Managing Premenstrual Syndrome Symptoms

Common physical PMS symptoms include:

• feeling bloated
• tender breasts
• headaches
• backache
• spotty skin
• abdominal pain or cramps
• feeling or being sick
• constipation
• diarrhoea
• food cravings
• weight changes
• general aches and pains

Common emotional PMS symptoms include:

• mood swings
• feeling irritable
• tiredness
• anxiety
• sleep issues
• poor concentration
• changes in sex drive

When do PMS symptoms start?

PMS symptoms start just before your period, usually in the week or 2 before. PMS symptoms commonly begin in the luteal phase of your menstrual cycle, which is the second half of your cycle – after ovulation.

When do PMS symptoms end?

PMS symptoms typically end a few days after your period begins. Most people find their symptoms have gone away before their period ends.

Although the cause of PMS is not fully understood, it is thought to be caused by hormonal changes that happen during your menstrual cycle.

Some research has suggested that high oestrogen and low progesterone levels could be the cause. Other researchers have found that increased sensitivity to progesterone and the substances it’s broken down into within the body could play a role.

PMS has also been linked to several neurotransmitters, which are chemical messengers in your body that help regulate your body's functions. These include serotonin, which affects your wellbeing and happiness and gamma-aminobutyric acid (GABA), which is linked to a reduction in anxiety and stress. Low levels of these neurotransmitters can affect your mood, causing anxiety, depression, or increased feelings of stress.

Some lifestyle factors can also make PMS symptoms worse, such as:

• stress
• poor diet
• lack of exercise
• smoking

What can cause severe PMS symptoms?

Several factors can influence how severe your PMS symptoms are, including your age, genetics, and lifestyle. Understanding these can help you manage your symptoms more effectively and identify areas where you may be able to make changes.

Age

Age can affect the severity of PMS symptoms in some people. Some studies have found that certain premenstrual symptoms can get worse as you get older, including low sex drive, concentration or memory issues, and hot flashes. These can also be perimenopause symptoms. The most severe symptoms were recorded in the 35 to 44-year age group.

As you approach perimenopause, hormone levels start to fluctuate more dramatically and can make PMS symptoms feel stronger or last longer. Many people notice that mood changes, bloating, and breast tenderness become more pronounced in the years before their periods stop completely.

If your symptoms have worsened, speak with your doctor to check for any underlying causes and to chat about how best to help you manage these.

Genetics

Your genes can play a role in your experience of PMS. Some studies suggest that a severe form of PMS called premenstrual dysphoric disorder (PMDD) may run in families, and premenstrual mood disorders may also be genetic. However, more research is needed to confirm this link.

Lifestyle factors

Some lifestyle factors can make PMS symptoms worse. For example, high stress levels, poor sleep, and a lack of regular exercise can disrupt your hormonal balance and increase symptoms, such as irritability, fatigue, and anxiety.

Similarly, a diet that’s high in sugar, caffeine, alcohol, or processed foods can intensify mood swings and bloating, while smoking increases the chance of PMS by 56%.

PMS can be managed by making small lifestyle changes, medical treatments, or a combination of both.

Lifestyle changes

There are many things you can do yourself to help manage PMS symptoms, particularly by making small lifestyle changes. It can take a little while to find what works best for you, but some of the things you can try include:

1. Eating a healthy, balanced diet that is rich in complex carbohydrates, like wholemeal pasta, rice, and bread. You should aim to eat smaller, more frequent meals, usually every 2 to 3 hours, to help limit symptoms like bloating and feeling sick. Try to incorporate natural anti-inflammatory foods, including oily fish, which is rich in omega-3. Swap fizzy or caffeinated drinks for plain water or herbal tea.
2. Getting regular exercise like walking, running, or swimming can help relieve stress, boost your confidence, improve your mood, and manage symptoms like bloating and tiredness.
3. Prioritising good sleep by aiming to get 7 to 9 hours per night. This can help to regulate your mood and leave you feeling less tired. Going to bed at the same time each night and waking at the same time every morning can help your body get into a consistent routine.
4. Practice mindfulness or relaxation techniques, like yoga, meditation, and breathing exercises, to relieve stress and help you manage feelings of irritability or sadness.
5. Quit smoking if you smoke cigarettes, because this can make PMS symptoms worse and more likely. If you are struggling to give up smoking, there are treatments available.
6. Follow a good skincare routine if you are prone to hormonal acne or spots. Your routine should include gentle cleansing twice a day and avoiding comedogenic ingredients that can clog the pores, such as those contained in certain shampoos and soaps.
7. Try a warm compress or a hot water bottle if you get period cramps.

Treatments

As well as lifestyle changes, there are treatments available for PMS, including over-the-counter and prescription-only medications.

Over-the-counter treatments

For some people, over-the-counter treatments, like ibuprofen or paracetamol, can help them manage symptoms such as headaches, aches, pains, and breast tenderness.

There is also some limited evidence that suggests the use of supplements can help manage PMS, including:

• St John’s wort
• calcium and vitamin D
• gingko biloba
• evening primrose oil
• vitamin B6
• magnesium

Prescription treatments

If lifestyle changes, over-the-counter painkillers, or supplements are not enough to manage PMS, then there are several prescription-only alternatives.

Mefenamic acid

Mefenamic acid is a type of non-steroidal anti-inflammatory drug (NSAID), which can be prescribed for the following PMS symptoms:

• heavy or painful periods
• migraines
• joint or muscle pains
• breast pain

Studies show it is 72% effective at reducing PMS symptoms, with significant improvements in headaches, heavy periods, breast tenderness, and irritability being reported. Mefenamic acid is available as an oral tablet, and the usual dose is one 500mg tablet 3 times a day.

Combined contraceptive pill

The combined oral contraceptive pill can be prescribed to help manage PMS symptoms, especially if you also require contraception. A doctor or nurse will check this is suitable for you before prescribing. Some of the pills that can help manage painful or heavy periods and PMS symptoms are:

• Levest
• Microgynon 30
• Ovranette
• Rigevidon
• Eloine

The mini pill is not usually recommended for managing PMS symptoms because, although it may help some people, it can make symptoms worse for others.

When to see a doctor

If your PMS symptoms are severe enough that they are impacting your daily life, work, or relationships, or they do not improve with lifestyle changes, speak to a doctor. Other treatments that can be effective include cognitive behavioural therapy and a class of antidepressant medication called SSRIs.

It is also important to get immediate help if you are experiencing thoughts of self-harm or suicide by calling 999 or going to A&E.

Do PMS symptoms get worse as you get older?

Yes, some people find that their PMS symptoms get worse with age, particularly during their late 30s and 40s. It’s thought that fluctuating hormone levels during perimenopause can play a role, which can make emotional or physical PMS symptoms worse.

When is PMS the worst in cycle?

PMS symptoms are typically worse during the week before your period, often peaking around 4 days before your period begins. The symptoms tend to improve or go away a few days after your period starts.

Can PMS affect my mental health?

Yes, PMS can affect your mental health, causing symptoms such as mood swings, irritability, anxiety, and depression. These symptoms are caused by hormonal changes and can range from mild to severe. If they are very severe and interfere with your daily life, this could be a sign of premenstrual dysphoric disorder (PMDD).

How can I control PMS anger?

To control PMS anger, there are several things you can do, such as focusing on lifestyle changes, like eating a balanced diet that’s low in sugar, salt, and caffeine, getting regular exercise, and getting adequate sleep.

Managing stress through activities like meditation, yoga, and mindfulness can also help, while some people find certain supplements useful. If you think PMS anger is an issue for you, speak to a doctor to discuss treatments and coping strategies.

Do you still get PMS symptoms when pregnant?

Early pregnancy and PMS symptoms are very similar, and it can be difficult to tell them apart. That’s because in the 2 weeks before your period, your body produces more progesterone to prepare for pregnancy, and changes in progesterone can be responsible for many PMS symptoms.

If I have no PMS symptoms does it mean I’m pregnant?

No, a lack of PMS symptoms does not automatically mean you are pregnant because it is possible to have no symptoms in either case. The only way to be sure if you are pregnant is to take a pregnancy test.

Does HRT improve PMS?

Yes, hormone replacement therapy (HRT) can help manage PMS symptoms, particularly during perimenopause, by balancing your hormone levels. If you are going through perimenopause and you still have your womb intact, you’ll usually be given HRT as a combination of oestrogen and progesterone. If you are under 50 and need contraception, the combined pill may be useful instead.