PMS is a combination of physical, psychological and/or behavioural symptoms that many women suffer during the one or two weeks before their period begins. Most women suffer PMS symptoms at some point, but for five per cent of women the symptoms are so severe it seriously affects their quality of life.
The exact cause of PMS is unknown, but there are several factors that may contribute to the condition. One is the fluctuating levels of female hormones that occurs after ovulation – when an egg is released from the ovary each month. These symptoms disappear during pregnancy and after the menopause when hormones are more stable.
Chemical levels of the 'feel-good' hormone serotonin, which helps regulate mood and makes you feel happier, may also be lower than normal in women who suffer from PMS. This may explain why antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), help some women with PMS.
Lifestyle factors may also increase your risk of PMS. These include: being overweight and not exercising; stress; a high salt intake, which may contribute to fluid retention and bloating; fizzy drinks; alcohol; and low levels of vitamins and minerals.
PMS usually strikes during the luteal phase, the medical name for the time between ovulation (egg release) and the start of your period. Symptoms may vary in intensity month to month and over 150 different symptoms of PMS have been identified.
Some of the most common physical symptoms are headaches, feeling bloated, backache, nausea, weight gain related to fluid retention, fatigue, breast pain, abdominal pain and acne flare-ups. Psychological symptoms include irritability, mood swings, anxiety and tearfulness. Behavioural symptoms include reduced concentration and aggression.
A minority of women suffer with severe, disabling PMS, known as premenstrual dysphoric disorder (PMDD).The symptoms are much more severe versions of PMS.
There’s no test that can diagnose PMS, although blood and urine tests can help rule out other common conditions, such as an underactive thyroid and iron-deficiency anaemia, which have symptoms like those of PMS. Your GP may recommend you keep a symptom diary for two to three months so a diagnosis can be made.
PMDD is usually only diagnosed when then symptoms are so severe they stop you from living a normal life. The GP may refer you to a mental health specialist for further investigation.
Who gets PMS?
PMS affects women of childbearing age including those under 20, but it is most common in women aged 30 to 40 years.
If your symptoms are mild, lifestyle changes may be enough to ease your symptoms. These include: staying hydrated by drinking lots of water, avoiding salty foods to reduce bloating and fluid retention, getting more than eight hours sleep a night and reducing the amount of fat, sugar, caffeine and alcohol you consume. Eating a healthy balanced diet with vegetables and fruit, lean protein and complex carbohydrates is also recommended.
Relaxation techniques, such as meditation and yoga can help with stress and regular exercise such as swimming, walking and cycling can help you deal with fatigue and low mood. Regular sleep can also improve moodiness and fatigue.
There’s also evidence that natural supplements, such as agnus castus,magnesium, vitamin B6 and vitamin D may ease some PMS symptoms.
Other treatment options include: taking paracetamol or a non-steroidal anti-inflammatory drugs, such as ibuprofen, to ease stomach cramps; the combined contraception pill to stop ovulation and stabilise hormone levels; and SSRI antidepressants, to help with mood swings.
More drastic options include gonadotropin-releasing hormone (GnRH) analogues, which are synthetic hormones that create a temporary menopause and stop periods by blocking the production of oestrogen and progesterone.
If you’re suffering with psychological symptoms, the talking therapy cognitive behavioural therapy (CBT) may help.