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Premenstrual syndrome (PMS)

What is premenstrual syndrome?

Premenstrual syndrome (PMS) is a collection of physical and mental symptoms which women experience to a greater or lesser degree before their menstrual period each month. The symptoms complained of are noticed by some women days before their period, and by other women only hours prior to their period. Symptoms usually disappear when the period starts.

Who gets PMS?

It is believed that 70% to 90% of women experience PMS sometime between 25 and 45 years of age. For many years PMS was largely ignored by the medical profession, but is now accepted as a very real and often difficult time in the lives of many women. The effects of PMS range from minor discomfort, which most women can live with, to symptoms so severe it can disrupt a woman's life and that of her family.

What causes PMS?

No one knows for sure what causes PMS. As the symptoms start mid-cycle after ovulation (when the egg is released) it is thought that the hormonal changes which normally occur during each menstrual cycle may produce a variety of symptoms.

These hormonal changes (the main hormones are called oestrogen [estrogen] and progesterone) affect different women in different ways and can be affected by lifestyle, hereditary factors, nutritional status, and the emotional state of the woman at the time PMS symptoms appear. That is why some women have symptoms but can deal easily with them, and other women have symptoms which they simply cannot cope with and need help from health professionals.

More studies are being carried out to determine the cause of PMS. Many of the symptoms are similar to those experienced by women during pregnancy, and in the years before and during menopause.

PMS is not usually due to a lack of a particular hormone or because you have 'too many' hormones.

Symptoms of PMS

The symptoms of PMS are not the same for every woman. The most common are:

  • moodiness
  • irritability
  • tension
  • crying easily
  • headache
  • confusion
  • sore breasts
  • depression
  • constipation or diarrhoea
  • feeling bloated (retaining water)
  • backache
  • being clumsy.

Other less common symptoms include:

  • sleep disturbances
  • food cravings
  • skin problems such as pimples
  • joint pain
  • hot flushes
  • mild to severe personality changes
  • feeling hostile towards others
  • irregular heartbeat and palpitations
  • feeling indecisive
  • those who have asthma sometimes find it gets worse at this time.

PMS is diagnosed by your symptoms and excluding other illness. Blood tests for hormonal levels are of little value as symptoms can occur at any hormonal level.

Treatments for PMS

A symptom diary

Treatment centres on relieving your particular symptoms. Keeping a daily record enables you to clarify exactly what your symptoms are and when they occur. This information will help you and your doctor decide what treatment may suit you best. Make a note of things such as:

  • whether you are taking an oral contraceptive
  • what and when you eat
  • whether you smoke, drink or take other recreational drugs, and if so, how much
  • your stress levels at work or home
  • at what stage of your menstrual cycle you first notice symptoms of PMS
  • the amount and type of exercise you do.

Lifestyle measures 

  • Make sure you eat regularly and sensibly, including plenty of fresh fruit and vegetables in your daily eating. Avoid salt, caffeine, alcohol and excessive fluids.
  • Exercise regularly. Exercise helps in a number of ways. A daily walk at least five times a week for 30 minutes is relaxing and releases natural antidepressants (endorphins) into the system which, in turn, reduces your stress levels. It also gives you time to think on your own. As a weight-bearing exercise it will often help to reduce any joint pain you may have.
  • Get a good night's sleep.

Complimentary health measures

Other choices such as acupuncture, massage or yoga to relax you or relieve your symptoms are proving to be very beneficial for many women.

Medicines

Calcium or vitamin B6: Some women find calcium or vitamin B6 useful in controlling PMS symptoms. Calcium can be taken every day and vitamin B6 can be taken a few days before PMS symptoms start and continued until your period commences. Evidence from studies suggests the effective dose of calcium supplementation for PMS symptoms is about 1000mg per day; there is also some evidence that a calcium-rich diet may be beneficial for symptoms, eg, four servings of low-fat dairy products a day.

Calcium and vitamin B6 do not require a prescription and can be bought from pharmacies, supermarkets and health food shops. Remember to read the instructions on the bottle for the correct dosage - check with your pharmacist if unsure. Let your doctor know if you are taking either of these supplements, particularly if you are on prescribed medicines.

Prescription medicines: Prescription medicines can also be helpful for women who have not been able to control their symptoms with lifestyle changes. Diuretics (water pills) have been given in the past to reduce the bloated feeling. This is not such a popular choice now, but is still prescribed occasionally. Some doctors prescribe hormones in the form of tablets.

Antidepressants: Antidepressants are another form of medication. Any medication requires regular medical supervision, so remember to have a six-monthly check with your doctor. If your symptoms do not improve or get worse, seek further assistance from your doctor.

More information

For further information and support talk to your doctor or practice nurse. Family Planning centres can assist with information (see contact details further below). Some hospitals are offering specialist PMS clinics. Ask your doctor for a referral.

Written by Anna Mickell RCpN, and edited by everybody. Reviewed by Dr Helen Roberts, University of Auckland, May 2011. Latest review by Health Navigator, September 2014.

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