Premenstrual Syndrome

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• Women's Wellness
• Premenstrual Syndrome

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What are the symptoms of PMS?

There are several different PMS symptoms. You may have experienced one, some or all of the following:

• Mood swings: Mood swings are a very common PMS symptom. Mood swings are unpredictable and may cause a woman to feel anxious, tearful, irritable, angry or depressed. Some women may find that their concentration and memory are affected during this time.
• Change in sleeping patterns: PMS can cause a woman to feel tired or she may find herself struggling to fall asleep (insomnia) on certain days of her menstrual cycle.
• Abdominal bloating: Bloating is another very common PMS symptom. Usually this will start two or three days before your period is due and will resolve once it has started.
• Sore or tender breasts: Breast tenderness can begin around two weeks before your period is due. Also known as cyclic mastalgia, this tenderness is due to rising oestrogen levels ahead of ovulation, which then sees progesterone levels rise up until your period starts. Oestrogen is responsible for the development of milk ducts, while progesterone helps develop the glands that produce milk. These fluctuating hormones can cause enlargement of these glands and ducts, leading to tenderness.
• Headaches: Many women experience headaches caused by changes in their hormone levels. More than half of women who suffer with frequent migraines notice a link with their menstrual cycle. A migraine is most likely to develop in the two days before a period or during the first three days of a period. This is due to a natural drop in oestrogen levels.
• Food cravings: Some women may crave certain foods shortly before their period is due. Most often, these cravings are for sweet or salty foods. However other women may find that they lose their appetite or experience an upset stomach caused by premenstrual syndrome.
• Acne: Hormonal changes can cause glands in the skin to increase production of an oily substance called sebum. This can clog pores, leading to an acne breakout. This PMS symptom can affect women of any age, as it is not confined to teenagers.
• Greasy hair: This increased production of sebum on the scalp can cause hair to become greasy and oily.
• Increased libido: It is common for women to experience a rise in libido midway through their menstrual cycle or while ovulating. This is because oestrogen and testosterone levels are at their peak.

A small number of women may experience more severe PMS symptoms, known as premenstrual dysphoric disorder (PMDD).

PMDD symptoms are more intense than PMS and can have an overwhelmingly negative impact on a woman’s quality of life. PMDD symptoms can include headaches, cramps, joint pain, muscle pain, sleep problems, binge eating, extreme anxiety, depression, anger and sometimes even suicidal thoughts and feelings.

What causes PMS?

The exact cause of PMS is unknown, but there are several factors that contribute to this condition.

• Fluctuating hormone levels: The week before a woman’s period is due, there is a drop in the levels of the hormones progesterone and oestrogen. Doctors believe that this drop triggers PMS symptoms.
• Chemical changes in the brain: Changes in the levels of brain chemical serotonin can contribute to premenstrual syndrome. Low levels of serotonin may be responsible for premenstrual depression, sleep disruptions, food cravings and fatigue.
• Depression: Some women who experience severe PMS may be suffering from undiagnosed depression. However depression alone does not cause all of the PMS symptoms listed above.
• Vitamin and mineral deficiencies: Low levels of certain vitamins or minerals can have an effect on PMS symptoms. A woman who suffers from PMS may find her symptoms are worse if she is not getting enough folic acid, vitamin B6, magnesium, calcium or vitamin E.
• Certain food and drink: Certain types of food and drink can make PMS symptoms worse. This includes sugar, which can make food cravings worse, salt, which can increase abdominal bloating, caffeine, which can cause irritability and alcohol, which can impact mood. Some women find that cutting back on these can help to ease their PMS symptoms.

What treatment options are available for PMS?

If lifestyle changes or dietary changes are not enough to alleviate your PMS symptoms, then the doctor may suggest one of the following PMS treatments.

• Hormonal medicine: The combined oral contraceptive pill, often just referred to as ‘the pill’ contains synthetic versions of female hormones oestrogen and progesterone, which are produced naturally in the ovaries. Because the pill delivers these hormones in a controlled and steady dose, it makes your hormone levels more predictable and helps to reduce common PMS symptoms including acne and mood swings.
• Cognitive Behavioural Therapy (CBT): Some women with premenstrual syndrome may benefit from cognitive behavioural therapy (CBT), a form of talking therapy that focuses on the interaction between thoughts, feelings, and behaviours. It is an effective treatment for anxiety and mood disorders, including those caused by PMS. CBT cannot help with physical symptoms such as headaches or acne, but it may be a useful treatment alongside medication.
• Antidepressants: SSRIs (selective serotonin reuptake inhibitor) are a type of antidepressant and are the only type which has been shown to work for PMDD. A doctor may recommend taking SSRIs throughout the month, or just during the luteal phase of your menstrual cycle, the two weeks or so between ovulation and when your period starts.
• Dietary supplements: Your doctor may advise you to take dietary supplements if they feel they will help to ease your PMS symptoms. Research has shown Vitamin B6 can help to alleviate PMS symptoms such as food cravings, anxiety and low mood. This may be because vitamin B6 plays a crucial role in creating neurotransmitters, the chemical messengers that relay information between brain cells, including mood-regulating serotonin.

Some women may turn to complementary therapies as an alternative PMS treatment. Women who opt for complementary therapies such as acupuncture and reflexology swear by these treatments, although the evidence of their effectiveness is limited.

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