Pre-Menstrual Syndrome (PMS)

70 to 90 % of women in their reproductive years experience some physical, emotional or behaviour symptoms 2-14 days before their periods. Premenstrual Syndrome (PMS) is a term used to describe the collection of symptoms which occur before a period starts and ends shortly after the arrival of the period. The same set of symptoms occur at the same time each month. Symptoms can begin as a teenager when the periods start (menarche) and may worsen with age, after pregnancy or at times of stress. It may occur in women who have had a hysterectomy if the ovaries still function. It is most common in women between the ages of 30 - 39 years. Other illnesses such as depression, anxiety, eating disorders, migraine and asthma can worsen around the pre-menstrual or menstrual time

SYMPTOMS
Over 100 symptoms have been described. Many experience minor symptoms, but a few women suffer from severe symptoms which may affect daily functioning. The common symptoms are:

• Depression, anxiety, irritability, anger
• Cravings for salty/sweet food
• Breast tenderness/swelling, weight gain, fluid retention
• Fatigue, headache, sleep disturbances
• Feeling out of control, overwhelmed, tense or on edge
  

PREMENSTRUAL DYSPHORIC DISORDER
Sometimes the emotional symptoms premenstrually can be very severe and this is called Pre-menstrual Dysphoric Disorder. This occurs in 3-8% of women, more often in women whom have a past history of depression, have a family history of PMDD or who have had mood changes with the oral contraceptive pill

CAUSE
This is unknown at present. There is no evidence of high or low levels of hormones. There may be an abnormal response to normal levels of hormones and this may involve a chemical in the brain called serotonin

DIAGNOSIS
There is no laboratory test to make the diagnosis of PMS or PMDD. The diagnosis comes from the cyclical nature of the symptoms, in other words they start just before a period and stop once a period begins. Your doctor may ask you to chart your symptoms for at least 2 months

MANAGEMENT
There is no one single treatment that will cure PMS or PMDD. However a number of different things may help to reduce or prevent the symptoms. Often this means changing aspects of your lifestyle

DIET
Don't go on a diet but try to change your eating pattern. Eat frequently and never go without food for more than 5 hours:

Increase:

• the amount of water
• the amount of green vegetables and salad
• the amount of fruit and nuts
• the amount of pasta, brown rice, and dried beans
• the amount of chicken and fish

Reduce:

• intake of sugar including honey, additives with '-ose' at the end and sweeteners
• intake of junk food - fast foods, burgers, crisps
• intake of salt since this may reduce bloating
• amount of tea and coffee since caffeine causes irritability
• intake of cigarettes and alcohol
  

EXERCISE
Exercise will reduce physical and emotional symptoms. It releases built up stress and enhances your sense of well being. If you do no exercise at the moment, then do some gentle exercise such as going for a short walk. Start exercising slowly, don't push yourself and listen to your body. Try to exercise for 20-30 min 3 times a week. Remember exercise should be fun. As well as exercising, make sure you get enough rest each day

STRESS REDUCTION
Think about your life at home and at work. Identify things that cause you stress. Often it is not possible to eliminate all stress but try reducing it if possible. You may find anxiety management and relaxation techniques useful. Take time to care for yourself. Make space for yourself. Enjoy a warm bath or a massage. Try using aromatherapy oils

MEDICATION

• Vitamins - Some women find vitamin B complex and evening primrose oil useful. If you want to try them check with your doctor that this is all right
  
• Oral Contraceptive Pill - Often your GP may prescribe the pill for PMS. The pill stops the periods and therefore should stop symptoms of PMS
  
• Antidepressants - These can be used if depressive symptoms are common. Sometimes some tablets have side effects. You may wish to discuss this with a member of staff at your surgery
  

PREMENSTRUAL SYMPTOM DIARY
A PMS diary is available that you can use to record your symptoms. Click the appropriate icon to open in either Word or PDF

HELP AND SUPPORT

• National Association for Premenstrual Syndrome, 08707 772177 www.pms.org.uk
• Leeds Counselling, 0113 245 0303 www.leedscounselling.org.uk
  
• Leeds Mind Counselling and Therapy Service 0113 230 7673 www.leedsmind.org.uk
  

Self help books:

• Managing Anxiety & Depression, Mental health Foundation www.mentalhealth.org.uk
  
• Overcoming Depression and low mood, 2nd edition 2006, Dr Chris Williams, (Hodder Arnold H & S)
• Mind over Mood: Cognitive Treatment Therapy Manual for Clients, Christine Padesky & Dennis, Greenberger (Guildford Press)

Source text: Leeds Mental Health Trust and Leeds Primary Care Trusts
The original version of this leaflet was written by Ardsley Community Mental Health Team, East Ardsley Health Centre, Wakefield WF3 2DN

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Last revision: April 2011