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Premenstrual Syndrome

What you can do about PMS or PMDD

Premenstrual Syndrome

What you can do about PMS or PMDD

Premenstrual syndrome, PMS (sometimes called premenstrual tension, PMT), is a condition that can occur before and during your period. It can involve a number of symptoms that can be mild or more difficult to manage. When the symptoms are very severe it can be classified as premenstrual dysmorphic disorder, PMDD.

Because PMS can occur every menstrual cycle, it can really help to know how to manage the symptoms.

Last reviewed: 19/12/2019 by Dr Simran Deo

Contents

What can I do about my PMS right now?

If you are suffering from bad PMS symptoms at the moment there are a number of strategies you can try to make them better. These include:

  • Painkillers to help with the pain and discomfort:
    • Paracetamol
    • Ibuprofen
  • A hot water bottle to soothe stomach cramps
  • Light exercise:
    • Can help with low mood and depression. 
    • Can also improve stomach cramps, joint aches, and pains
    • Can help with cases of insomnia
  • Drink plenty of water:
    • To relieve/prevent headaches
    • Keep you hydrated 
    • To improve mood status
    • May help relieve the feeling of being bloated
In most cases, the symptoms occur during the two weeks prior to the monthly period. Once the period has begun the symptoms of PMS get better and usually resolve after the monthly period has ended.

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What can I do to help with my PMS long-term?

The list above includes strategies which may help to relieve the immediate symptoms or onset of PMS. However, there are several long term steps you can take to help relieve and reduce the symptoms of PMS, including:

  • Diet
  • Exercise
  • Medication

Diet – maintaining a healthy and balanced diet can help to control the symptoms associated with PMS. Beneficial foods may include:

  • Complex carbohydrates
    • Fruit
    • Vegetables
    • Wholegrains
  • Calcium rich foods
    • Cheese
    • Milk 
    • Yoghurt
  • Drinking plenty of water

Complex carbohydrates – such as fruit, vegetables and whole grains are good for your digestion as they also contain a lot of fibre. Eating plenty of these foods as well as eating smaller meals more frequently can reduce bloating. 

Water intake – It is good to drink plenty of water to reduce dehydration which can make headaches and tiredness more severe. 

Reducing salt intake – this is also a good way to limit bloating and prevent fluid retention.

Calcium – during bouts of PMS it is common to experience feelings of low mood. In this instance it can be beneficial to eat calcium rich foods, which can also help relieve the physical symptoms too. Studies have shown calcium to be an effective treatment for PMS. Furthermore, it can also reduce the risk of conditions such as osteoporosis which can develop later in life with the menopause. 

Reduce caffeine and alcohol – as these can lower your mood.

Exercise – as with the immediate benefit on PMS symptoms, exercise is an important aspect of everyday life as it can improve your overall health. It also helps to improve low mood. Advice is to do 30 minutes of moderate-intense exercise each day. 

There are also other benefits associated with regular exercise such as:

  • weight loss
  • lower blood pressure
  • lower risk of heart disease
  • helps to alleviate stress
  • improves sleep
Moderate exercise such as yoga and pilates can also be good ways to combat the symptoms of stress, low mood and can help you to get a better nights sleep.

Quitting Smoking – smoking can worsen PMS symptoms, and so stopping can help.

Medication – if you suffer from severe PMS or PMDD medical treatment may be a viable option. However, there is no single medication which is suitable for everyone and so several different options may have to be tried before finding the best one to suit you.

Medications which can help with PMS include:

  • Combined oral contraceptive pill helps relieve symptoms such as:
    • Bloating
    • Headaches
    • Breast pain
  • Selective serotonergic reuptake inhibitors (SSRIs). Can relieve:
    • Tiredness
    • Insomnia
    • Food cravings
  • Gonadotrophin-releasing hormones (GnRH)
    • Reduces oestrogen and progesterone levels 
    • Induces a temporary menopause, so stops PMS
  • Vitamin and mineral supplements
    • a high intake of calcium and vitamin D can reduce symptoms
    • milk consumption can lower the PMS risk
    • calcium protects against osteoporosis

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Is it PMS or PMDD?

How are they different? – while PMS and PMDD both have emotional and physical symptoms associated with them, PMDD is more severe. PMDD can cause extreme changes in mood which can have a negative effect on relationships and disrupt working life. 

The key features of PMDD include:

  • Severe depression:
    • Extreme sadness
    • Feeling of hopelessness
    • Suicidal thoughts
    • Feeling detached from your normal routine
  • Extreme anxiety:
    • Feeling very tense
    • Feeling on edge
  • Severe mood swings
If you think you may be suffering from PMDD you should consult your GP. 

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Why is my PMS worse than other people’s?

Age can be a factor – the symptoms of PMS may be more intense shortly after the start of puberty but may occur at any time during the reproductive life of a woman 

Genetics – it is estimated that approximately 70% of women who suffer with PMS have mothers who also experienced the symptoms. This is also true of women who are symptom free, with around 63% reporting their mothers were also symptom free.

Lifestyle differences – as above the following can contribute to the severity of symptoms:

  • Smoking
  • Diet
  • Exercise

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Is it definitely PMS-related or something else?

Symptoms of PMS include:

  • abdominal cramps and discomfort
  • headaches
  • joint and muscle pain
  • breast tenderness
  • nausea
  • weight gain
  • food cravings
  • mood changes
  • feeling low
  • feeling angry/irritable
  • anxiety
  • low self esteem
  • low libido
Signs like the following can be an indicator of something more serious, and you should inform your GP immediately if you experience any of them.
  • discoloured, offensive vaginal discharge
  • unexpected or irregular bleeding 
  • rashes
  • flu-like symptoms
  • fever
  • diarrhoea
  • dizziness
  • breathing difficulties
  • drowsiness

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Will my PMS get better on the Pill?

Yes it could – studies have shown that the combined oral contraceptive pill may be beneficial in not only preventing pregnancy but also easing the symptoms of PMS. Newer versions of the pill have also been shown to be effective in treating the specific symptoms of PMS and may even help improve the symptoms of PMDD. One example is YAZ, a low oestrogen pill which is sometimes prescribed to treat acne to women aged 14 years and over. It has also been used to treat the symptoms of PMS and PMDD.

Combined hormonal contraceptive pills are commonly prescribed to treat the symptoms of PMS. These pills have been shown to improve:

  • Bloating
  • Stomach cramps
  • Breast pain
  • Headaches

Higher dose pills work best for PMS – the contraceptive pills containing a higher dose of oestrogen are more likely to improve PMS symptoms, however the risk of blood clots is higher with these pills. It is important to note that the contraceptive pill is not the best choice of treatment for everyone, as in some cases it can cause similar symptoms to PMS.

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Sources

Calcium and Vitamin D Intake and Risk of Incident Pre-menstrual Syndrome (2005) Arch Intern Med [accessed 4th August]

Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome) (2017) Endotext [accessed 1 April]

Premenstrual Syndrome Among Females (2017) International Journal of Home Science [accessed 1 April]

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