Premenstrual syndrome (PMS)
Your health experts: Dr Madhavi Vellayan, Consultant Gynaecologist and Dr Ade Adeniyi, Bupa Clinics GP
Content editor review by Dr Kristina Routh, July 2021
Next review due July 2024
Premenstrual syndrome (PMS) is the name given to a range of symptoms that you can get in the days or weeks before your monthly period. Most people who have periods get some symptoms but if these cause problems in your daily life, you can get help. Treatments for PMS include lifestyle changes and medication.
About premenstrual syndrome
Most people who have periods have some premenstrual symptoms at some time in their lives. These may include bloating, tender breasts or headaches before your period. Mild premenstrual symptoms can be uncomfortable but may not bother you too much. When these symptoms are bad enough to interfere with your daily life, it’s called premenstrual syndrome.
Premenstrual syndrome affects up to three in 10 women. If it affects you, you may find that your work and social lives are severely affected by your symptoms.
Premenstrual dysphoric disorder (PMDD)
Premenstrual dysphoric disorder (PMDD) is a severe form of PMS which affects your mental health. Between two and eight women in every 100 get PMDD. The symptoms of PMDD are similar to PMS but you’ll probably feel much more angry, anxious and irritable. PMDD is a distressing condition to have, and you’ll need treatment.
Symptoms of premenstrual syndrome
There are many different PMS symptoms. Everyone’s experience is different and PMS symptoms may vary from month to month. Your symptoms may get worse if you’re under stress. 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-worth
- clumsiness
- difficulty sleeping
- forgetfulness and difficulty concentrating
Physical symptoms include:
- feeling bloated
- tender breasts
- headaches
- feeling more hungry than usual or craving certain foods
- tummy (abdominal) pain
- constipation or diarrhoea
- general aches and pains
- feeling or being sick
- spots
- hot flushes or cold sweats
The timing and severity of your symptoms will indicate whether or not you have PMS. If you do have PMS, your symptoms will:
- appear in the two weeks before your menstrual period
- get better when you start your period, or soon after
- affect your day-to-day life
If you’re finding it difficult to manage your symptoms yourself or they’re severely affecting your daily life, contact your GP.
Premenstrual dysphoric disorder symptoms
The symptoms of PMDD are similar to those of PMS, but the emotional and behavioural symptoms are likely to be much worse. Your symptoms may have a severe effect on your quality of life. If you think you have PMDD, you should contact your GP.
Diagnosis of premenstrual syndrome
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 at least two months before you go and see a GP. This will help you and your GP 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. They may, for instance, offer you a blood test to rule out thyroid problems.
Self-help for premenstrual syndrome
There’s a lot you can do yourself to help your PMS symptoms, especially if they’re mild. It may take a while to find what works for you.
If you have PMS or PMDD symptoms, here are some self-help tips.
- Keep a diary of your symptoms to help you see what works to improve them.
- Be more active. Regular exercise may improve your symptoms, and some people find yoga helpful.
- Eat a healthy balanced diet. You may find it helps to have smaller meals more often. Try to include small amounts of starchy carbohydrates with each meal, such as wholemeal bread, pasta, rice and potatoes. Avoid sugary snacks and reduce salt.
- Avoiding caffeine and alcohol may help ease some of your symptoms.
- Try to reduce stress. Do activities that you find relaxing and try mindfulness exercises. If possible, tackle stressful tasks when you’re likely to be free from PMS symptoms.
- Try to get enough sleep.
- Wearing a supportive bra both day and night may help breast tenderness. Loose clothing may be more comfortable if you’re feeling bloated.
- Over-the-counter painkillers such as ibuprofen or paracetamol can help ease headaches or other aches and pains. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist.
Some people find that certain food supplements or herbal remedies help their PMS symptoms. But it’s still not clear how well any of these work. If you’re considering taking supplements or herbal remedies for PMS symptoms, talk to your pharmacist. They can give you advice about safe doses and possible interactions with other medicines you’re taking.
Treatment of premenstrual syndrome
If self-help measures don’t work to ease your PMS symptoms, other treatments are available. Premenstrual dysphoric disorder (PMDD) is treated in a similar way to PMS.
Medicines for PMS
Your GP may recommend the combined contraceptive pill. The combined pill prevents ovulation and affects your hormone levels. It’s not possible to predict if this will actually work to ease your PMS symptoms. You may sometimes be advised to take these pills every day, without a break, to help to ease your symptoms.
If you have severe symptoms, medicines called selective serotonin re-uptake inhibitors (SSRIs) may help. These are antidepressants, but they may help PMS symptoms. They may be especially useful for emotional and behavioural symptoms rather than physical ones. If you’re under 18, a specialist will need to decide if this is the right treatment for you.
If initial treatments don’t help, your GP may refer you to a doctor who specialises in PMS. Your doctor 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 balance hormone levels in your body along with hormone replacement therapy (HRT). Your specialist will only offer these if you have severe PMS and other treatments haven’t worked for you. This is because GnRH analogues can cause osteoporosis if given without HRT.
Talking therapies for PMS
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 for PMS
Surgery to have your ovaries removed (oophorectomy) is used only as a last resort for PMS. It stops your periods completely so you will become menopausal. You should only consider surgery if you’re sure you don’t want to become pregnant in future.
If you're considering this operation, your doctor may suggest you have an injection of a GnRH analogue first. A GnRH analogue reduces your oestrogen levels and stops your periods. You might be given hormone replacement therapy to counteract the symptoms of hormone deficiency. This will give you an idea of what you might feel like after the surgery. It will also help show if surgery would work to ease your PMS symptoms.
Causes of PMS
We don’t know what causes PMS. It may be linked to the changing hormone levels in your body at certain times of the month. Some people may be more sensitive to these than others. These hormones interact with your brain's mood-controlling chemicals (such as serotonin).
You may be more likely to get PMS or PMDD if you:
- have a close relative with it
- have had depression in the past
- smoke
- have gained weight
- are under stress
- have been sexually abused or suffered domestic violence
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At the moment, there’s little evidence to show that evening primrose oil can reduce PMS symptoms. But some people find it helps with breast tenderness just before a period. If you’re considering taking evening primrose oil, ask a pharmacist for advice.
If your partner has PMS, their symptoms may put a strain on your relationship. Try not to be critical or blaming – remember that these symptoms are out of their control. They may find it difficult to deal with day-to-day activities when experiencing symptoms. So, think about any practical things you can do to help, and give your partner time to relax. Offer support with the things we list in our section on self-help for PMS. Encourage your partner to contact their GP if these don’t help.
Benefits of exercise
Not only does regular exercise help you manage your weight and reduce your risk of developing diseases, it can help prevent and treat mental health problems
Seven tips for a healthy and well-balanced diet
A healthy, well-balanced diet involves eating foods from a variety of food groups to get the nutrients that your body needs to function.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy. It helps you change how you think, feel and behave.
Over-the-counter painkillers
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- Personal communication, Dr Madhavi Vellayan, Consultant Gynaecologist, July 2021
