Premenstrual syndrome (PMS or PMT)

Premenstrual syndrome (PMS) is the physical, psychological and behavioural symptoms that often occur in the days before a woman’s monthly period. Also known as premenstrual tension (PMT), symptoms will vary from woman to woman.

While nearly all women of reproductive age will experience some symptoms of PMS, some will experience symptoms which are particularly severe. Symptoms typically occur in the two weeks before the period starts, improving and easing once the period starts and in the days after.

Common symptoms include bloating, breast pain, mood swings and tiredness.

What is PMS?

Premenstrual syndrome is thought to affect as many as 30% of women in the UK, with symptoms ranging from moderate to severe. According to the NHS, around one in 20 women have symptoms that are so severe they prevent them from living normal lives. This more intense form of PMS is commonly known as premenstrual dysphoric disorder (PMDD).

What causes PMS?

The exact cause of PMS is unclear. However, it's thought to be related to the menstrual cycle, and the changing hormones in the woman’s body during this time.

It's believed this is the cause, due to the fact that symptoms of PMS improve during pregnancy and ease after the menopause, when hormone levels are more stable.

Symptoms of PMS

PMS can vary in symptoms and severity. While one person may not experience many symptoms, or symptoms are very minor, others can experience symptoms which are so severe they affect their day to day life. Every woman tends to have a slightly different experience of PMS. There are many different symptoms and throughout life, these symptoms may change.

Symptoms of PMS typically happen at the same time of the menstrual cycle each month. Symptoms may start to occur up to two weeks before the period starts. 

There have been more than 100 different symptoms recorded. Generally, symptoms of PMS fall into two categories: physical, and psychological and behavioural. 

Common physical symptoms include:

  • bloating
  • headaches
  • backache
  • breast pain
  • abdomen (tummy) pain and discomfort
  • sleeping problems
  • weight gain (up to 1kg) 

Common psychological and behavioural symptoms include:

  • mood swings
  • emotional
  • irritable
  • difficulty concentrating
  • clumsiness
  • tiredness
  • restlessness
  • decreased self-esteem
  • food cravings and/or appetite changes 

Any long-term conditions such as asthma or migraines may get worse during this time. Certain lifestyle factors are thought to worsen symptoms, such as lack of exercise, poor diet and stress.

Premenstrual dysphoric disorder (PMDD)

PMDD is a more intense type of PMS, where symptoms affect the individual’s daily life and well-being. PMDD can be particularly hard to deal with. While symptoms are similar to those of PMS, they are typically more severe and may include more psychological symptoms.

Symptoms of PMDD include feelings of hopelessness, persistent sadness or depression, extreme anger, change in sleeping patterns, extreme tension or irritability. 

When to seek help

Most women will experience some form of PMS in the weeks before the start of their monthly period. This is normal. If symptoms are affecting your everyday life, however, consider speaking to your doctor. They may ask you to record how you’re feeling during this time, for at least two or three months. This will allow your GP to recognise any patterns in your symptoms.

For diagnosis of PMDD, symptoms need to be seriously affecting your relationships and ability to work or attend school. If they suspect PMDD, you may be referred to a mental health specialist for further treatment.

Treatment

There are a number of treatments that may help you manage symptoms of PMS, especially if they are interfering with your daily life. If symptoms of PMS are mild to moderate, there are certain lifestyle and diet changes that can help ease symptoms. For more severe cases, psychological therapy or medical treatment may be suggested.

PMS lifestyle changes

Lifestyle changes

While these changes won’t make PMS disappear, they can help to ease symptoms, making the days and weeks before the monthly cycle more manageable. Eating a balanced diet can be a great help in managing symptoms of PMS. These tips help you maintain a healthy lifestyle and may help control your symptoms.

Eat little and often - smaller meals more frequently can help reduce bloating during this time of the month. Try to avoid particularly salty foods as this can make bloating worse.

Drink plenty of water - drinking water throughout the day keeps you hydrated. Dehydration can make headaches and tiredness worse, exacerbating symptoms.

Choose complex carbohydrates - these are found in fruit, green vegetables, starchy carbohydrates (potatoes and sweet potatoes) and whole grains (oats, whole grain pasta and bread). They are higher in vitamins and minerals than simple carbohydrates and are a slow-releasing energy. Rich in fibre, complex carbohydrates also keep you fuller for longer.

Eat your five a day - fruit and vegetables are rich in vitamins and minerals, which are thought to ease PMS symptoms. Aim to eat at least five portions a day.

Reduce caffeine and alcohol intake - caffeine and alcohol can affect your mood and energy levels, making these symptoms worse. It’s thought that some people have a stronger desire for alcohol before their period starts, but PMS can affect the body’s ability to break it down. If you can’t avoid alcohol completely, try to limit your consumption.

Physical activity

Of course, regular physical activity is essential in maintaining a healthy lifestyle. If possible, aim to do at least 150 minutes of moderate-intensity activity each week (30 minutes for five days). This could be walking, swimming or cycling. Regular exercise keeps the body healthy, and can also help alleviate tiredness and depression. Stretching-based activities, such as yoga and pilates are great ways to de-stress and help you sleep better. In some cases, stretching is also thought to help ease abdominal discomfort during your period.

Why contact a nutrition professional?

For most women, PMS is something of an inconvenience, but doesn’t interfere too much with daily life. But, those with frequent, severe symptoms may need further help, so that symptoms are more easily managed and not affecting daily life. If one of your symptoms is bloating, for example, they may be able to adjust your diet so that any potential triggers are avoided.

If you are looking to change your diet and learn more about the nutrients your body needs, a nutrition professional can help. A nutritionist can give you a personalised food plan, tailored to you, your lifestyle and your symptoms.

There are many benefits to seeking advice and support from a qualified nutrition professional. Whether you’re looking to adjust your diet to help manage the symptoms of a medical condition, or to improve your life and health for the better, professional support can be extremely beneficial.

Complementary treatments 

Alternative treatments and supplements have been said to help ease symptoms of PMS. However, there is as yet no evidence that these are effective treatments. If you’re interested in alternative treatment for PMS, it’s important you consult your doctor before taking any supplements. 

Psychological therapy 

If you’re experiencing psychological symptoms, such as anxiety and depression, seeking professional help can be beneficial. There are many talking therapies available. Cognitive behavioural therapy (CBT) in particular is a therapy designed to help people manage feelings of anxiety and depression.

To learn more about talking therapies and mental health, visit Counselling Directory.

Medical treatment

If you are experiencing particularly severe symptoms of PMS or you have PMDD, you may be considering medical treatment. There are a number of treatments available, and no one treatment works for everyone. Speak to your doctor and together you can decide on a treatment. This will depend on the severity of your symptoms, and any possible side effects. Medical treatments for PMS include painkillers, a combined oral contraceptive pill and oestrogen-only patches and implants.

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