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Premenstrual syndrome (PMS)

Published by Bupa's health information team, September 2009.

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

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

About PMS
Types of PMS
Symptoms of PMS
Causes of PMS
Diagnosis of PMS
Treatment of PMS
Questions and answers
Related topics
Further information
Sources

About PMS

PMS is common in young and middle-aged women - three in four women have PMS symptoms. It can start up to two weeks before your period and usually goes away when your period starts.

Types of PMS

PMS can affect your quality of life and relationships. A more severe form of the syndrome is premenstrual dysphoric disorder (PMDD). The emotional symptoms of mood swings, depression, anxiety and irritability are more common in PMDD and the condition can interfere substantially with everyday life. PMDD affects between three and eight women in every 100.

PMS and PMDD differ in severity but the types of symptoms are the same.

Symptoms of PMS

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
irritability
depression
a loss in confidence
clumsiness

Physical symptoms can include:

headaches
feeling bloated
a change in your appetite
pain in your joints
tender breasts
abdominal (tummy) pain

These symptoms aren't unique to PMS - it's the timing of the symptoms that is the telltale sign of the condition. 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

Causes of PMS

The exact cause of PMS isn't known, but one theory is that getting PMS means you're particularly sensitive to the varying levels of hormones in your body at certain times of the month. It's possible that these hormones also interact with your brain's mood-controlling chemicals (serotonins).

Another theory is that PMS may to be related to disturbances in the levels of certain fatty acids in your body.

Diagnosis of PMS

Your GP will ask about your symptoms and medical history.

There are no specific tests that can diagnose PMS. Your GP 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 menstrual cycles before you visit your GP. This will help you both to see if the symptoms are related to your menstrual cycle. The National Association for Premenstrual Syndrome has an online diary that you can use to create a personalised chart of your symptoms.

It's important to distinguish between PMS and other problems that could be causing similar physical or emotional symptoms, because the treatment will be different. Your GP may do tests to rule out other illnesses that could be causing your symptoms.

Treatment of PMS

There are a number of treatments that can help relieve the symptoms of PMS.

Self-help

If you keep a symptom diary, you may find that your physical or emotional symptoms are linked with your period. You can then predict more accurately how you will feel at certain times of the month. This may help you to plan your time so you can try to prevent being in stressful situations on key days and pinpoint any emotional triggers that make your symptoms worse.

Your GP may advise you to take regular exercise and eat a healthy, balanced diet that's low in saturated fat, sugar and salt and high in fibre, vegetables and fruit. Some research suggests that reducing the amount of salt you eat may minimise the bloated feeling and tender breasts that you may have with PMS. Other studies recommend limiting caffeine because it's related to premenstrual irritability and insomnia. However, more research is needed to prove these effects.

There is some limited scientific evidence that taking vitamin B6 supplements is helpful for PMS when taken in 100mg doses. However, high doses can damage the nervous system so don't take more than 50 to 100mg of vitamin B6 supplements each day and don't take it long-term. If you have any questions or concerns, talk to your GP or pharmacist.

Medicines

If you have pain from premenstrual headaches, backache or other aches and pains, it may be relieved by over-the-counter painkillers, such as paracetamol, ibuprofen or aspirin. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If you have symptoms that are disrupting your life, and that don't improve with self-help measures or painkillers, consider seeing your GP for advice. He or she may prescribe medicines, depending on the type of symptoms you have. Some of these are listed here.

The combined contraceptive pill, for example one with drospirenone and oestrogen, prevents ovulation and may help with some symptoms, possibly by stabilising the levels of your hormones.
Treatment with 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 scientific evidence to know whether this is an effective treatment for most women.
A diuretic (water tablet), such as spironolactone, may help to relieve symptoms such as tender breasts and bloating.
Medicines called selective serotonin re-uptake inhibitors (SSRIs), such as fluoxetine, can be effective. These are antidepressant medicines but appear to have a positive effect on both the physical and behavioural symptoms of PMS.
You may be offered a medicine called a gonadorelin analogue. This is a synthetic form of the hormone gonadorelin that acts to decrease the level of oestrogen produced by your body. If PMS is related to your menstrual cycle, this may be helpful in the short term as it effectively switches it off.

Talking therapies

If you have severe PMS, cognitive behavioural therapy (CBT) is a treatment option. CBT is a short-term psychological treatment that helps to change the way you think, feel and behave. Ask your GP for more information.

Surgery

A hysterectomy (removal of your womb) with oophorectomy (removal of the ovaries) is a permanent solution to PMS as it stops your menstrual cycle completely. The procedure is only rarely performed for PMS however, since less severe alternatives can usually be found. If you're considering this operation, your doctor may suggest an injection of a gonadorelin analogue first to see if this improves your symptoms. If this makes no difference, it means your symptoms aren't linked to your menstrual cycle and therefore it's unlikely that surgery will help.