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Premenstrual syndrome


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Premenstrual syndrome
Women's health
Premenstrual syndrome (PMS) is widely recognised as a medical condition that affects many women. PMS describes a range of symptoms that occur before the menstrual period and usually improve when the period starts.

Most women of child-bearing age will have some premenstrual symptoms. In about 5-10% of these women, symptoms will be sufficiently severe to affect their daily activities and for the condition to be called PMS.

Symptoms of PMS generally increase after child birth, after a change in contraception and at other times of hormonal changes. Women aged 30-45 years tend to experience the severest of symptoms.

For some women with PMS, the symptoms are so severe that they are considered disabling. This form of PMS is known as premenstrual dysphoric disorder or PMDD.
PMS affects women only during the later stage of their menstrual cycle. This stage is known as the luteal phase and occurs between days 15 to 26 of their monthly cycle.

The main hormone controlling the luteal phase is progesterone, but it is a time when levels of all hormones involved in the menstrual cycle can fluctuate dramatically. It is the body’s response to the changing hormones and to the level of hormones that is thought responsible for the symptoms of PMS.

Decreased levels of the chemical messenger serotonin in the brain are also thought to make women particularly sensitive to progesterone, causing symptoms of aggression and for them to act impulsively.
Symptoms of PMS and their severity can vary from person to person and even from month to month. Over 150 symptoms of PMS have been identified. Common physical symptoms include bloating, breast tenderness, headache, weight gain, skin problems and fatigue. Women with PMS can also suffer from a variety of psychological problems such as poor concentration and mood swings. These can range from irritability and tearfulness to depression, aggression and feelings of being misunderstood.

The symptoms of PMS can appear up to two weeks before a period is due and generally disappear or improve either on the first day of the period or after the day when the flow is heaviest. Most women are then symptom-free for a significant time before the next period.

Any woman who experiences these types of symptoms throughout the menstrual cycle is unlikely to have PMS and so should see her doctor to discuss other possible causes.
There are a number of treatments that can help improve the symptoms of PMS, such as water tablets (diuretics) to relieve bloating, painkillers, antidepressants and hormonal drugs.

Complementary medicine such as acupuncture, aromatherapy and reflexology has also proved popular in managing the symptoms of PMS.

When to see your pharmacist
Talk to your pharmacist if you are affected by PMS. If you are feeling bloated and have water retention, your pharmacist may recommend mild diuretics such as Aqua-Ban, that help increase water loss by making you go to the toilet more frequently.

Complementary therapies such as evening primrose oil and dietary supplements containing supplements of vitamin B6, vitamin E, calcium or magnesium, which some women find helpful, are also available through your pharmacy without a prescription.
When to see your doctor
If you are uncertain whether you are suffering from PMS, you should complete a menstrual chart or diary outlining your symptoms for at least three consecutive months and show it to your doctor.

If your symptoms are so severe that they are interfering with your daily activities, your doctor may decide to prescribe drugs such as fluoxetine to control symptoms of anxiety or depression, or to prescribe a combined oral contraceptive that has the effect of stabilising hormone levels.

If symptoms are experienced throughout the cycle and do not disappear or significantly improve either on the first day of your period or after the day when the flow is heaviest, it is unlikely to be PMS. Consequently, you should see your doctor to determine the cause for your symptoms.
Living with PMS
The surest way to determine whether you are suffering from PMS is to keep a menstrual diary. Kept for 3 cycles a diary will help you see a pattern of when symptoms first start, when they are most severe and when they begin to decline. Many women find that just knowing for certain they have PMS brings relief and can help them better understand the problem.

A menstrual diary will also help if you need to go to see your doctor. It will clearly show that your symptoms are cycle related, and it will help your doctor decide on an appropriate treatment.

Whatever your symptoms are, you will benefit from some simple dietary and lifestyle changes. Eat at regular meal times, particularly in the 2 week period before your period starts. Reduce your intake of sugar, salt, caffeine and alcohol, and increase your intake of fruit, vegetables, complex carbohydrates and water.

Exercise regularly, learn to relax and try to avoid stressful situations.
Useful Tips
  • Cut down on alcoholic drinks and avoid too much caffeine
  • Increase intake of complex carbohydrates such as oats, wholemeal bread, pasta
  • Eat at regular meal intervals, especially in the 2 weeks prior to your period
  • Take up regular exercise
  • Try relaxation techniques
Further information
The National Association for Premenstrual Syndrome (NAPS) is the only society promoting the interests of premenstrual syndrome sufferers. Members of NAPS have access to personal advice from clinical experts, information about premenstrual syndrome, dietary and lifestyle advice, and access to an interactive menstrual chart that allows recording of symptoms.

National Association for Premenstrual Syndrome
41 Old Road
East Peckham
Kent TN12 5AP
Helpline: 0844 815 7311

Reviewed on 23 May 2011