Premenstrual syndrome

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PMS is common in young and middle-aged women – three in four women have PMS symptoms. It can start up to two weeks before your period and usually goes away when your period starts.

Types of PMS

PMS can affect your quality of life and relationships. A more severe form of the syndrome is premenstrual dysphoric disorder (PMDD). The emotional symptoms of mood swings, depression, anxiety and irritability are more common in PMDD and the condition can interfere substantially with everyday life. PMDD affects between three and eight women in every 100.

PMS and PMDD differ in severity but the types of symptoms are the same.

What are the symptoms of premenstrual syndrome?

Many different symptoms have been reported. The most common are listed below. You may have just one or two symptoms, or have several.

Psychological (mental) symptoms include: tension, irritability, tiredness, feelings of aggression or anger, low mood, anxiety, loss of confidence, feeling emotional. You may have a change in your sleep pattern, in sexual feelings and in appetite. Relationships may become strained because of these symptoms.

Physical symptoms include: breast swelling and/or pain, abdominal bloating, swelling of the feet or hands, weight gain, an increase in headaches. If you have epilepsy, asthma, migraine or cold sores, you may find that these conditions become worse before a period.

Who gets premenstrual syndrome?

PMS most commonly affects women aged 30-40 years. However, it can affect you at any age, even if you are less than 20 years old. Most women can tell that a period is due by the way they feel both physically and mentally. For most, the symptoms are mild and do not cause too much bother.

About one in twenty women have ‘true’ PMS. This is where the symptoms become bad enough to disrupt your normal functioning and quality of life. Day-to-day life and work performance can be affected. It may cause tension with family and friends.

Causes of PMS

The exact cause of PMS isn’t known, but 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 (serotonins).

Another theory is that PMS may to be related to disturbances in the levels of certain fatty acids in your body.

Diagnosis of PMS

There are no specific tests that can diagnose PMS. Diagnosis is usually based on a description of your symptoms and when they occur.

If you suspect you have PMS, keep a diary of your symptoms for few menstrual cycles . This will help to show whether the symptoms are related to your menstrual cycle. It’s important to distinguish between PMS and other problems that could be causing similar physical or emotional symptoms, because the treatment will be different. Tests may be done to rule out other illnesses that could be causing your symptoms.

Treatment of PMS

There are a number of treatments that can help relieve the symptoms of PMS.

Not treating is an option

Understanding the problem, anticipating symptoms and planning a coping strategy are all that is required for many women. Some women find the self-help measures listed above and such things as avoiding stress or doing relaxation exercises prior to a period can 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 may help you to plan your time so you can try to prevent being in stressful situations on key days and pinpoint any emotional triggers that make your symptoms worse.

Take regular exercise and eat a healthy, balanced diet that’s low in saturated fat, sugar and salt and high in fibre, vegetables and fruit. Some research suggests that reducing the amount of salt you eat may minimise the bloated feeling and tender breasts that you may have with PMS. Other studies recommend limiting caffeine because it’s related to premenstrual irritability and insomnia. However, more research is needed to prove these effects.

Treatments over the shelf

Vitamin B6 (pyridoxine). This vitamin is part of a normal diet, but extra amounts are thought to help with PMS. However, the evidence to support this is still conflicting. You can take the vitamin tablets either in the two weeks before periods, or every day. However, high doses can damage the nervous system so don’t take more than 50 to 100mg of vitamin B6 supplements each day and don’t take it long-term.

Calcium. Some studies have shown that taking calcium (1000-1200 mg a day) may improve premenstrual symptoms.

Magnesium. Taking magnesium (200-400 mg a day) during the two weeks before a period may improve symptoms.

Agnus castus. This may provide some benefit in some women.

St John’s wort. This is a herbal remedy which can be bought from pharmacies. However, there is only very limited evidence that it is effective.

Bright light. One study showed improvement in symptoms in some women with severe PMS who looked at bright light from a face mask for a time each day. This is a similar treatment to that used for a condition called ‘seasonal affective disorder’. The reason why bright light may help in PMS is not known. More research is needed to clarify if this is a useful treatment.

Anti-inflammatory painkillers (for example, ibuprofen) may ease painful symptoms.

Evening primrose oil may ease breast discomfort

Treatments that your doctor may prescribe

These treatments have been shown in studies to be the most effective for women with PMS. Your doctor may recommend at least one of these treatments for you.

Selective Serotonin Re-uptake Inhibitors (SSRIs)

An SSRI medicine is commonly prescribed to treat more severe PMS. These medicines were first developed to treat depression. However, they have also been found to ease the symptoms of PMS, even if you are not depressed. They work by increasing the level of serotonin in the brain (see above in ‘What causes premenstrual syndrome?’). You have a good chance that symptoms of PMS will become much less if you take an SSRI.

Research suggests that taking an SSRI for just half of the cycle (the second half of the monthly cycle) is just as effective as taking an SSRI all of the time. Side-effects occur in some women, although most women have no problems taking an SSRI. There are various types and brands.

The combined oral contraceptive pill (COCP)

In theory, preventing ovulation should help PMS. This is because ovulation, and the release of progesterone into the bloodstream after ovulation, seems to trigger symptoms of PMS. The COCP (known as ‘the pill’) works as a contraceptive by preventing ovulation.

However, most pills do not help with PMS as they contain progestogen hormones (with a similar action to progesterone). A newer type of pill called Yasmin contains a progestogen called drospirenone which does not seem to have the downside of other progestogens. If you have PMS and require contraception, then this pill may be a possible option to use for both effects. If you take this, your doctor may advise you to reduce the pill-free week to only four days, or even run three packets together without having a break.


Oestrogen given via a patch or gel has been shown to improve symptoms. Oestrogen tablets are not effective though. However, you will also need to take progestogens if you have not had a hysterectomy. These can be taken as tablets or by having the intrauterine system called Mirena inserted. The doses of oestrogen in a patch are much lower than in the COCP, so a patch does not work as a method of contraception.


A diuretic (water tablet), such as spironolactone, may help to relieve symptoms such as tender breasts and bloating.

Gonadotrophin-releasing hormone analogues

These are drugs that can prevent ovulation. Although these often work well, side-effects commonly occur which limit their usefulness for PMS.

Talking therapies

This is a talking treatment (psychological treatment), during which, ways to find more adaptive ways of coping with premenstrual symptoms are explored. This has been shown to be effective for some women.


A hysterectomy (removal of your 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 performed for PMS however, since less severe alternatives can usually be found. If you’re considering this operation, your doctor 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.

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