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Premenstrual Syndrome

Premenstrual syndrome (PMS) is a collection of physical, psychological and emotional symptoms related to your menstrual cycle. Generally, the symptoms come in the days leading up to your period, improve when your period starts and disappear a few days afterwards.

The majority (about 95 percent) of women of child-bearing age have some premenstrual symptoms. Between 5 and 10 percent of these women will have severe enough symptoms for it to be called PMS. Usually, PMS goes away after the menopause. The exact cause of PMS is not fully understood. However, it is thought to be linked to the changing levels of hormones in your body during your menstrual cycle.

Symptoms

PMS is a collection of symptoms. The exact symptoms and how severe they are vary from person to person. Anything up to 150 separate symptoms have been linked to PMS, but the most common are:

  • Feeling irritable and bad tempered
  • Headaches
  • Feeling depressed
  • A general feeling of being upset or emotional
  • Difficulty sleeping
  • Difficulty concentrating
  • Feeling full and 'bloated'
  • Backache
  • Breast tenderness
  • Some weight gain (up to 1 kg)

The symptoms usually happen at the same time in your menstrual cycle each month. They usually improve when your period starts and then disappear for at least seven days, often longer.

Causes

The exact cause of PMS is not fully understood. It is thought to be linked to the changes in hormone levels that happen throughout your menstrual cycle. It is possible that women with low levels of the brain chemical serotonin are particularly sensitive to levels of the hormone progesterone, and this might lead to the symptoms of PMS.

Diagnosis

Usually, you can make the diagnosis yourself using a menstrual chart for 2-3 months.

Treatment

The aim of treatment for PMS is to tackle the symptoms you are having so that your menstrual cycle does not disrupt your life. A wide range of treatments are available. Your choice of treatment will be influenced by the symptoms you are having and how severe they are, what treatments are available and their side effects. The following is a general guide to the treatments available, but you should discus the options fully with your doctor before making a decision. The following have been shown to be effective in treating PMS symptoms:

  • Diuretics ('water tablets') that reduce the levels of fluid in the body. This can help with breast tenderness and feeling bloated
  • Non-steroidal anti-inflammatory drugs (NSAIDs; eg ibuprofen) help with a number of symptoms
  • Selective Serotonin Reuptake Inhibitors (SSRIs) a type of antidepressant drug often used to treat depression and anxiety. SSRIs can help with a number of symptoms but may have some unpleasant side effects. Examples are fluoxetine and paroxetine. SSRIs should not generally be prescribed for depression in children and adolescents under the age of 18, although fluoxetine can be prescribed if specialist advice is obtained.

The following treatments are also likely to help relieve PMS symptoms:

  • Exercise (taking regular exercise is good for your general health too)
  • Cognitive Behaviour Therapy (CBT) a 'talking treatment' often used for a number of psychological conditions
  • Oral contraceptive pill - the contraceptive pill works by stopping ovulation (egg release) and helps to stabilise hormone levels
  • Low-dose oestrogen - oestrogen is a hormone that occurs naturally in both men and women. Carefully altering the level of oestrogen may help with some PMS symptoms. A recently developed treatment is transdermal oestrogen, which involves a dose of the hormone being given through a patch on the skin.

A number of other treatments may also be used. Whilst there is not convincing research evidence that these treatments work, it is possible that they might help some people:

  • Dietary supplements eg vitamin B6, vitamin E, calcium, magnesium
  • Evening primrose oil
  • Relaxation therapy
  • Complementary therapies such as chiropractic, reflexology, acupuncture
  • Removal of one or both ovaries (oophorectomy)
  • Removal of the womb (hysterectomy)

A number of other drugs have also been tried in the treatment of PMS. Whilst they may be helpful in certain cases, they also have a number of unpleasant side effects. These include bromocriptine, danazol, gondorelin and several non-SSRI antidepressant drugs. The drug progesterone was used to treat PMS in the past. It is no longer considered to be effective and should not be used. Eating a good balanced diet with plenty of fresh fruit and vegetables is good for your health and may help to relieve the symptoms of PMS. Your diet should be low in fat, salt, alcohol and caffeine but high in fibre. You should aim to eat at least five portions of fruit or vegetables every day.

Complications

Some courts of law have accepted PMS as a ground for the defence of diminished responsibility in criminal cases.

The information shown here is Crown copyright and has been reproduced with the permission of NHS Direct. Last updated June 2007.