In the days leading up to a period (menstruation), up to 30% of women experience emotional and physical symptoms, often called premenstrual syndrome (PMS). Most women experience one or two symptoms that can be managed. Symptoms start about 4-10 days before a period and usually stop after bleeding begins.
What is PMS?
What are the symptoms of PMS?
Symptoms of PMS vary in intensity from woman to woman and can vary from one cycle to the next. The most common symptoms include:
|Emotional symptoms||Physical symptoms|
What is premenstrual dysphoric disorder (PMDD)
Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that causes psychological distress and socioeconomic dysfunction. PMDD affects about 3-8% of women with PMS.
Causes of PMS & PMDD
It is not clear why some women develop PMS and PMDD. There appear to be very complex interactions between certain chemicals in the brain and progesterone that lead to symptoms. PMS does not occur if there is no ovulation, or after menopause. A woman’s stress levels, psychological state, poor physical health, genetic makeup, cultural and social environment and changes in brain chemicals (such as serotonin) may all influence the development of PMS symptoms. Having a high body mass index (BMI) and smoking are also risk factors.
How are PMS & PMDD different from depression?
PMS and PMDD have similar symptoms to depression. However, with PMS and PMDD, the symptoms get better completely as soon as menstruation begins, while those of depression do not.
PMS and PMDD need to be distinguished from underlying depression because the treatments are different.
Management & treatment of PMS symptoms
There are ways you can manage and reduce your PMS symptoms.
|Be physically active||Physical activity increases endorphins (‘feel-good’ hormones), which can reduce symptoms. Endorphins also act as natural painkillers and help you feel more relaxed and in control.
Choose a form, or variety, of physical activity you enjoy, and aim for 30 minutes of moderate-intensity activity on most, if not all, days, especially when symptoms are at their worst.
|Reduce stress levels||Stress can worsen PMS symptoms.
Talk to your family about your PMS and help them to develop strategies to be supportive during this time. Take time out to relax and enjoy your own interests.
If you feel your levels of stress are increasing, consider professional counselling; cognitive behavioural therapy (CBT) and relaxation therapies can help.
|Maintain a healthy lifestyle||
|Vitamins, minerals and herbs [3, 4, 5]||Although the evidence is not strong, some supplements that may be effective in treating PMS include:
Consult your health practitioner before taking any supplement, as they can have unwanted effects, or interact with other medications you are taking.
|Complementary therapies||Complementary therapies such as acupuncture or naturopathy can be helpful in relieving psychological and/or physical symptoms of PMS for some women. However, a lack of controlled studies means there is no clear evidence of their benefits.|
|Hormonal treatments||These treatments can suppress ovulation and reduce the hormones of the premenstrual phase. Hormone therapies can include contraceptive therapies, such as the oral contraceptive pill. Ask your doctor for more information about hormone treatment options.|
|Medication||There is a range of medications available that have been proven to help, such as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), anti-prostaglandin (for pain/cramps), anti-inflammatories, and spironolactone diuretic (for bloating). See your doctor to discuss these.|
Management & treatment of PMDD symptoms
PMDD often requires treatment with medication as well as lifestyle modifications. First-line treatment is usually an SSRI (serotonin reuptake inhibitor), an antidepressant that helps 60-70% of women. Second-line options include hormonal medication to stop ovulation, such as oral contraceptives.
Things to keep in mind
- Premenstrual syndrome (PMS) refers to the range of emotional and physical symptoms some women experience in the lead-up to their period, which may interfere with their quality of life
- Most PMS symptoms can be managed with lifestyle modifications, such as exercise, diet and supplements
- If symptoms persist and interfere with daily activities, see your doctor or seek referral to a gynaecologist with expertise in PMS
- It can be useful to keep a detailed daily diary of at least two menstrual cycles to see if there is a pattern with your symptoms to help you and your doctor discuss the best treatment options for you.
If PMS symptoms persist and the above does not help, see your doctor. It is important that other possible causes of the symptoms are excluded. Although no ‘cure’ can be offered, there are many treatments that can help manage, reduce and, for some women, completely alleviate PMS symptoms.
Sex during a period
There is no medical reason why a woman cannot have sex during her period. Some women prefer not to because of personal preferences, or because of cultural or religious reasons.
Practising safer sex is important at any time to prevent contracting sexually transmissible infections (STIs), such as chlamydia, herpes, hepatitis B or HIV, including during your period.
Pregnancy can still occur when you have your period, especially in the perimenopause, so if you want to prevent pregnancy, always use contraception.