premenstrual syndrome

What is it?

It's normal for women, especially those in their 30s and 40s, to at least sometimes experience symptoms such as irritability or bloating in the days leading up to their period. This is often called premenstrual tension (PMT).

For some women, these and other symptoms are more of a problem, lasting longer and stopping them from doing activities they would normally do. This is usually called premenstrual syndrome (PMS). PMT and PMS are often used to describe the same condition.

At the most severe end of the spectrum is premenstrual dysphoric disorder, where premenstrual symptoms are persistent and include severe emotional and physical problems. What all these conditions have in common is a break in symptoms soon after the period starts for at least a week.

Why do women get it?

No one really knows. Although it's often spoken of as a hormonal imbalance, none has ever been found. It's thought that some women might be more sensitive to normal hormone levels just before their period starts.

What are the symptoms?

Around 200 different symptoms have been described. These include:

irritability, mood swings, crying, difficulty concentrating and feelings of hopelessness
changes in sleep
tiredness
bloating
changes in appetite, overeating or specific food cravings
weight gain
skin changes
breast tenderness or pain
headaches.

What can you do?

PMS is a frustrating problem that affects many women to some extent and a small number severely. Although there isn't an easy solution, it's important to try and improve your general health and seek help from a doctor, especially if your condition doesn't improve.

Planning ahead

Although general changes to improve your health haven't specifically been shown to improve PMS, they might help you manage it. Many women find keeping a diary of symptoms helps predict when the worst times will be. They can then plan their lives accordingly, keeping stress to a minimum and avoiding major decisions during these times.

Exercise

Exercise is really important. Experts recommend you do at least 30 minutes of moderately intense activity, five days a week. As long as you exercise for at least 10 minutes at a time, these sessions can add up over a day. This could include walking briskly, cycling and swimming. There is also evidence that suggests you might also benefit from exercise that builds strength, such as gym training.

Food and supplements

The last thing you might feel like doing when you're premenstrual is cutting down on caffeine, salt, alcohol and refined sugar, but these changes might help. Eating small regular meals with fruit, vegetables and wholegrains might help control your appetite.

Some women find the following supplements also help:

Calcium: 600mg taken twice daily in the two weeks before your period starts might ease PMS (you need to persist for at least three months)
Vitamin B6: 50-100 mg taken each day might improve premenstrual symptoms of depression
Vitex agnus-castus or chasteberry: these tablets are available at health food stores and have been shown to reduce some of the physical and psychological symptoms of PMS

Other general/ natural therapies

Some women take magnesium, Vitamin E, St. John's Wort and evening primrose oil, but evidence about how well they work is limited. If you're considering natural therapies, it's important to first speak with a qualified practitioner.

Relaxation therapies, massage and acupuncture haven't conclusively been shown to help PMS, but might be worth trying.

Medical treatments

The pill

Some women will experience an improvement in PMS when taking the pill, but some might feel worse. Evidence suggests running pill packets together and missing the sugar tablets might be effective.

Anti depressants

A group of anti depressants known as selective serotonin reuptake inhibitors (SSRIs) have been shown to be very effective in treating the emotional and physical symptoms of women with PMDD.

Non steroidal anti inflammatory drugs

This group of drugs includes ibuprofen (Brufen®) and naproxen (Naprogesic®), which can help relieve breast pain and general aches that happen premenstrually.