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Premenstrual syndrome

Published by Bupa's health information team, August 2007.

This factsheet is for women who have premenstrual syndrome (PMS) or anyone who would like information about it.

Premenstrual syndrome (PMS) is a mixture of physical and emotional symptoms that some women experience during the days, or sometimes weeks, leading up to their menstrual period.

What is PMS?

PMS can start up to two weeks before your period and usually goes away when your period starts. It most commonly affects teenagers and women in their early 20s. Some women have symptoms of PMS each month before their period starts.

Nearly all women get some mild symptoms before their period. However, around one in 20 women have symptoms that interfere with their quality of life.

Symptoms

More than 100 symptoms have been associated with PMS. Common symptoms can be grouped into emotional, behavioural and physical categories.

Emotional and behavioural symptoms can include:

  • anxiety
  • mood swings
  • tiredness
  • poor concentration
  • irritability
  • aggression
  • depression
  • clumsiness

Physical symptoms can include:

  • headaches
  • feeling bloated
  • weight gain
  • breast tenderness
  • back or lower abdominal pain

These symptoms are common and are not unique to PMS. So it's the timing of the symptoms that are the telltale signs of PMS. With PMS, the symptoms will:

  • appear during the two weeks leading up to your menstrual period
  • get better once your period has started
  • come back each month

A small number of women with PMS may be diagnosed with premenstrual dysphoric disorder (PMDD). This is a more severe form of the syndrome characterised by mood swings, depression, anxiety and irritability that interferes substantially with everyday life.

Causes

No one knows the exact cause of PMS, but one theory is that women with PMS are particularly sensitive to the varying levels of hormones in the body at certain times of the month. It's possible that these hormones also interact with the body's mood-controlling chemicals (such as serotonin) in the brain.

Diagnosis

There are no specific tests that can diagnose PMS. Your doctor will usually make a diagnosis based on a description of your symptoms and when they occur.

If you suspect you have PMS, keep a diary of your symptoms for two or three menstrual cycles before you visit your GP. This will help you and your doctor to see if the symptoms are related to your menstrual cycle. The National Association for Premenstrual Syndrome has an online diary that you can fill in to create a personalised chart of your symptoms.

It's very important to distinguish between PMS and other problems that could be causing similar physical or emotional symptoms, because the treatment will be different.

Treatment

Many women put up with PMS, believing it to be a normal part of being female. However, there is a great deal that you can do to help reduce mild to moderate symptoms.

Self-help

If, by keeping a symptom diary, you think that your physical or emotional symptoms are linked with your period, then you may have already crossed the first hurdle. Now you can predict more accurately how you will feel at certain times of the month, this may help you to:

  • avoid stress at home and at work on key days
  • pinpoint any emotional triggers that make the symptoms worse

Some women find that PMS symptoms improve if they take regular exercise and eat a healthy, balanced diet rich in fruit, vegetables and wholegrain carbohydrates, with limited caffeine, alcohol and salt. There is no evidence to back this up, but these lifestyle habits promote good health and a sense of wellbeing.

It's reasonable to try some painkillers if you experience premenstrual headaches, backache or other aches and pains. Over-the-counter painkillers, such as those you would normally take for a headache, may help. Get advice from your GP or pharmacist before using over-the-counter medicines, and always follow the instructions on the packet.

Some women have found that taking vitamin B6 supplements is helpful. There is some limited scientific evidence that this works, but high doses can damage the nervous system. Don't take more than 50 or 100mg of vitamin B6 supplements each day and if you have any questions or concerns, talk to your GP or pharmacist.

You may have to try several self-help measures before you find something that is effective for you.

Medicines

If you have symptoms that are disrupting your life, and these don't improve with self-help measures, consider seeing your GP for advice. He or she may do tests to rule out other illnesses that could be causing your symptoms. If PMS is diagnosed, your GP may prescribe medicines, depending on the type of symptoms you have.

If you are one of the small proportion of women who has PMDD, prescription medicines called selective serotonin reuptake inhibitors (SSRIs) can be effective, such as fluoxetine (Prozac). Despite being an antidepressant medicine, fluoxetine appears to have a positive effect on both the physical and behavioural symptoms of PMS. You may have side-effects from the medicine, such as:

  • difficulty sleeping
  • extreme tiredness
  • feeling sick
  • vomiting
  • diarrhoea or constipation

If self-help measures and treatment with SSRI medicines don't relieve your symptoms, your doctor may prescribe different types of medicines. These may be hormonal treatments, or medicines to target specific symptoms. Some options are listed below.

  • The combined oral contraceptive pill prevents ovulation and can help with some symptoms, although research evidence for this is limited. This is only appropriate if you aren't trying to get pregnant. In addition, for some people, the side-effects of oral contraceptives are very similar to PMS.
  • Treatment with a hormone called progesterone may help to balance out the fluctuating levels of this hormone during the weeks leading up to your period. However, there isn't enough research evidence to know whether this is an effective treatment for most women. The treatment does have potential side-effects, including sleepiness and changes to length of your menstrual cycle.
  • Mefenamic acid is a type of prescription painkiller that may help with painful PMS symptoms.
  • A diuretic (water tablet), such as spironolactone, may help to relieve symptoms such as breast tenderness and bloating.

Further information

 

Premenstrual syndrome Q&As

See our answers to common questions about premenstrual syndrome, including:

Related topics

Sources

  • Grady-Weliky TA. Premenstrual Dysphoric Disorder. N Engl J Med 2003, 248(5); 433-438
  • Wyatt KM, Dimmock PW, Jones PW, O'Brien PMS. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ 1999, 318; 1375-1381
  • The Cochrane Collaboration: Menstrual disorders and subfertility group reviews,
    www.cochrane.org
    accessed 15 December 2006

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2007.

 

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