Premenstrual syndrome (PMS)
PMS is a condition in women where certain symptoms occur each month before a period. PMS is sometimes called premenstrual tension (PMT) or premenstrual disorder (PMD).
What are the symptoms of premenstrual syndrome (PMS)?
Many different symptoms have been reported. The most common are listed below. A woman may have just one or two symptoms, or have several:
- Mental (psychological) symptoms include: tension, irritability, tiredness, feelings of aggression or anger, low mood, anxiety, loss of confidence, and feeling emotional. A change in sleep pattern, in sexual feelings and in appetite may be noted as well. Relationships may become strained because of these symptoms.
- Physical symptoms include: breast swelling and/or pain, tummy (abdominal) bloating, swelling of the feet or hands, weight gain, and an increase in headaches.
Who gets premenstrual syndrome (PMS)?
PMS most commonly affects women aged 30-40 years. However, it can affect one at any age, even 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 not troublesome.
About one woman in twenty has PMS where the symptoms become bad enough to disrupt normal functioning and quality of life. Day-to-day life and performance at work can be affected. It may cause tension with family and friends.
How is premenstrual syndrome (PMS) diagnosed?
There is no test for PMS. The diagnosis of PMS is based on symptoms.
Sometimes it is difficult to tell if the symptoms are due to PMS, or if they are due to other conditions such as anxiety or depression. Keeping a diary of symptoms over a couple of months can help with diagnosis. It is when the symptoms occur, not just their nature or type, that indicates PMS.
Typically, symptoms occur during the five days before a period. However, some women have symptoms for two weeks or so leading up to a period. Typically, symptoms gradually become worse as the period approaches. Symptoms that go within three to four days after your period starts.
Symptoms that occur all the time are not due to PMS.
What causes premenstrual syndrome (PMS)?
The cause is not known. It is not due to a hormone imbalance, or due to too much or too little of any hormone (as was previously thought). However, the release an egg from an ovary each month (ovulation) appears to trigger symptoms. It is thought that women with PMS are more sensitive to the normal level of progesterone. This hormone is passed into the bloodstream from the ovaries after ovulation.
One effect of over-sensitivity to progesterone seems to reduce the level of a brain chemical (neurotransmitter) called serotonin. This may lead to symptoms, and may explain why medicines that increase the level of this brain chemical work in PMS.
The following may help women cope with PMS:
- Reading about it. It may help in understanding what is happening and relieve some of the anxiety about symptoms.
- Talking about it with husband, family and friends. It may help people in understanding how one is feeling. It may be best to do this after your period when symptoms have eased.
- Exercise. Some women who exercise regularly say they have less of a problem with PMS. Try doing some regular exercise several times a week.
- Food and drink. Reducing the amount of sugar and refined carbohydrates before the period starts may help with symptoms.
- Reduce caffeine intake. Some women find that caffeine (found in tea, coffee, cola, etc) makes their symptoms worse. So, it may be worth a trial of not having caffeine prior to periods to see if this helps.
What are the treatment options for premenstrual syndrome (PMS)?
Many treatments for PMS have been tried over the years. There are very few that have been proven to work. Treatments may not cure symptoms completely. However, the symptoms often become a lot easier or less frequent with treatment.
Not treating is an option
Understanding the problem, knowing when the symptoms are coming 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.
Treatments that you can buy without needing a prescription
Various products are sold for the treatment of PMS, including calcium, magnesium and vitamin B6 (pyridoxine). There is very little evidence to support the use of them.
Simple painkillers may help with breast tenderness.
Selective serotonin reuptake inhibitors (SSRIs)
An SSRI medicine is commonly prescribed to treat more severe PMS. These medicines were developed to treat depression. However, they have also been found to ease the symptoms of PMS, even if a woman is not depressed.
Cognitive behavioural therapy (CBT)
CBT 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.