Premenstrual syndrome (PMS)

Published by BUPA's Health Information Team
August 2003

Premenstrual syndrome (PMS) also known as premenstrual tension (PMT), is a mixture of physical and emotional symptoms that some women experience in the days, or sometimes weeks, leading up to their menstrual period.

About PMS

Symptoms of PMS can start up to two weeks before each period and usually stop when the period starts.

PMS is more common in women over the age of 30 years and tends to stop with the menopause. PMS also stops in women who have an operation to remove both their ovaries.

Nearly all women have some PMS symptoms. However, only around 1 in 20 women have symptoms that seriously interfere with their quality of life.

Symptoms

A long list of symptoms have been attributed to PMS. Some of the more common ones are:

• headache
• feeling bloated
• weight gain
• breast tenderness
• back or lower abdominal pain
• irritability or aggression
• depression and anxiety
• mood swings
• tiredness
• poor concentration

A more severe form of PMS is called premenstrual dysphoric disorder (PMDD), in which the emotional symptoms, such as depression, mood swings, anxiety and tension, are particularly serious. It occurs in only a small percentage of women with PMS.

Causes of PMS

No-one knows the exact cause of PMS, but suggested causes include:

• abnormal sensitivity to hormones - some women may be more sensitive to the normal levels of the hormone progesterone released into the blood during the second half of the menstrual cycle. One effect of over-sensititivity to progesterone is a reduced level of a brain chemical called serotonin, which is involved in controlling mood.
• nutrients - some people think that the symptoms may result from or be aggravated by variations in nutrients such as magnesium and calcium, although there is limited scientific evidence for this.
• some people think that yeast infections (such as thrush) can cause PMS.

Diagnosing PMS

There are no specific tests that can diagnose PMS. A doctor will usually suggest a diagnosis of PMS based on a a description of the symptoms and when they occur. A woman who suspects she has PMS should keep a diary of her symptoms for a few months before the first visit to the GP and then in between visits. This is the best way to identify if the symptoms are related to the menstrual cycle.

If a woman goes to see her GP with PMS symptoms, he or she may also do an internal examination to check that there are no problems with her womb or ovaries. The doctor may also take some blood samples to measure hormone levels

Treatment of PMS

Many women tolerate PMS believing it to be a normal part of being female. However, treatment is available for severe PMS symptoms.

Self-help

A woman can do several things that may improve the symptoms of PMS. Different women find that different remedies help and it may be that several have to be tried before finding something that is effective.

• Taking regular exercise, such as aerobics or jogging - exercise can help with the symptoms, but it should be done regularly, not just when symptoms are present.
• Avoiding stress at home and work in the time before a period is due.
• Pinpointing and avoiding any emotional triggers or stress that make the symptoms worse; discussing these with your partner or a friend and asking for their support.
• Some women have found that taking vitamin B (particularly B6) is helpful, but there is only limited scientific evidence that this works, and high doses can cause damage to the nervous system.
• Daily magnesium or calcium supplements may help.
• Some women find that taking evening primrose oil helps relieve breast discomfort but the scientific evidence is patchy. Long-term treatment (more than 3 months) may be required before any effect is noticed.

There is no clear scientific evidence that a special diet helps with PMS. However, eating a balanced diet that is rich in fruit and vegetables and contains plenty of complex carbohydrates (wholemeal bread, rice, pasta, potatoes, etc.) certainly promotes general good health.

Medicines

Anyone with symptoms that don't improve with self-help treatments can consider seeing their GP. He or she may prescribe medicines, depending on the type of symtoms and their severity.

• Mefenamic acid (eg Ponstan) is a type of painkiller that may help with any painful PMS symptoms. It should be taken for about 12 days before a period is due and the dose should be increased during the period.
• The combined oral contraceptive pill, which prevents ovulation, can help with some symptoms, though evidence for this is limited.
• A diuretic (water tablet), such as spironolactone, taken for the week before each period, may help to relieve symptoms of water retention such as breast tenderness and bloating.
• Antidepressants called selective-serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) improve PMS symptoms, and may be especially helpful for women with premenstrual dysphoric disorder, although side-effects can include nausea, insomnia and headaches.
• Tranquillisers such as alprazolam can help reduce anxiety if this is a symptom of PMS, but they should not be used in the long term.
• A low dose of the hormone oestrogen improves PMS symptoms because it prevents ovulation. This can be taken as a combined oral contraceptive (pill containing both oestrogen and a progestogen). Alternatives include skin patches and an intra-uterine device (Mirena coil) that releases progestetrone into the uterus (womb).
• Progestogens taken for the week before a period is due may help reduce symptoms, but there is conflicting scientific evidence for this.
• A medicine called danazol prevents ovulation and reduces PMS symptoms, but the possible side-effects such as masculinisation (increased hair growth, oily skin) make it a less useful treatment.
• Bromocriptine is an effective treatment if breast tenderness is a major problem. However, this can also have troublesome side-effects such as nausea and vomiting.

Further information

National Association for Premenstrual Syndrome
0870 7772178
http://www.pms.org.uk

 

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