of PMS, but your anger and irritability are likely to be much worse. You may have little interest in your usual daily activities, which can be very distressing and affect your whole life. PMDD can make the weeks before your period unbearable.

    You may be given a diagnosis of PMDD if you have at least five of the following symptoms in the week before your period starts. At least one of your symptoms will be one of the top four in the list. These may include:

    • severe mood swings
    • severe irritability or anger
    • depression and feelings of hopelessness
    • severe tension and anxiety, or feeling on edge all the time
    • less interest in your usual daily activities
    • difficulty concentrating
    • low energy levels
    • severe tiredness
    • changes in your appetite, such as overeating or food cravings
    • sleep problems, such as too little sleep or too much sleep
    • feeling out of control
    • physical PMS symptoms, such as insomnia and tender breasts.

    These symptoms will completely, or almost completely, disappear during the week after your period. If you think you may have PMDD, speak to your GP.

    Keeping a symptom diary for two months will help your GP recommend the best treatment for you. They may suggest you try lifestyle changes, such as doing more exercise and making changes to your diet. They may also prescribe some medicines, such as selective serotonin re-uptake inhibitors (SSRIs). Always ask your doctor for advice and read the patient information leaflet that comes with your medicine. For very severe PMDD, you will need to be referred to a specialist doctor.

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


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Related information

    • Premenstrual syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2014
    • Reproductive psychiatry, sexual dysfunction and sexuality. Oxford handbook of psychiatry (online). 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published December 2015
    • Premenstrual syndrome. PatientPlus. patient.info/patientplus, last checked April 2015
    • Premenstrual syndrome. Medscape. emedicine.medscape.com, updated September 2016
    • Premenstrual syndrome (PMS). The MSD Manuals. www.msdmanuals.com, last full review/revision November 2015
    • Premenstrual syndrome and dysphoric disorder. BMJ Best Practice. bestpractice.bmj.com, last updated April 2016
    • Women’s health: Premenstrual disorders. GP Update (online). GP Update Ltd, gpcpd.com, accessed October 2016
    • Gynaecology. Oxford handbook of general practice (online). 4th ed. Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Vitamin B Group. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed October 2016
    • Vitamin B Group: Pyridoxine hydrochloride. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed October 2016
    • What is CBT? British Association for Behavioural and Cognitive Psychotherapies. www.babcp.com, published October 2012
    • Cognitive and behavioural therapies. PatientPlus. patient.info/patientplus, last checked April 2014
    • Mental Health. Oxford handbook of general practice (online). 4th ed. Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Psychotherapy. Oxford handbook of psychiatry (online). 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published March 2013
    • Breast disease. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
    • Evening Primrose Oil (Herbs/supps). Medscape. reference.medscape.com, accessed October 2016
    • Oxford handbook of clinical pharmacy (online). 2nd ed. Oxford Medicine Online. oxfordmedicine.com, published January 2012
  • Reviewed by Pippa Coulter, Specialist Health Editor, Bupa Health Content Team, January 2017
    Expert reviewer, Dr Raj Mathur, Consultant Gynaecologist
    Next review due January 2020



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