Premenstrual Syndrome (PMS) symptoms, diagnosis, and treatment

Symptoms of premenstrual syndrome

PMS symptoms vary widely, both in type and severity. They typically appear in the second half of the menstrual cycle and resolve shortly after menstruation begins. Symptoms are generally classified as follows:

Physical symptoms of PMS:

• Headaches or migraines
• Swollen or painful breasts
• Weight gain or swelling in the feet and hands
• Abdominal bloating

Behavioural symptoms of PMS:

• Aggravation of pre-existing conditions, including asthma or migraines
• Difficulty with cognitive tasks such as attention and making decisions
• Changes in sexual desire, sleep patterns, or appetite

Psychological symptoms:

• Fatigue and difficulty concentrating
• Irritability and tension
• Feelings of low confidence or worthlessness
• Mood swings, anxiety, or aggression

Causes of premenstrual syndrome

The exact cause of PMS remains unclear. It was once believed to result from hormonal imbalances, but research has since shown that levels of hormones in women with PMS are typically normal. However, women with PMS appear to have an increased sensitivity to the natural hormonal changes that occur after ovulation, particularly progesterone.

This heightened sensitivity is thought to disrupt the balance of neurotransmitters (brain chemicals) such as GABA (gamma-aminobutyric acid) and serotonin. A decrease in these neurotransmitters can contribute to symptoms like irritability and mood swings.

Diagnosing Premenstrual syndrome

There is no specific testing for premenstrual syndrome; diagnosis is based on symptoms and their timing in relation to the menstrual cycle. Your symptoms must:

• Begin after ovulation and worsen in the days leading up to menstruation
• Subside within a few days of starting your period
• Be absent for the remainder of the cycle

To aid diagnosis, healthcare professionals may recommend tracking symptoms in a diary over several months.

Managing PMS symptoms

Self-help measures

Dietary Changes: While evidence is limited, some women report benefits from reducing sugar, caffeine, and alcohol intake. A diet rich in complex carbohydrates (e.g., wholemeal bread) and smaller, frequent meals may help stabilise mood and energy levels.

Education: Understanding PMS and tracking your cycle can help reduce anxiety. Keeping a diary of symptoms can help you anticipate and prepare for them.

Exercise: Regular physical activity, such as brisk walking or yoga, may alleviate symptoms for some women.

Communication: Discussing your symptoms with loved ones can improve support and understanding. Choose times when symptoms are minimal to explain how PMS affects you.

Treatment options for PMS

Over-the-counter remedies: Supplements such as magnesium, calcium, and vitamin B6 may help some women, though the evidence is varied as there is not enough proof to show that they actually help. Simple pain relievers (e.g., ibuprofen) and evening primrose oil may ease breast tenderness and headaches.

Surgical Options

A hysterectomy (removal of the womb) combined with bilateral oophorectomy (removal of both ovaries) is a last resort for women with severe PMS that does not respond to other treatments.

Hormonal Therapies

Oestrogen Patches or Gels: These can suppress ovulation and reduce symptoms. Additional progestogens are usually required unless a hysterectomy has been performed.

Gonadotrophin-Releasing Hormone (GnRH) Analogues: These medications, often combined with hormone replacement therapy (HRT), are reserved for severe cases.

Psychological therapies

Prescription medications: SSRIs (Selective Serotonin Reuptake Inhibitors): Commonly prescribed for severe PMS, SSRIs such as citalopram and fluoxetine can improve mood by raising serotonin levels. These medications may be taken daily or only during the second half of the cycle.

Cognitive Behavioural Therapy (CBT) can equip women with coping strategies for managing emotional and behavioural symptoms. There has been proof that this treatment is helpful and has been quite effective for several women.

COC (Combined oral contraceptive) Pill: Preventing ovulation with the pill may reduce symptoms for some women, though not all find it effective. Pills containing drospirenone may offer additional benefits.

Prognosis and outlook

The severity of PMS can fluctuate throughout a woman's life and may worsen during times of stress. Symptoms often cease after menopause and subside when pregnant. While PMS cannot always be fully cured, many women find their symptoms improve with a combination of self-help strategies and medical treatments.

Need More Information?

For further information and guidance on PMS and how to manage them, please contact us today.