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Premenstrual syndrome Content Supplied by NHS Choices
Introduction

Premenstrual syndrome (PMS) is the name given to the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman's monthly period. It's also known as premenstrual tension (PMT).

There are many different symptoms of PMS, but typical examples are:

These symptoms usually improve when your period starts and disappear a few days afterwards.

Nearly all women of childbearing age have some premenstrual symptoms, but women in their late 20s to their early 40s are most likely to experience PMS.

Around 1 in every 20 women have symptoms that are severe enough to stop them living their normal lives. This is often the result of a more intense type of PMS known as premenstrual dysphoric disorder (PMDD).

Read more about the symptoms of PMS.

When to see your GP

You should see your GP if you're finding it difficult to deal with the symptoms of PMS.

They can help determine if you have PMDD, and may be able to offer you advice and treatment to manage the symptoms you're experiencing.

Why it happens

The exact cause of PMS isn't fully understood. However, it's thought to be linked to the changing levels of hormones in the body during a woman's menstrual cycle.

The fact that PMS improves during pregnancy and after the menopause, when hormone levels are stable, supports this theory.

Certain lifestyle factors are also thought to aggravate the symptoms of PMS, including:

  • lack of exercise and being overweight
  • stress
  • a poor diet

Read more about the causes of PMS.

Managing PMS symptoms

Certain lifestyle changes may help you manage PMS if your symptoms aren't severe. These include:

Psychological therapy or hormone medications may be recommended in more severe cases.

Read more about treating PMS.


Symptoms of premenstrual syndrome (PMS)

There are many different symptoms of premenstrual syndrome (PMS), which can vary from person to person and change slightly every month.

You may have similar PMS symptoms every month that vary in intensity, or slightly different symptoms every few months. PMS tends to be different for every woman.

The symptoms of PMS usually happen at the same time in your menstrual cycle each month. This can be up to two weeks before your period starts.

Symptoms usually improve once your period has started and disappear until your cycle starts again.

Common symptoms of PMS

More than 100 different symptoms of PMS have been recorded. Some of the most common are listed below.

Physical symptoms

  • feeling bloated
  • pain and discomfort in your abdomen (tummy)
  • headaches
  • backache
  • muscle and joint pain
  • breast pain
  • trouble sleeping (insomnia)
  • nausea
  • weight gain (up to 1kg)

Any long-term (chronic) illnesses, such as asthma or migraines, may get worse.

Psychological and behavioural symptoms

  • mood swings
  • feeling upset or emotional
  • feeling irritable or angry
  • crying
  • anxiety
  • difficulty concentrating
  • confusion and forgetfulness
  • clumsiness
  • restlessness
  • tiredness
  • decreased self-esteem
  • loss of libido - loss of interest in sex
  • appetite changes or food cravings

Premenstrual dysphoric disorder (PMDD)

While most women with PMS find their symptoms uncomfortable, a small percentage have symptoms severe enough to stop them living their normal lives.

This is the result of a more intense type of PMS known as premenstrual dysphoric disorder (PMDD).

The symptoms of PMDD are similar to those of PMS, but are more exaggerated and often have more psychological symptoms than physical ones.

Symptoms can include:

  • feelings of hopelessness
  • persistent sadness or depression
  • extreme anger and anxiety
  • decreased interest in usual activities
  • sleeping much more or less than usual
  • very low self-esteem
  • extreme tension and irritability

As depression is a common symptom of PMDD, it's possible that a woman with PMDD may have thoughts about suicide.

PMDD can be particularly difficult to deal with as it can have a negative effect on your daily life and relationships.

When to see your GP

It's normal to experience mild PMS symptoms in the two weeks before your period starts. However, you should see your GP if the symptoms are making everyday life difficult.

Your GP may ask you to use a diary to record how you're feeling each day in the run-up to your period.

You may have to do this for at least two or three months so your GP can spot any patterns in your symptoms.

PMDD is only diagnosed when your mood symptoms seriously affect your relationships and stop you functioning properly at work or school.

Your GP may refer you to a mental health specialist for further assessment and treatment if they think you have PMDD.

 

Causes of premenstrual syndrome (PMS)

The exact cause of premenstrual syndrome (PMS) isn't fully understood, but a number of things may contribute to the symptoms.

Hormone changes

During your menstrual cycle, levels of hormones such as oestrogen and progesterone rise and fall. Hormone 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, and when hormone levels are stable, supports this theory.

Chemical changes in the brain

It's also been suggested that changes in hormone levels during the menstrual cycle may affect the levels of certain chemicals in your brain, such as serotonin.

Serotonin is known to help regulate your mood and make you feel happier, so a reduction in the level of serotonin caused by changes in hormone levels may explain the mood changes often associated with PMS.

It may also explain why a type of antidepressant medication that increases serotonin levels - known as selective serotonin reuptake inhibitors (SSRIs) - helps some women with PMS.

Lifestyle factors

There are also a number of lifestyle factors that can increase your risk of PMS. These are outlined below.

Weight and exercise

Research has shown you're more likely to have PMS if you're obese (you have a body mass index of more than 30) and if you do little exercise.

Read more about calculating your BMI and health and fitness.

Stress

You may find symptoms of PMS get worse as you become more stressed. While it's not a direct cause, stress can aggravate the symptoms of PMS.

Read more about understanding stress.

Diet

Eating too much of some foods and too little of others may also contribute to PMS symptoms. For example, too much salty food may make you feel bloated.

Alcohol and caffeinated drinks can disrupt your mood and energy levels. Low levels of vitamins and minerals may also make your PMS symptoms worse.

Read more about maintaining a balanced diet.


Treating premenstrual syndrome (PMS)

Treatments for premenstrual syndrome (PMS) may help you manage your symptoms so they don't interfere with your daily life.

If your PMS is mild or moderate, you may want to make changes to your diet and lifestyle before resorting to medical treatment.

This is because many of the medical treatments can have side effects that may be worse than your PMS symptoms.

Lifestyle changes

Diet

The following tips can help you maintain a healthy, balanced diet, and may also help control the symptoms of PMS:

  • eat smaller meals more frequently to help reduce bloating
  • avoid eating salty foods to limit bloating and fluid retention
  • drink plenty of water to avoid dehydration - being dehydrated can make headaches and tiredness worse
  • eat lots of complex carbohydrates, which can be found in foods such as fruit, vegetables and wholegrains
  • eat calcium-rich foods such as cheese and milk to improve the physical and psychological symptoms of PMS - if you can't eat dairy products, try calcium-fortified soya alternatives
  • eat plenty of fruit and vegetables, which are rich in vitamins and minerals and may ease your PMS symptoms - aim to eat at least five portions a day
  • avoid caffeine and alcohol, which can affect your mood and energy levels

Read more information about healthy eating.

Smoking

If you smoke, quitting may help to reduce mild PMS symptoms.

Read more about how to stop smoking.

Exercise

If possible, aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of activities include walking, swimming and cycling.

Exercise improves your overall health and can help alleviate depression and tiredness.

Stretching and breathing exercises, such as yoga and pilates, can help you sleep better and reduce your stress levels.

Read more about health and fitness and how to manage stress.

Complementary treatments

There are many non-prescribed alternative treatments and supplements that claim to help treat PMS. Some women may find these helpful for easing their symptoms.

For example, supplements of calcium, vitamin D, magnesium and agnus castus (a herb known as chasteberry) may reduce some symptoms of PMS.

However, many complementary therapies and supplements have either not been tested or haven't been proven to be effective.

Always see your GP before taking any supplements, as taking them alongside certain medications or in excessive amounts can be harmful.

If you decide to take a complementary treatment, take one at a time so you know it works for you. Go back to your GP if your symptoms don't change after three months, as they may recommend another treatment.

Psychological therapy

If you have psychological symptoms, such as feeling depressed or emotional, it may help to talk to a health professional.

Cognitive behavioural therapy (CBT) is the term for a group of therapies designed to help solve problems such as anxiety and depression. A cognitive behavioural therapist can help you learn new ways of managing some of your symptoms.

Read more about cognitive behavioural therapy.

Medical treatment

You may wish to try a medical treatment if your PMS is severe or you have premenstrual dysphoric disorder (PMDD). However, there's no single treatment that works for everyone.

A wide range of treatments is available. You may have to try several before you find one that suits you. Your choice of treatment will be based on your symptoms and how severe they are, and the possible side effects of the medication.

If you're prescribed treatment for PMS, you may be asked to record any changes to your symptoms so you know how effective it is for you. If the treatment doesn't ease your symptoms, you may be prescribed an alternative.

Medical treatments for PMS include:

  • painkillers
  • a combined oral contraceptive pill
  • oestrogen-only patches and implants
  • selective serotonin reuptake inhibitors (SSRIs)
  • gonadotrophin-releasing hormone (GnRH) analogues

These are described in more detail below.

Painkillers

Painkilling medication, including paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), can relieve some of the painful PMS symptoms such as:

  • stomach cramps
  • headaches
  • muscle pain and joint pain

These medications are available over the counter without a prescription, so make sure you read the manufacturer's instructions before taking them. Children under the age of 16 shouldn't take aspirin and people with asthma shouldn't take ibuprofen.

Oral contraceptive pills

As well as preventing pregnancy, the combined contraceptive pill may help improve symptoms of PMS in some women by preventing ovulation (when an egg is released from your ovaries).

In particular, newer types of contraceptive pill containing certain versions of the hormone progestogen, such as the Yasmin pill, have been shown to be effective for treating some PMS symptoms, and may even be effective for improving symptoms of PMDD.

However, contraceptive pills don't help all women and they can have side effects similar to the symptoms of PMS, such as breast pain or a depressed mood.

Oestrogen-only patches and implants

Like combined contraceptive pills, oestrogen-only patches and implants may help improve some symptoms of PMS by preventing ovulation. However, they're usually only used to treat PMS under the guidance of a gynaecologist.

Unless you've had a hysterectomy (removal of your womb), oestrogen patches and implants also need to be combined with a low dose of the hormone progestogen.

This is to reduce the risk of thickening of the womb lining (endometrial hyperplasia), which can develop into womb cancer. This may be in the form of progestogen tablets or a progestogen-releasing intrauterine system (IUS).

Side effects of using an oestrogen patch can include skin irritation, itching and soreness, and the additional progestogen dose can have side effects similar to the symptoms of PMS.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) may be the most effective treatment if you have severe PMS or PMDD.

SSRIs, such as fluoxetine and sertraline, are antidepressants that can be taken daily to relieve tiredness, food cravings and sleep problems, and combat depression.

However, SSRIs also may have negative side effects that could outweigh their benefits, such as:

Gonadotrophin-releasing hormone (GnRH) analogues

Gonadotrophin-releasing hormone (GnRH) analogues are synthetic hormones that create a temporary menopause and stop your periods by blocking the production of oestrogen and progesterone. They're taken as an injection.

GnRH analogues should only be used in women with severe PMS when all other treatments have failed. They often have side effects such as:

  • hot flushes
  • vaginal dryness
  • loss of libido
  • osteoporosis (thinning of the bones)

They should only be taken alone for up to six months.

If GnRH analogues are used for longer than this, you'll be advised to take hormone replacement therapy (HRT) to reduce menopausal complications such as osteoporosis.


 
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