Premenstrual Syndrome (PMS)
What is premenstrual syndrome (PMS)?
It is a collection of symptoms that occur in the second half of the menstrual cycle. A key feature is that symptoms are cyclical and that they disappear within 48 hours of the onset of menstruation.
What are the symptoms?
There are a number of physical and psychological symptoms. Physical symptoms include:
- Abdominal bloating
- Pelvic pain in the days before a period and for the first day or two of a period;
- Breast pain or breast enlargement
- Generalised fluid retention
- Increased likelihood of migraines in migraine sufferers
- Irritable bowel
Psychological symptoms include:
- Feeling sad
- Craving for sweet foods
How common is it?
Most women will be able to identify a few of the symptoms listed above. It is estimated that 90 – 95% of women will be aware of some cyclical changes happening. Symptoms tend to become more severe as women go through their 30’s and into their 40’s.However, for the vast majority the changes are minor and do not disturb the women’s life to any significant degree.
What causes PMS?
The cause of PMS is not known. Given the cyclical nature of the symptoms, it is thought that the normal hormonal changes that happen in the second half of the menstrual cycle are involved in some way. Several studies have been done to try to identify the changes involved. To date, the hormones measured by researchers have found the same levels in women who have mild or no PMS symptoms as in women who have severe PMS.
Another theory is that it is the women’s reaction to changes in hormones in the brain (neurotransmitters) that cause PMS to be severe in some and not in others.
Because no cause has been found, there is no diagnostic test. So, for example, blood tests are not helpful in diagnosing this condition.
When should I seek help?
For some women PMS is not confined to a few days before a period, they may have symptoms for two weeks out of every four. If the symptoms are severe enough to cause you to alter your lifestyle – for example if you avoid meeting up with friends coming up to a period or you need to take time off work – then you should consider making changes in your life and this may include talking to a doctor about treatment options.
What first steps can I take?
- It is useful to keep a diary of symptoms for two to three months. This will make it clear as to whether the problem definitely has a cyclical pattern or not.
- Do a lifestyle audit. PMS seems to be more common in women who have been under stress or have had a recent significant lifestyle event such as a bereavement or marital separation.
Make a list of stresses that may be occurring in the four significant areas of your life:
If you have identified significant areas of stress, can you make changes to improve things?
Many people find that life is so busy that they no longer include exercise as part of their routine. Walking for an hour three or four times a week or getting involved in sport can improve the psychological symptoms in PMS and possibly some of the physical symptoms too.
A healthy diet with plenty of fresh fruit and vegetables will improve overall well being. Eating regularly throughout the day and avoiding long intervals between meals may be of benefit.
Evening primrose oil or starflower oil can be bought in pharmacies or healthfood stores. In some women this can relieve breast tenderness.
Nonsteroidal anti inflammatory painkillers such as ibuprofen can relieve pelvic pain. If you are on prescribed medication from your doctor, it would be important to consult him/her before taking this medication. Asthmatics should avoid this type of painkiller altogether.
Consulting your doctor
If you feel that your symptoms are not improving despite having tried some of the suggestions listed above, then it is worthwhile making an appointment with your doctor.
Your doctor will take a full medical history and will then be able to discuss appropriate treatments. For example, if your symptoms are mostly physical, then some form of hormone treatment may be tried – either a contraceptive pill or an oestrogen patch.
In women who have significant psychological symptoms that last for several days every month, it may be more beneficial to consider a type of antidepressant medication. Since the early 1990s, studies have consistently shown that one particular type of antidepressant – SSRIs (selective serotonin reuptake inhibitors) – reduce the psychological symptoms. There are various SSRIs available and they may be prescribed throughout the cycle or for the two weeks before a period or just in the week coming up to a period. As with any prescription medication, side effects are possible. Nausea, sweating, menstrual disturbance and lack of orgasm may occur.
Sometimes when the psychological symptoms are under control, women feel more able to look at the various aspects of their lives and make changes to alleviate sources of stress. Medication can then be withdrawn without the PMS returning to previous levels.
The future for PMS
PMS has always been a feature of womens lives. The severity of symptoms can vary between women and within the individual woman depending on external stressors. The best defence is to try to maintain a healthy balanced lifestyle. For some women unfortunately this is not sufficient and PMS can be severe. Research continues but no new modes of treatment other than the SSRIs have emerged.