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Premenstrual syndrome

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 5 minutes read
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Premenstrual syndrome (PMS) is a cyclical worsening of mood and physical health due to hormones released during the menstrual cycle. Most women experience some symptoms of PMS, and about 1 in 20 women will have severe symptoms.

Women normally experience PMS for approximately two weeks, around half of their menstrual cycle. Doctors describe menstrual cycle lengths by calling day 1 the first day of your period, and for women with an average cycle length (around 28 days), PMS tends to start around day 15, which is around the time of egg release (ovulation). The symptoms can last until the end of your period. Often women experience an easing of their symptoms once their period begins.

PMS includes an extensive range of both physical and psychological symptoms. These physical and psychological symptoms can be severe enough to affect daily activities. They may impair school performance, interfere with work, and affect family life or relationships with others.

Doctor’s advice

What does PMS feel like?

Psychological symptoms are common and can include anxiety, low mood, irritability, rage, mood swings, restlessness, poor concentration, insomnia, and confusion.

Physical symptoms can occur across all body systems. Common symptoms can include headaches, tiredness, sore breasts, bloating, changes in appetite, muscular pains, backache, and skin problems.

Women who have a pre-existing mental health condition may experience a worsening of their usual symptoms for that portion of their menstrual cycle.

Some women will have PMS purely as a result of an external source of hormones, such as the contraceptive pill. It can also occur if you have a coil in place (like the hormone Mirena coil), which can reduce the frequency and heaviness, or even stop you from having periods.

Why does PMS happen?

One of the causes of PMS is now thought to be related to a by-product of progesterone, one of the normal female hormones. Alongside this, there are other genetic, environmental, and social factors that can play a part, too.

Alterations in neurotransmitter activity, such as serotonin, dopamine, and others, have been implicated in the development of PMS symptoms. Serotonin, in particular, plays a key role in regulating mood, sleep, and appetite, and disruptions in serotonin levels may contribute to mood swings, irritability, and food cravings commonly experienced during PMS.

Some individuals may be more sensitive to hormonal fluctuations than others, leading to an increased susceptibility to PMS symptoms. Factors such as genetics, stress levels, and underlying medical conditions may influence an individual's hormonal sensitivity and predisposition to experiencing PMS.

Psychological and emotional factors, such as stress, anxiety, depression, and personality traits, can exacerbate PMS symptoms and contribute to their severity. Women who experience high levels of stress or have a history of mood disorders may be more likely to experience intense PMS symptoms.

Certain lifestyle factors, including poor diet, inadequate exercise, lack of sleep, and substance abuse, can exacerbate PMS symptoms by disrupting hormonal balance, exacerbating stress levels, and impairing overall physical and emotional well-being.

Self-treatment advice

There are some simple steps to help you on the way to getting well. Start monitoring your symptoms alongside tracking your periods for at least 2 cycles. This will increase self-awareness and be useful should you need to visit your doctor at a later date. Simple over-the-counter painkillers will help with some of the physical pain symptoms of PMS. These include anti-inflammatories such as ibuprofen and aspirin, and other painkillers like acetaminophen.

Exercise has been shown to be beneficial. Thirty minutes of daily aerobic activity will help release endorphins, increasing your energy and reducing pain levels. Brisk walking, swimming, running, and cycling are all good choices. Combine this with a healthy diet full of fresh fruit and vegetables to maximize your energy.

Complementary therapies can help. There is some evidence for Vitamin B6 and St John's wort. If trying St John's wort, remember that it can interact with some prescribed medications, such as reducing the effectiveness of contraceptive pills. Other herbal options to try are primrose oil and chasteberry.

Talking therapies can be of great help if PMS results in difficult behaviors and situations. These can be done via your phone or online. Your doctor can recommend any available for free, or there are paid options also.

When should I see my doctor?

If you have tried the self-treatment tips, but they are not helping, or you have particularly severe symptoms, it is worth speaking to your doctor. Your doctor may offer a blood test to ensure there is no other cause for your symptoms.

They might suggest a referral for talking therapy or counseling for psychological symptoms. Certain hormonal treatments, such as the continuous oral contraceptive pill or hormone replacement therapy, can help some women with their symptoms.

Some women will have a very severe form of PMS and may have suicidal thoughts – this is called premenstrual dysphoric disorder (PDD). If you feel that your symptoms are severe or have thoughts of self-harm or suicide, do not delay seeking urgent medical advice.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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