Premenstrual
What is PMS?
PMS (Pre Menstrual Syndrome) is the name given to the set of physical, psychological and emotional symptoms that appear in the days leading up to a woman’s monthly period. Some people refer to it as PMT (Pre Menstrual Tension). Usually, the symptoms improve when your period starts and disappear completely a few days afterwards.
It is not uncommon for all women of child-bearing age to have some premenstrual symptoms. For a small number of women these symptoms will be severe enough to disrupt their daily lives. PMS usually disappears after the menopause.
The exact cause of PMS is not fully understood but it is thought to be linked to the changing levels of hormones that a woman experiences during her menstrual cycle. The variation in symptoms that women experience would suggest however, that PMS is also influenced by other factors.
There is no cure for PMS but there are treatments available that can help women to manage her symptoms.
What are the symptoms of PMS?
As many as 150 different symptoms of PMS have been reported and some of the most common include:
Physical
- Bloating/fluid retention (which can lead to a feeling of weight gain, up to 1kg)
- Fatigue
- Headache/Migraine
- Acne
- Backache
- Tender/sore breasts
- Cramp pains
- Generalised aches
- Nausea
- Altered bowel habit
Psychological
- Nervous tension
- Anxiety
- Agitation
- Irritability
- Depression
- Confusion
- Forgetfulness
- Crying
- Loss of interest in sex
- Loss of confidence
- Low self esteem
- Mood swings
- Poor concentration
Behavioural
- Clumsiness
- Loss of performance at work
- Avoidance of social activities
- Alcohol binges
What are the possible causes?
As previously mentioned the exact causes are unknown but the contributing factors are
Hormonal Changes
During your menstrual cycle, levels of hormones, such as oestrogen and progesterone, rise and fall. Hormonal changes are thought to be the biggest contributing factor to many of the symptoms of PMS. The fact that PMS improves during pregnancy and after the menopause, when hormones are stable supports this theory.
Chemical changes
Like your hormone levels, certain chemicals in your brain, such as serotonin, fluctuate during your menstrual cycle. Serotonin is known to help regulate your mood and make you feel happier, and so it is possible that women with low levels of serotonin are particularly sensitive to the symptoms of PMS. Low levels of serotonin may also contribute to symptoms such as tiredness, food cravings and difficulty sleeping.
Stress
You may find that your symptoms of PMS become worse the more stressed you are. Whilst not a direct cause, being stressed can aggravate the symptoms of PMS.
Diet
Eating too much of some foods and too little of others may also affect
your symptoms.
For example, too many salty foods may affect fluid retention, and make
you feel bloated. Caffeinated food and alcohol can disrupt your mood
and energy levels. Low levels of vitamins and minerals may also make
your symptoms of PMS worse.
How can a diagnosis of PMS be made?
There is no test or procedure that can diagnose PMS. If you are finding your symptoms difficult to deal with your should see your GP, ourselves or contact the local PMS/menopause helpline on 01387 – 241121.This number is available on a Thursday morning between 9am to 12 noon.
You may be asked to keep a diary of your symptoms. Keeping a record of them for a couple of months before a visit to see a medical practitioner will be really useful for them to see if any pattern is associated with how you are feeling and when you have your period.
Treatment of PMS
A cure for PMS does not currently exist; the main aim is to manage the symptoms.
The symptoms of PMS can be treated in a variety of ways depending on
the severity.
Treatments include:
- Self help remedies, e.g. diet and lifestyle modification
- Mild diuretics (water tablets)
- Vitamin/mineral supplements
- Pyridoxine (Vitamin B6)
- Evening primrose oil
- Antidepressants
- Stress management
- Alternative complimentary therapies
- Hormone therapy
- Support
Diet
Changing eating habits can help to relieve symptoms of PMS.
It is important to eat a well balanced diet,
- Eat little and often and do not skip meals
- Reduce sugar and junk foods, this can help to prevent the rapid rise and fall of sugar within the blood which can worsen symptoms such as irritability, shaking, tiredness and anxiety.
- Eat more carbohydrate /starchy food. Starchy foods give a much more sustained release of glucose because they take longer to digest and avoid the sudden rise and fall of blood sugar.
- Reduce salt intake by cutting down on amounts used in cooking, at the table and used as preservatives in processed foods. This can help to alleviate fluid retention, bloating, breast tenderness and migraine
- Reduce caffeine levels. Caffeine can worsen symptoms of PMS by increasing pulse rate, trembling, feeling of anxiety and irritability. Spring water, herbal and decaffeinated drinks make good alternatives. Lime and blossom tea can improve moods and camomile tea aids relaxation.
- Reducing fluid intake and help with bloated ness.
- Reduce fat intake, especially saturated fat which can affect the production of the hormone like compound called prostaglandin. This in turn can worsen PMS by making the body sensitive to the changing hormone levels. Reducing fat consumption also contributes to overall health and in the prevention of heart disease.
- Increase fibre and eat plenty of fruit and vegetables to ensure adequate vitamin intake.
- Eat foods high in vitamin B6 and magnesium, e.g. dried grains, beans, seafood, tomatoes and peanuts.
- Use fresh or frozen, not canned foods
- Limit alcohol intake. This can affect mood swings by affecting prostaglandin production.
Lifestyle and Exercise
Try and exercise for at least half and hour five times a week. Exercise improves your overall health and can help alleviate depression and tiredness.
Stretching and breathing exercises such as yoga and palates can help you sleep better and reduce your stress levels.
Try and make some time each day for your self and do simple things like take a warm bath or pursue a hobby. Both of which are refreshing and relaxing.
It is also important that family and friends understand how you are feeling and allow you some me time.
Mild Diuretics
May be helpful for relieving fluid retention and weight gain in the premenstrual phase of the cycle. However they are not recommended for long term use as they can worsen the symptoms that they were originally prescribed for.
Vitamin/mineral supplements
It is thought that vitamin and mineral supplements may help some PMS sufferers. Magnesium can help fluid retention, zinc can help acne. However the best advice is to eat a healthy balanced diet.
Pyridoxine (vitamin B6)
Evidence suggests differing results when looking at the benefits of
vitamin B6. It is thought that it can help alleviate symptoms such as
breast tenderness, fluid retention, headache, tension and irritability.
It is available form health food shops in lower doses (10mg tablets)
with women self medicating.
IT IS VERY IMPORTANT THAT DOSES ARE NOT EXCEEDED. HIGHER DOSES ARE AVAILBLE
FROM PHARMACIES AND YOUR GP. HIGHER DOSES MUST BE TAKEN UNDER MEDICAL
SUPERVISION.
Evening Primrose Oil
Contains Gamolenic acid, which is an essential fatty acid, essential for a healthy nervous system. It can be useful in alleviating headache, fluid retention, breast tenderness, joint pain, irritability and anxiety.
Antidepressants
These can help with symptoms of depression and mood swings. They raise serotonin levels in the brain and promote a feeling of well being.
Alternative/complimentary therapy – e.g. aromatherapy, reflexology, herbalism, homeopathy and acupuncture.
All of the above may be helpful in relieving some of the symptoms of PMS. It is important that women find their own reputable therapist and make their own choices about treatment.
Hormone Therapy
Again hormone therapy may be helpful in relieving some of the symptoms of PMS. It works by suppressing ovulation which in turn helps to prevent the rise and fall of hormone levels associated with the menstrual cycle. It can be given in oral or uterine form. For more advice see your GP or visit your local sexual health clinic.
Support
Talking to other people can help PMS by reducing stress and sharing
information.
Support, education and counselling can help improve knowledge about PMS,
allowing greater understanding for both women and their families. HRT
and Sexual health clinics can provide this support as well as national
organisations such as:
National Association for Premenstrual Syndrome (NAPS)
7 Swifts Court
High Street
Sevenoaks
Kent
TN15 0EG
Tel:
01732 760011 (Office)
01732 760012 (helpline)
PREMSOC (The Premenstrual Society)
PO Box 429
Addlestone
Surrey
KT15 1DZ
PMS Help
PO Box 160
St Albans
Herts
AL1 4UG
With thanks to NHS Dumfries and Galloway, and in particular Katrina Martin for providing some of the information used in the above.