What is PMS?

Premenstrual syndrome (PMS) involves the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman's monthly period.

There are many different symptoms of PMS which usually improve when the period starts and disappear a few days afterwards.

Nearly all women of child-bearing age have symptoms of PMS, but those between their late 20s and early 40s are most likely to experience it.

There is no cure for PMS, but there are treatments and lifestyle changes that women can make to better manage their symptoms.

Symptoms

There are many different symptoms of PMS, and these can vary from person to person. Most women only experience a few PMS symptoms each month, but these may differ over time.

For example, you may find that you have similar PMS symptoms every month but they vary in intensity. Or you may have 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, which can be up to 2 weeks before your period starts. They usually improve once your period has started, and then disappear until your cycle starts again.

Physical symptoms

• feeling bloated
• pain and discomfort in your tummy
• headaches
• changes to skin and hair (acne flare-ups)
• backache
• muscle and joint pain
• breast tenderness
• insomnia (trouble sleeping)
• dizziness
• tiredness/fatigue
• nausea
• weight gain (up to 1kg, due to fluid retention)
• any chronic (long-term) illnesses, such as asthma or migraine, may get worse
• constipation or diarrhoea

Psychological symptoms

• mood swings
• feeling upset or emotional
• feeling irritable or angry
• depressed mood
• crying and tearfulness
• tension and anxiety
• poor concentration
• confusion and forgetfulness
• restlessness
• decreased self-esteem

Behavioural symptoms

• change in libido
• appetite changes or food cravings

Causes of PMS

The exact cause of PMS is not fully understood, however a number of factors may contribute to the symptoms:

Hormone changes

During your menstrual cycle, your hormone levels (oestrogen and progesterone) rise and fall. This is 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, when hormone levels are stable, supports this theory.

Chemical changes

Like your hormone levels, certain chemicals in your brain, such as serotonin, fluctuate during your menstrual cycle. Serotonin is known to help regulate your mood and make you feel happier, so it is possible that women with low levels of serotonin are particularly sensitive to the symptoms of PMS. Low levels of serotonin may also contribute to symptoms such as:

• tiredness
• food cravings
• insomnia (difficulty sleeping)

Weight & lack of exercise

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

Stress

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

Diet

Eating too much of certain foods and too little of others can also contribute to PMS symptoms. Too much salty food can add to fluid retention and make you feel bloated. Alcohol and caffeine can disrupt both your mood and energy levels. Low levels of vitamins and minerals may also make your symptoms worse.

In order to identify exactly what symptoms you have and their severity, your GP may ask you to use a diary to record how you are feeling each day in the run-up to your period for at least two months so that your GP can monitor any patterns.

Premenstrual Dysphoric Disorder (PMDD)

While most women with PMS find their symptoms uncomfortable, a small amount have symptoms that are severe enough to affect their normal, daily lives. This is due to a more severe type of PMS, known as premenstrual dysphoric disorder (PMDD).

The symptoms of PMDD are similar to those of PMS, but more extreme. They can include:

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

PMDD is only diagnosed when your symptoms seriously affect your relationships and stop you from functioning properly in your day-to-day lives.

If you think you may have premenstrual dysphoric disorder (PMDD), see your GP.

How to help PMS: Lifestyle changes

If your PMS is mild or moderate, you may want to make changes to your diet and lifestyle before resorting to medical treatment. Certain medical treatments can have side effects that may be worse than your PMS symptoms.

1. Diet

The foods you eat make the hormones that fuel your whole cycle, however, the adjustments to the food you consume have to happen before the bleeding starts. Our diet has a direct impact on our hormonal balance, and certain foods can exacerbate things like cramping, mood swings, nausea, and bloating.

This means doubling up on the foods that help support a happier period, in addition to limiting those that don't.

• Avoid eating salty foods to limit bloating and fluid retention
• Eat lots of complex carbohydrates, which can be found in foods such as fruit, vegetables (also packed with vitamins and minerals) and wholegrains. If you're prone to bloating, leafy greens like kale, spinach, and collards will help
• Avoid caffeine (despite the fatigue). Research shows that coffee can seriously exacerbate menstrual pain. Caffeine makes our blood vessels constrict, which can ultimately have a tightening effect on the uterus
• Avoid sugar & artificial sweeteners. By messing with your blood sugar and cortisol levels, sugar will likely only exacerbate bad mood swings, acne and energy levels. Artificial sweeteners are also shown to disrupt hormones. If you're craving something sweet, reach for some unsweetened dark chocolate instead
• If you suffer from heavy periods, then consuming flax ahead of your cycle is a must. It helps flush out excess estrogen that can lead to heavy bleeding and clots. Try adding some ground flaxseed to a smoothie, or even sprinkle it over yogurt and fruit
• Bananas are full of potassium, which helps restore the natural fluid balance in our bodies, thus relieving bloating.
• Chamomile tea. Swap out your caffeinated drinks for chamomile tea – it relaxes muscles, eases nerves, reduces hormone-related anxiety.
• Lower your alcohol intake. As your body is already fatigued, adding a toxin to the mix will do more harm than good – both for mental and physical symptoms
• Drink lots of water (about six to eight glasses a day). Being dehydrated will make headaches and feelings of tiredness worse
• To improve physical and psychological symptoms of PMS, eat calcium-rich foods, such as cheese and milk. If you cannot eat dairy products, try calcium-fortified soya alternatives
• Eat little and often. Eat smaller meals more frequently to help reduce bloating

2. Exercise

Exercise for 30 minutes, at least five times a week. Exercise can help to alleviate low mood and tiredness. Regular exercise has been shown to help both the physical and psychological causes of PMS. Stretching and breathing exercises, such as yoga and pilates, can help you sleep better and reduce your stress levels.

3. Sleep

Get 7 to 8 hours of sleep, especially during your cycle as fatigue can kick in.

4. CBT

If you have 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 number of therapies designed to help issues such as anxiety and depression by helping you to learn new ways of managing your symptoms.

5. Medical treatment

• Take painkillers such as ibuprofen or paracetamol to ease the pain of stomach cramps and sore breasts. They may also relieve headaches, muscle pain and joint pain, but they can make fluid retention worse. If you have asthma, do not take ibuprofen.
• Oral Contraceptives. The contraceptive pill can be prescribed to regulate symptoms of PMS. It stops ovulation and stabilises hormone levels, which can help to control mood swings and other symptoms.

If your GP prescribes you a treatment for PMS, they may ask you to record any changes to your symptoms so that you both know how effective it is for you. If the treatment does not ease your symptoms, your GP may prescribe an alternative.

Pop into your local CarePlus Pharmacy and speak to our friendly Pharmacists for more advice or help when it comes to PMS.

*Information adapted from the HSE