PMS is a group of symptoms that occur in the second half of your menstrual cycle (before the period starts). These symptoms include physical, psychological and behavioural complaints. Some are severe enough to cause problems with interpersonal relationships or work activities. To diagnose PMS, and eliminate some other causes of similar complaints, you must have at least one week symptom-free following your period.
Race, culture or socio-economic status are no protection – all women who have a menstrual cycle are equally likely to suffer from PMS. Women in their 30s are most commonly affected.
Up to 150 symptoms have been described. The more common complaints include irritability, tiredness, anger, depression, anxiety, low self-esteem, lack of control, and suicidal thoughts. Physical symptoms include breast tenderness, abdominal bloating, weight gain, headache, constipation or diarrhea, menopausal-like hot sweats or chills, increased thirst, craving for sweets or salt foods and inability to sleep.
One of the best ways to identify PMS is to chart your symptoms daily. Note how severe they are in relation to menstrual periods. This is also helpful when trying to decide how well a treatment program is going.
Many theories exist ranging from an imbalance in body hormone levels before the menstrual period, to vitamin and mineral deficiencies. It is probable there is more than one factor leading to the many symptoms.
Stress is also a factor. It does not cause PMS but there is no doubt that it make it harder to deal with the symptoms.
There is no single pill or therapy for this complex disorder. As with many illnesses, the first step in treatment is to learn about it. This can be done through reading and talking to your family doctor.
When possible, women who have PMS should reduce stress especially for this time. Experts sometimes suggest women postpone important decisions or avoid confrontations until after the premenstrual period. Taking time to relax and asking for help and support from the other household members is also helpful.
A regular exercise program (at least 30 minutes four times a week) is a good way of coping with stress and appears to help reduce some symptoms. Diet measures include restricting salt, cheese, fatty meat, alcohol, caffeine containing foods (coffee, tea, cola drinks and chocolate) and refined foods for seven to 10 days before the period. Many women will feel better following these simple measures.
Weight gain, abdominal bloating and swelling may respond to diuretics (water pills). Cramping, heavy bleeding, headache or breast tenderness may respond to anti-inflammatory drugs like mefenamic acid (Ponstan™) or ibuprophen.
Severe symptoms of anxiety, depression or insomnia of PMS can be treated with tranquillizers or antidepressants. These medications are not without problems. Tranquillizers can be habit-forming and must be used with caution. Women who only have symptoms for one week of the month may not be keen to go on long term antidepressant therapy.
Some women have found that taking birth control pills improves their PMS. This treatment option would be especially suitable for women who also require contraception. Danazol™ is a medication that stops the normal hormone cycle. It has a number of side effects and is only used where symptoms are severe and have not responded to other therapy.
Other therapies used are Vitamin B6 (which can be toxic if taken in large amounts), Efamol™ (evening primrose oil), Vitamin E and progesterone which is usually prescribed as a vaginal suppository. While often used, studies have not proven a clear benefit of these treatment choices for PMS.
Premenstrual symptoms are very common but only occasionally severe. Most women will respond to relaxation, regular exercise, eating properly and reducing stress. Medications are sometimes used and can be helpful. As we learn more about the causes of PMS, we may be able to offer treatments with more consistent effectiveness.