Premenstrual Syndrome (PMS): Causes, Symptoms & Treatment Options
Understand PMS symptoms, causes, and treatment options, and learn when to seek expert gynecological care.
In short: Premenstrual syndrome is a group of emotional and physical changes that appear after ovulation; many women have it, and in about 5% it is severe. It is caused by sensitivity to progesterone and changes in serotonin. Symptoms are irritability, anxiety, tiredness, bloating and breast pain. Exercise, less salt and caffeine, and vitamin B6, calcium and magnesium help; in severe cases the doctor prescribes medication.
Premenstrual syndrome (PMS) refers to the physical, emotional, and psychological symptoms that many women experience after ovulation (the luteal phase), which typically ease once menstruation begins. A smaller number of women experience a more severe form of PMS, with intense anxiety, irritability, and anger that can make it difficult to manage daily activities and relationships. This more severe condition is known as premenstrual dysphoric disorder (PMDD).
Variants of Premenstrual Syndrome
- Progestogen-induced PMS, caused by progestogens in HRT or the combined pill.
- Premenstrual exacerbation of an underlying condition (such as depression, epilepsy, asthma, diabetes or migraine): symptoms are present throughout the cycle but become worse before the period.
- Menstrual cramps are not the same as PMS, although they may be experienced together; they are caused by prostaglandins that make the uterus contract during the period. They are usually managed with over-the-counter analgesia and NSAIDs.
How Common Is Premenstrual Syndrome?
About four in ten women experience premenstrual symptoms at some point in their lives, and around 5 to 8% of all women have severe symptoms (PMDD).
What Causes Premenstrual Syndrome?
Because PMS involves such a wide variety of symptoms, it can be difficult to give a firm diagnosis. Several theories have been proposed to explain the cause of PMS; however, none has been fully proven, and the exact treatment approach for PMS is still not clearly established.
There are two main theories that may help explain PMS:
First
Some women appear to be more sensitive to progesterone than others.
Second
Neurotransmitters and brain receptors may respond differently to serotonin and GABA
(these neurotransmitters are linked to mood changes).
Symptoms of Premenstrual Syndrome
Psychological symptoms
- Anger
- Anxiety
- Tension
- Depression
- Crying
- Oversensitivity
- Mood swings
Physical symptoms
- Fatigue
- Bloating (due to fluid retention)
- Weight gain
- Breast tenderness
- Acne
- Sleep disturbances
- Appetite changes with food cravings
How Is Premenstrual Syndrome Diagnosed?
Symptoms usually begin around the time of ovulation (mid-cycle) and last from a few days to several days, until menstrual bleeding starts. This is usually followed by a period of relief until ovulation in the next cycle — and this pattern is often the key clue used in diagnosis.
PMS can be difficult to diagnose. The key step is keeping a daily symptom diary for at least two menstrual cycles to confirm that symptoms appear in the second half of the cycle and ease after the period starts. There is no blood test for PMS; tests such as thyroid function are only used when another condition is suspected.
Conditions That Can Mimic PMS
- Idiopathic edema
- Depression
- Chronic fatigue
- Hypothyroidism
- Irritable bowel syndrome
Another way doctors may help confirm the diagnosis is by prescribing gonadotropin-releasing hormone medication (such as Decapeptyl) that temporarily stops ovarian function. If symptoms improve with this treatment, PMS becomes a more likely diagnosis.
Managing Premenstrual Syndrome
Treatment can be challenging since the exact underlying cause is still not fully understood.
A healthy lifestyle can help, including:
- Regular exercise
- Emotional support
- Salt restriction before the menstrual period
- Reducing caffeine intake before the menstrual period
- Smoking cessation
- Limiting alcohol intake
- Reducing sugar intake
Some studies suggest that vitamin B6, calcium, and magnesium supplements may help with symptoms, though results can vary from person to person.
Most herbal remedies and complementary treatments have not been proven to relieve PMS symptoms; agnus castus (chasteberry) has some limited evidence of benefit, but herbal products can interact with other medicines and should be discussed with your doctor.
For more severe symptoms, cognitive behavioral therapy (CBT) — a type of psychotherapy — can help patients manage their thoughts and behaviors and reduce mental stress.
Medical and hormonal treatment options may include:
Combined oral contraceptive pills, especially those containing drospirenone, which may be taken continuously (without the monthly break)
Antidepressants of the SSRI type (such as fluoxetine or sertraline), taken either every day or only from mid-cycle until the period, are one of the most effective treatments for severe PMS and PMDD.
For severe symptoms that do not respond to these treatments, medicines that temporarily switch off the ovaries (GnRH analogues) with add-back hormone therapy may be used, and in rare, very severe cases surgery may be discussed.
If your PMS symptoms are affecting your daily life, relationships, or wellbeing, it can help to speak with a gynecologist for a proper evaluation and a personalized management plan. Dr. Najeeb Layyous and his team welcome the opportunity to discuss your symptoms and guide you toward the options that may be right for you.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
We’re grateful for dealing with such a physician — he’s very caring and deals with each case separately. We would’ve loved to spend more time with him, however he was never in a hurry during our given time.