Premenstrual syndrome (PMS)


Premenstrual syndrome (PMS) refers to the range of physical and emotional symptoms many women experience in the lead up to a period. Premenstrual dysphoric disorder (PMDD) is a more serious form of PMS. Here you will find information on PMS, PMDD symptoms, causes and treatments.

What is PMS?

In the days leading up to a period (menstruation) up to 30% of women experience emotional and physical symptoms, often called premenstrual syndrome (PMS). Most women experience one or two premenstrual symptoms that can be managed. Symptoms start about four to ten days before a period and usually stop after bleeding begins.

PMS

What are the symptoms of PMS?

Symptoms of PMS vary in intensity from woman to woman and can vary from one cycle to the next. The most common symptoms include:

Emotional symptoms

Physical symptoms

  • irritablity
  • anxiety
  • nervous tension
  • lower coping ability
  • difficulty concentrating
  • wanting to be alone
  • lower libido
  • reduced interest in work and social life
  • mood swings
  • depression
  • aggression
  • fluid retention (swollen fingers or ankles)
  • bloating around the abdomen
  • breast swelling and tenderness
  • skin problems such as acne
  • headaches and/or migraines
  • poor coordination or clumsiness
  • tiredness, lethargy, insomnia
  • increase in weight
  • constipation and/or diarrhoea
  • food cravings
  • aches and pains

What is premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a more serious form of PMS. Women who have PMDD experience severe PMS symptoms that interfere with daily life. PMDD affects about three to eight per cent of menstruating women.

Causes of PMS & PMDD

It's not clear why some people develop PMS and PMDD. There appear to be very complex interactions between certain chemicals in the brain and progesterone that lead to symptoms. PMS does not occur if there is no ovulation or post menopausally[1].  Stress levels, psychological state, poor physical health, our genetic makeup, cultural and social environment and changes in neurotransmitters (like serotonin) may all influence the development of PMS symptoms. Having a high body mass index (BMI) and smoking are also risk factors.

How are PMS & PMDD different to depression?

PMS and PMDD have similar symptoms to depression but with PMS and PMDD, the symptoms get better completely as soon as menstruation begins, but those of depression do not.

PMS and PMDD need to be distinguished from underlying depression because the treatments are different.

Management & treatment of PMS symptoms

There are a number of things you can do yourself to manage and reduce your PMS symptoms.

Be physically active

Physical activity increases endorphins (feel good hormones) that can reduce symptoms. Endorphins also act as natural painkillers and help you feel more relaxed and in control.

Choose a form or variety of physical activity you enjoy, and aim for 30 minutes of moderate intensity activity on most, if not all days, especially when symptoms are at their worse.

Reduce stress levels

Stress can exacerbate PMS symptoms.

Talk to your family about your PMS and help them develop strategies to be supportive during this time and take time out to relax and enjoy your own interests.

If you feel your levels of stress are increasing, consider professional counselling as cognitive behavioural therapy (CBT) and relaxation therapies can assist.

Maintain a healthy lifestyle

  • Eat regular, healthy meals including plenty of vegetables, fruit, mixed grains and cereals
  • Eat small meals to maintain stable energy levels
  • Drink less caffeine, particularly if you are suffering breast tenderness
  • Try drinking 6-8 glasses (1.5-2 litres) of water each day
  • Cut down salt and salty foods to help reduce fluid retention
  • Get enough rest, sleep and exercise to help manage stress
  • Try relaxation techniques like yoga or meditation
  • Don't smoke – if you need help, call the Quitline on 13 7848 or visit www.quit.org.au
  • Wear a well-fitting cotton bra if you suffer tender, painful breasts
  • Write down your symptoms to help you identify a pattern for things that might trigger or worsen your symptoms

Vitamins, minerals and herbs

Although the evidence is not strong, some supplements that may be effective in treating PMS include:

  • vitamin E
  • magnesium pyrrolidone
  • vitamin B6
  • chaste tree

Calcium has been shown to improve symptoms in the dose of about 600mg twice a day

Consult your health practitioner before taking any supplement, as they may have unwanted effects or interact with other medications you are taking.

Complementary therapies

Complementary therapies such as acupuncture or naturopathy may be helpful in relieving psychological and/or physical symptoms for some women. However, a lack of controlled studies means there is no clear evidence of their benefits.

Hormonal treatments

These treatments can suppress ovulation and reduce the hormones of the premenstrual phase. Hormone therapies can include contraceptive therapies such as the oral contraceptive pill. Consult your doctor for further information regarding hormone treatment options.

Medication

There is a range of medications available that have been proven to help, such as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), anti-prostaglandin (for pain/cramps), anti-inflammatories, and spironolactone diuretic (for bloating). See your doctor to discuss these.

Things to keep in mind:

  • Premenstrual syndrome (PMS) refers to the range of emotional and physical symptoms some women experience in the lead-up to their period, which may interfere with their quality of life
  • Most PMS symptoms can be managed with lifestyle modifications, such as exercise, diet and supplements
  • If symptoms persist and interfere with daily activities see your doctor or seek referral to a gynaecologist with expertise in PMS
  • It may be useful to keep a detailed daily diary of at least two menstrual cycles to see if there is a pattern with your symptoms so you and your doctor to talk about the best treatment options for you

If PMS symptoms persist and the above does not help, see your doctor. It's important that other possible causes of the symptoms are excluded. Although no 'cure' can be offered, there are many treatments that can help manage, reduce and for some women, completely alleviate PMS symptoms.

References

  1. Matsumoto, T. Biopsychosocial aspects of premenstrual syndrome and premenstrual Dysphoric disorder. Gyne Endo, 2013; 29: 63

Last updated 24 July 2017 — Last reviewed 09 December 2013

** Currently under review **

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at December 2013.

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