Premenstrual syndrome (PMS)

What is PMS?

In the days leading up to a period (menstruation), up to 30% of women experience emotional and physical symptoms, often called premenstrual syndrome (PMS). Most women experience one or two symptoms that can be managed. Symptoms start about 4-10 days before a period and usually stop after bleeding begins.

What are the symptoms of PMS?

Symptoms of PMS vary in intensity from woman to woman and can vary from one cycle to the next. The most common symptoms include:

Emotional symptoms

• irritability
• anxiety
• nervous tension
• lower coping ability
• difficulty concentrating
• wanting to be alone
• lower libido
• reduced interest in work and social life
• mood swings
• depression
• aggression
• sadness

Physical symptoms

• fluid retention (swollen fingers or ankles)
• bloating around the abdomen
• breast swelling and tenderness
• skin problems such as acne
• headaches and/or migraines
• poor coordination or clumsiness
• tiredness, lethargy, insomnia
• increase in weight
• constipation and/or diarrhoea
• food cravings
• aches and pains

What is premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that causes psychological distress and socioeconomic dysfunction. PMDD affects about 3-8% of women with PMS.^[2]

Causes of PMS & PMDD

It is not clear why some women develop PMS and PMDD. There appear to be very complex interactions between certain chemicals in the brain and progesterone that lead to symptoms. PMS does not occur if there is no ovulation, or after menopause^[1]. A woman's stress levels, psychological state, poor physical health, genetic makeup, cultural and social environment and changes in brain chemicals (such as serotonin) may all influence the development of PMS symptoms. Having a high body mass index (BMI) and smoking are also risk factors.

How are PMS & PMDD different from depression?

PMS and PMDD have similar symptoms to depression. However, with PMS and PMDD, the symptoms get better completely as soon as menstruation begins, while those of depression do not.

PMS and PMDD need to be distinguished from underlying depression because the treatments are different.

Management & treatment of PMS symptoms

There are ways you can manage and reduce your PMS symptoms.

Be physically active

Physical activity increases endorphins ('feel-good' hormones), which can reduce symptoms. Endorphins also act as natural painkillers and help you feel more relaxed and in control.

Choose a form, or variety, of physical activity you enjoy, and aim for 30 minutes of moderate-intensity activity on most, if not all, days, especially when symptoms are at their worst.

Reduce stress levels

Stress can worsen PMS symptoms.

Talk to your family about your PMS and help them to develop strategies to be supportive during this time. Take time out to relax and enjoy your own interests.

If you feel your levels of stress are increasing, consider professional counselling; cognitive behavioural therapy (CBT) and relaxation therapies can help.

Physical activity increases endorphins ('feel-good' hormones), which can reduce symptoms. Endorphins also act as natural painkillers and help you feel more relaxed and in control.

Choose a form, or variety, of physical activity you enjoy, and aim for 30 minutes of moderate-intensity activity on most, if not all, days, especially when symptoms are at their worst.

Maintain a healthy lifestyle

• Eat regular, nutrient-dense meals, including plenty of vegetables, fruit, protein and whole grains
• Eat small meals of lean protein and low-GI complex carbohydrates to maintain stable energy levels
• Drink less caffeine, particularly if you are suffering breast tenderness
• Try drinking 6-8 glasses (1.5-2 litres) of water each day
• Eat less salt and salty foods to help reduce fluid retention
• Get enough rest, sleep and exercise to help manage stress
• Try relaxation techniques such as yoga or meditation
• Don't smoke. If you need help with this, call the Quitline on 13 7848 or visit www.quit.org.au
• Wear a well-fitting cotton bra if you suffer tender, painful breasts
• Write down your symptoms to help you identify a pattern for things that might trigger or worsen your symptoms

Vitamins, minerals and herbs ^{[3, 4, 5]}

Although the evidence is not strong, some supplements that may be effective in treating PMS include:

• chaste tree (also known as chaste berry and vitex agnus castus): has been shown to reduce mood swings and irritability when professionally prescribed
• vitamin B6, (pyridoxine): 50mg, preferably as part of a B complex vitamin
• magnesium: low magnesium levels can be seen in women with PMS, and studies have suggested that magnesium supplementation may improve PMS mood changes
• calcium: has been shown to improve symptoms in the dose of about 600mg twice a day
• evening primrose oil for breast swelling and pain

Consult your health practitioner before taking any supplement, as they can have unwanted effects, or interact with other medications you are taking.

Complementary therapies

Complementary therapies such as acupuncture or naturopathy can be helpful in relieving psychological and/or physical symptoms of PMS for some women. However, a lack of controlled studies means there is no clear evidence of their benefits.

Hormonal treatments

These treatments can suppress ovulation and reduce the hormones of the premenstrual phase. Hormone therapies can include contraceptive therapies, such as the oral contraceptive pill. Ask your doctor for more information about hormone treatment options.

Medication

There is a range of medications available that have been proven to help, such as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), anti-prostaglandin (for pain/cramps), anti-inflammatories, and spironolactone diuretic (for bloating). See your doctor to discuss these.

Management & treatment of PMDD symptoms

PMDD often requires treatment with medication as well as lifestyle modifications. First-line treatment is usually an SSRI (serotonin reuptake inhibitor), an antidepressant that helps 60-70% of women. Second-line options include hormonal medication to stop ovulation, such as oral contraceptives.^[6]

Things to keep in mind

• Premenstrual syndrome (PMS) refers to the range of emotional and physical symptoms some women experience in the lead-up to their period, which may interfere with their quality of life
• Most PMS symptoms can be managed with lifestyle modifications, such as exercise, diet and supplements
• If symptoms persist and interfere with daily activities, see your doctor or seek referral to a gynaecologist with expertise in PMS
• It can be useful to keep a detailed daily diary of at least two menstrual cycles to see if there is a pattern with your symptoms to help you and your doctor discuss the best treatment options for you.

If PMS symptoms persist and the above does not help, see your doctor. It is important that other possible causes of the symptoms are excluded. Although no 'cure' can be offered, there are many treatments that can help manage, reduce and, for some women, completely alleviate PMS symptoms.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at July 2018.