If you would like to know more about PMT symptoms and diagnosis, and about PMT treatments, read the following article for more information.
Premenstrual syndrome can cause various symptoms before periods. In some women, the symptoms can badly affect quality of life before periods. There are various treatment options which are discussed below.
What is the premenstrual syndrome (PMS)?
The premenstrual syndrome (PMS) is a condition in women where certain symptoms occur each month before a period. PMS is sometimes called premenstrual tension (PMT) - but increased tension may not be the only symptom.
What are the symptoms of PMS?
Many different symptoms have been reported. The most common are listed below. You may have just one or two symptoms, or have several.
- Psychological (mental) symptoms include: tension, irritability, tiredness, feelings of aggression or anger, low mood, anxiety, loss of confidence, feeling emotional. You may have a change in your sleep pattern, sexual feelings, and appetite. Relationships may become strained because of these symptoms.
- Physical symptoms include: breast swelling and/or pain, abdominal bloating, swelling of the feet or hands, weight gain, an increase in headaches. If you have epilepsy, asthma, migraine or cold sores, you may find that these conditions become worse before a period.
Who gets PMS?
- Most women can tell that a period is due by the way they feel both physically and mentally. For most, the symptoms are mild and do not cause too much bother.
- About 1 in 20 women have 'true' PMS. This is where the symptoms become bad enough to disrupt your normal functioning and quality of life. Day-to-day life and work performance can be affected. It may cause tension with family and friends.
- A small number of women have severe symptoms before a period such as very low mood or behaviour disturbance. This severe form of PMS is sometimes called premenstrual dysphoric disorder (PMDD).
How is PMS diagnosed?
Sometimes it is difficult to tell if your symptoms are due to PMS, or if they are due to other conditions such as anxiety or depression. It is often difficult to remember when symptoms occur. A doctor may ask you to keep a diary of symptoms over a couple of months or so. It is when the symptoms occur, not just their nature or type, that indicates PMS. So:
- Symptoms start sometime after ovulation which occurs about two weeks before the start of a period. You may have symptoms for just a few days before a period. However, some women have symptoms for the whole two weeks or so leading up to a period. Typically, symptoms gradually get worse as the period approaches.
- Symptoms go within a few days after a period starts.
- Symptoms that occur all the time are not due to PMS.
What causes PMS?
The cause is not known. It is not due to a hormone imbalance, or due to too much or too little of any hormone (as was previously thought). However, ovulation (when you release an egg from an ovary each month) appears to trigger symptoms. It is thought that women with PMS are more 'sensitive' to the normal level of progesterone. This hormone is passed into the bloodstream from the ovaries after you ovulate. One effect of over-sensitivity to progesterone seems to reduce the level of a brain chemical (neurotransmitter) called serotonin. This may lead to symptoms, and may explain why medicines that increase the serotonin level work in PMS.
What can I do to help?
- Be aware. It may help if you understand what is happening. This may relieve some of the anxiety about symptoms. It may be useful to keep a chart or diary. Note the days you feel irritable, low, anxious, or have any other symptom that you feel may be part of PMS. See how long symptoms last before a period. Then it may be worth noting in a diary when your periods are due. As you can predict when your PMS symptoms are likely to occur, you can expect them and be ready for them. For example, it may be possible to avoid doing important things on the days when symptoms are expected.
- Talk about it with your family, friends or partner. It may help them to understand how you are feeling. It may be best to do this after your period when you are more likely to be calm.
- Exercise. Some women who exercise regularly say they have less problem with PMS. Try doing some regular exercise several times a week.
- Food and drink. Some people claim that various diets help to ease PMS. However, there is little scientific evidence that food, or types of food, makes any difference. Some women find that alcohol or caffeine (found in tea, coffee, cola, etc) makes their symptoms worse. So it may be worth a trial of not having alcohol or caffeine prior to periods to see if this helps. Some women find that avoiding carbohydrate binges prior to periods can be helpful.
What are the treatment options for PMS?
Various treatments have been advocated for PMS. The treatment of PMS is a changing area as research continues to clarify which treatments actually work, and to try and find better treatments. The following gives a brief description of the main current treatment options.
Not treating is an option
Understanding the problem, anticipating symptoms, and planning a coping strategy is all that is required for many women. Some women find the self help measures listed above, and such things as avoiding stress, or doing relaxation exercises prior to a period can help a lot.
Treatments that you can buy without needing a prescription
- Vitamin B6 (Pyridoxine).You can buy vitamin B6 from pharmacies. It has has been used for PMS for several years. This vitamin is part of a normal diet, but extra amounts are thought to help with PMS. However, there is only limited research evidence that it works. Some research studies have failed to show any benefit, and some have shown a mild benefit. So, it is worth a try. You can take the vitamin tablets either in the two weeks before periods, or every day. But note: do not take more than the recommended dose (and definitely no more than 100 mg daily) as too much vitamin B6 can be harmful.
- Agnus castus fruit extract. You can buy this at health food shops and pharmacies. In one research study, one tablet of agnus castus extract was taken by a group of women with PMS every day for three menstrual cycles. Over half of the women reported a 50% or greater improvement in their symptoms. It is not clear how it works, but it contains substances that may affect certain brain chemicals (neurotransmitters). Side effects reported were few and mild. So, this may be worth a try.
Treatments that your doctor may prescribe
- SSRI medicines (Selective Serotonin Re-uptake Inhibitors). An SSRI is commonly prescribed to treat more severe PMS. These medicines were first developed to treat depression. However, they have also been found to ease the symptoms of PMS, even if you are not depressed. They work by increasing the level of serotonin in the brain (see above in 'What causes PMS?'). You have a good chance that symptoms of PMS will become much less if you take an SSRI. Research suggests that taking an SSRI for just half of the cycle (the second half of the monthly cycle) is just as effective as taking an SSRI all of the time. Side-effects occur in some women, although most women have no problems taking an SSRI. There are various types and brands.
- The pill. In theory, preventing ovulation should help PMS. This is because ovulation, and the release of progesterone into the bloodstream after ovulation, seems to trigger symptoms of PMS. The combined contraceptive pill ('the pill') works as a contraceptive by preventing ovulation. However, most pills do not help with PMS as they contain progestogen hormones (with a similar action to progesterone). However, a newer type of pill called Yasmin contains a progestogen called drospirenone which does not seem to have the downside of other progestogens. This pill is showing promise as a good treatment for PMS. If you have PMS and require contraception, then this pill may be a possible option to use for both effects.
Other ways of preventing ovulation
As mentioned above, preventing ovulation should prevents symptoms of PMS. Apart from 'the pill' there are other ways to prevent ovulation.
- Oestrogen prevents ovulation. The problem is, you must also take some progestogen in addition to the oestrogen to protect your uterus. (There is an increased risk of developing cancer of the uterus (womb) if you take oestrogen without progestogen.) One way round this is to take oestrogen, but to also have an intrauterine contraceptive system (IUS) inserted. The IUS releases a small amount of progestogen into the uterus, but with very little getting into the bloodstream to cause symptoms. (The IUS is also a very good contraceptive, and usually stops any period pain too.)
- Some medicines can prevent ovulation. For example, danazol and GnRH (gonadotrophin releasing hormone) analogues such as buserelin, goserelin, nafarelin, leuprorelin, and triptorelin. These often work well, but side-effects commonly occur which may limit their usefulness for PMS.
- Surgery to remove both ovaries prevents ovulation, and is likely to cure PMS. However, it is a very drastic treatment, and not done except in the most severe cases where nothing else has helped.
Some newer treatments that show promise
- St John's Wort. This is a herbal remedy that is commonly used to treat depression. You can buy it from pharmacies. One small study in women with severe PMS showed that symptoms improved greatly in some women. This study was not a 'controlled trial' and so has to be viewed with caution. So, it may help but more research is needed to confirm if it is a useful remedy for most women with PMS.
- Bright light. One study showed good improvement in symptoms in some women with severe PMS who looked at bright light from a face mask for a time each day. This is a similar treatment to that used for a condition called 'Seasonal Affective Disorder'. The reason why bright light may help in PMS is not known. More research is needed to clarify if this is a useful treatment for most women with PMS.
- Red clover. There is some evidence that this too may be beneficial. More research is needed to confirm this.
Treatments for specific symptoms
Some women just have one or two physical symptoms. The following treatments may help a specific physical symptom, but are unlikely to help psychological symptoms (unless the physical symptom is causing or aggravating the irritability, anxiety, etc.)
- Diuretics ('water tablets'), in particular, spironolactone, can help reduce fluid retention and bloating.
- Anti-inflammatory painkillers may help if painful symptoms develop.
- Evening primrose oil may ease breast discomfort.
If you take treatment for PMS
Treatments may take a while to work fully. If you start a treatment, try it for several months before deciding if it is helping or not. Treatments may not cure symptoms completely. However, the symptoms often become a lot easier or less frequent with treatment.
It is sometimes difficult to remember how things were several months ago. If you keep a diary of symptoms, it will help you decide if you are better with treatment than you were before.
Further help and information
NAPS - National Association for Premenstrual Syndrome
Premenstrual Society
PO Box 429, Addlestone, Surrey KT15 1DZ
Tel: 01932 872 560
Tel: 01932 872 560
©EMIS and PIP 2006
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