What is premenstrual syndrome?

Premenstrual syndrome (PMS) describes physical changes as well as changes in mood that occur around a week before your period each month. PMS is also known as premenstrual tension (PMT) — they mean the same thing.

What are the symptoms of premenstrual syndrome?

PMS symptoms usually start in the few days before you start bleeding, and finish during your period.

Symptoms can include:

• feeling bloated
• swollen ankles
• acne
• poor coordination or clumsiness
• tiredness, lethargy, insomnia
• food cravings and weight gain
• constipation and/or diarrhoea

You may also experience various pains in your body including abdominal pain, headaches and migraines, back ache and swollen tender breasts.

You might also find you are more irritable, nervous or depressed. You might have mood swings and difficulty sleeping.

You might also find that you have only 1 or 2 of these symptoms, or not experience any symptoms at all associated with your period.

What causes PMS?

Although the exact cause of PMS is unknown, it is thought to be linked to changing hormone levels during your normal menstrual cycle.

When should I see my doctor?

If your symptoms are severe, you should discuss treatment options with your doctor.

Tell your doctor about any physical or emotional changes you are experiencing and discuss any other medical conditions or health problems, as these may affect PMS.

How is PMS diagnosed?

PMS cannot be diagnosed by a test, but your doctor can diagnose it by asking you about your health and doing an examination.

Your doctor may also ask you to keep a record of your symptoms for a month or two. They may ask you to write down how you felt each day, both emotionally and physically, as well as noting when your period started and stopped.

This can help your doctor understand if the symptoms you are having are related to your period.

How is PMS treated?

There are several ways to help manage and treat symptoms of PMS.

Exercise

Exercise is a great way to improve your mood if PMS makes you feel tired, angry, depressed or emotional. Exercising naturally raises the level of a body chemical called serotonin, which naturally improves mood.

It is recommended that adults do at least half an hour (30 minutes) of exercise 5 times a week. It will not only improve the way you feel when you have PMS, it will also help prevent the onset of conditions such as heart disease, stroke, and diabetes.

Exercises such as Pilates, yoga and other stretching techniques, can help reduce your feelings of stress and tension. They can also increase your circulation and flexibility, help ease cramps, and improve sleep patterns.

When you do any type of exercise, it is important that you listen to your body. If you feel any discomfort or pain, you should stop immediately and rest. Never continue if you feel dizzy or faint as you could hurt yourself. Remember to drink plenty of water to replace any fluids that are lost through sweating.

Stress management

Stress can worsen your symptoms. Talk to your family about your PMS and work out ways that they can support you. Professional counselling can help, as can learning various relaxation techniques.

Diet and lifestyle

Maintaining a healthy lifestyle can also help reduce PMS symptoms. You could try to:

• Eat little and often. Eating smaller meals throughout the day can help avoid that bloated feeling. Your stomach will feel comfortably full throughout the day. It’s better than waiting until you feel hungry and eating large meals that may fill you up too much.
• Avoid foods that are high in salt as salt retains fluid, which can make you feel bloated.
• Drink water and avoid alcohol and caffeine, as these also cause bloating, mood swings, headaches and tiredness.
• Eat foods such as fruit, vegetables, and whole grains. These contain complex carbohydrates, which release energy slowly, so you don’t feel so tired or hungry.
• Eat plenty of vitamin-rich food, such as fresh fruit and vegetables, as these can ease symptoms and give the body an overall boost.
• Maintain your weight at a healthy level.
• Smoking or breathing in other people’s smoke can make symptoms worse. Try to avoid being around people who are smoking. If you smoke, try to cut down or quit.

Medicines

If these lifestyle changes don’t work, talk to your doctor about medicines that may help control your symptoms. Antidepressant medicines can help to improve your mood. Other medicines can be prescribed to help control pain. Hormonal therapies, like the pill, can also sometimes help with PMS.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) can also be useful if your mood is affected by PMS. CBT involves working with a psychologist who can help you become more aware of how your thoughts affect your emotions and behaviour.

Can PMS be prevented?

Exercise, stress management, dietary changes and medicines can all be used to try and prevent some of the symptoms of PMS.

Speak to your doctor, who can help you build a health management plan than can work towards preventing PMS symptoms from affecting your daily life.

Complications of PMS

Sometimes, PMS can be more severe, and can seriously impact your ability to function well at work and more generally. Severe PMS is known as premenstrual dysphoric disorder (PMDD). PMDD can significantly impact your quality of life causing severe physical and mental changes. Around 8 in 100 females are affected by PMDD.

PMDD often needs treatment with prescription medicines and changes to lifestyle. These may include an antidepressant (for example, serotonin reuptake inhibitor, known as SSRIs) or hormonal medicines (such as oral contraceptives, which stop ovulation).

Resources and support

If you are concerned about your premenstrual syndrome (PMS), use healthdirect’s online Symptom Checker to get advice on when to seek medical attention.

• The Royal Women’s Hospital provides overviews on premenstrual conditions including:
  • Sleep, sunshine and vitamin D
  • Contraceptive pills
  • Exercise, diet and periods
  • Complementary and alternative therapies
• The Jean Hailes website has information on PMS and PMDD that includes management and treatment options.