Premenstrual syndrome (PMS or PMT)
Premenstrual tension (PMT) and premenstrual syndrome (PMS) are terms used interchangeably to refer to the physical and psychological changes which often occur in the days before a women's period begins.
For many women symptoms are relatively mild, though a small number do find that during this time of the month they experience a series of physical and psychological symptoms which can effect home and work life.
Though exact figures are unknown, its been suggested that approximately a third of women suffer from a level of PMT which affects their life in some way. Common symptoms include psychological issues such as mood swings, loss of temper, tearfulness, aggression and irritability, and physical symptoms can include swelling and bloating of the abdomen, swollen ankles, headaches or migraines, weight gain and tenderness in the breasts.
Because many common symptoms of PMT are also caused by numerous other conditions such as depression, stress, thyroid problems etc, it can be difficult to determine whether or not they are caused by the menstrual cycle or not.
If you are unsure then the best thing to do is visit your GP who, depending on what side effects you are experiencing may take blood tests to make sure there isn't another cause of the symptoms.
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What causes PMS?
As it stands the exact cause of PMS is unknown and no theories have been officially proven. Previously a number of experts were of the belief that symptoms were linked in part to fluctuating female hormone levels which occur after ovulation. However, this is now a less common theory with many medical professionals favouring the explanation that it is ovulation itself which appears to trigger the symptoms.
This theory is based around the idea that women who suffer from PMS are more sensitive to what is considered as the 'normal' level of progesterone, and this is the hormone released into the bloodstream from the ovaries after ovulation takes place.
The main effect that this extreme reaction to progesterone seems to have is to lower the level of a hormone known as serotonin, which could explain why PMS medication aimed at increasing serotonin levels work so effectively.
What are the symptoms of PMS?
There are a huge number of symptoms linked to premenstrual syndrome both physical and psychological. Psychological issues may include irritability, anger, mood swings, sleep difficulties, loss in confidence and aggression. Physical symptoms may include abdominal bloating, weight gain, breast tenderness, swelling in extremities and headaches.
Who is affected?
Premenstrual syndrome can affect women of any age, though it most commonly occurs in those aged between 30 and 40. At some point virtually all women will experience at least one incidence of PMS, but one in twenty will be affected at such a level that it begins to disrupt their day-to-day life, activities and relationships.
Am I suffering from PMS?
As it stands there is no test which is able to diagnose PMS, so identifying the condition is based wholly around the assessment of your symptoms.
Unfortunately, because many PMS symptoms are also common in various other illnesses, diagnosis can prove quite difficult.
Your healthcare provider may ask you to keep a record of what symptoms occur and when as this will help them to reach the correct diagnosis.
Typically they will be looking to see when your symptoms begin as onset up to five days before a period or in the two weeks leading up to the period are common in women with PMS. Many women also seem to find that their symptoms worsen as menstruation nears and cease within three to four days after menstruation.
What are my treatment options?
If you are suffering from PMS it may help you to understand what is happening to you and why you feel the way you do. Some medical experts recommend that women keep a diary of how they are feeling and when, this way if you are feeling low, irritable or anxious you will be more likely to associate these feelings as being symptoms of PMS. Keeping your diary up to date will allow you to anticipate certain symptoms so that you can plan a coping strategy such as avoiding stressful situations if you repeatedly feel anxious during a specific few days each month.
There are various treatment options available for those who suffer significantly from PMS symptoms, information on which can be found below:
If you do visit your GP regarding your PMS symptoms then they may recommend one of the following:
- Combined oral contraceptive pill (COCP)
As mentioned previously, many medical experts believe that ovulation is a contributing factor in many PMS symptoms, therefor meaning that preventing this process should help.
Oestrogen given in either a patch or gel form has been proven effective in reducing symptoms in some women. Oestrogen tablets have no effect and it is also worth noting that those who have not undergone a hysterectomy will also have to take progesterones. Levels of progesterone which are present in patches are much lower than those in combined oral contraceptive pills so do not work as contraception.
- Selective Serotonin Re-uptake Inhibitors (SSRIs)
SSRI medication is commonly prescribed to treat severe cases of PMS. The medication is more commonly known for its use in the treatment of depression, though their ability to increase the level of serotonin in the brain means they are an effective treatment for the reduction of PMS symptoms.
Cognitive-behavioural therapy (CBT)
This therapy combines both cognitive and behavioural therapies and is based around the idea of changing the way you think (cognitive) and how you respond to certain thoughts (behaviour). In the case of PMS it can be used to find more adaptive ways of coping with symptoms.
Some women may feel anxious about taking medication to alleviate their symptoms and would prefer to try more natural options before consulting their GP. There are many over the counter remedy’s which are aimed at reducing PMS symptoms though be aware there is very little evidence to support their use and some may prove ineffective for you personally.
Over the counter remedies
- Agnus castus – This is a herbal remedy which is used for various gynaecological problems including PMS.
- Anti-inflammatory painkillers – Can be taken to reduce joint and muscle pain.
- Calcium – Taking 1000-1200 mg of calcium per day could help to improve symptoms.
- Diuretics – Though these will be of no benefit to psychological symptoms, diuretics can help to reduce bloating and fluid retention.
- Evening primrose oil – Thought to ease breast discomfort.
- Magnesium – Taking 200-400 mg of magnesium a day during the two weeks before menstruation may help to improve symptoms.
- St John's wort – This herbal remedy has long since been used as a treatment for PMS associated mood swings.
- Vitamin B6 – Though this vitamin will be part of most everyday diets, extra amounts are associated with helping to alleviate some PMS symptoms. Experts recommend that vitamins be taken either every day, or in the two weeks before menstruation. Please note, too much vitamin B6 can actually be harmful so please ensure you are not exceeding the recommended daily dose of 10 mg.
How can a nutritionist help me?
For most women PMS symptoms are just one of life’s little inconveniences that occur a few days each month but generally don't have a negative impact on our lives as a whole. However, those who experience frequent and severe symptoms often require further help to prevent their symptoms from affecting their day-to-day lives.
The treatments detailed in the previous section can be extremely affective in many women, as can referral to a specialist such as a gynaecologist or psychiatrist. What some women also find beneficial is a consultation with a nutritionist, who will take each individual’s personal circumstances and symptoms into account before issuing dietary and lifestyle recommendations.
A nutritionist will look at the dietary intake of a client so that they are able to identify any deficiencies there may be. In order to do this, individuals may be asked to provide a food diary or undergo food testing. These steps will allow the practitioner to establish certain changes that could be made to your diet to improve PMS symptoms.
Your nutritionist may recommend that you begin taking certain supplements to keep your vitamin and mineral levels topped up and may also advise you to avoid certain foods. Whilst any recommendations will be entirely dependent on your own unique personal circumstances, below is some general information about food groups that some sufferers may be advised to avoid:
- Carbohydrates which are high in fast releasing sugars such as cakes and biscuits – These can contribute to insulin resistance and weight gain.
- Fluids such as coffee, tea and sugar laden carbonated drinks – These can cause insulin resistance and water retention.
- Saturated fats from red meat, dairy and processed spreads - These can contribute to hormonal imbalances.
Your nutritionist will also encourage you to incorporate certain foods into your diet, and though recommendations will be dependent on your individual circumstances may include the following:
- Complex carbohydrates such as whole gains, brown rice and wholemeal flour – These have a low glycemic index and will trigger a more stable insulin response. Colourful fruit and vegetables such as peppers and carrots contain high levels of antioxidants which will contribute to the reduction of oxidative stress and green vegetables such as cabbage and broccoli will help oestrogen metabolism.
- Fats such as nuts, seeds and oily fish – These will supply essential fatty acids which help to restore insulin sensitivity.
- Fibre from fruit, vegetables, whole grains and oats – These will help to stabilise blood sugar response and also support probiotic bacteria in the intestines which play a part in metabolism and normal balance.
- Fluids such as fruit juice and herbal teas will help to prevent fatigue and constipation.
- Protein from lean white meat and fish, pulses, rice and live yoghurt will all help to encourage a healthy gut.
As well as making dietary recommendations and possibly drawing up a food plan, a qualified nutritionist may also make lifestyle recommendations which can be incorporated into your daily life.
Everyone knows that exercise plays an integral role in healthy living so your new programme may include an a regime or recommendations which are to be carried out multiple times throughout the week as well as time for relaxation for whatever it is you enjoy doing.
The aim of a nutritionist is not to make temporary changes until your symptoms have improved, but to actually change your way of life permanently. The changes made to your diet and lifestyle will be realistic and achievable and should you have any concerns these can be discussed with your practitioner along the way.
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