Premenstrual syndrome (pms)

Premenstrual syndrome (PMS)
Premenstrual syndrome (PMS) is a range of physical, psychological and behavioural symptoms that women can suffer up to two weeks before their period begins.1, 2 Doctors are still unsure what causes PMS but it’s been attributed to hormonal change, chemicals called neurotransmitters, hormone-like prostaglandins, diet and lifestyle.2 PMS often increases at times of hormonal change, for example, puberty, childbirth, after miscarriage or pregnancy termination or changes in contraception.1 Women aged 30 to 45 years often experience most severe PMS.1 Although most women learn to deal with PMS, about one in 20 women find their symptoms interfere with day-to-day living.1 Around three to five percent of women of reproductive age may be diagnosed with premenstrual dysphoric disorder (PMDD), where mood swings, depression, anxiety and irritability can make life very difficult.1 Symptoms
More than 100 symptoms have been recognised in association with PMS.1 Physical
Some women also suffer migraines.4 They can start a couple of days before your period or during your period, often masking their association with the menstrual cycle.4 They are triggered by a sudden fall in oestrogen levels at the end of a woman's cycle before bleeding and can last for up to five days.4 Migraine is more common in women in their 40s as they enter the menopause because hormone levels fluctuate much more.4 Psychological
The most common are depression, aggression and mood swings.1 Depression can be very debilitating, as well as being difficult for loved ones to deal with.1 • Difficulty in sleeping or wanting to sleep more Behavioural
There are a number of self-help measures that you can try to reduce the chance of suffering unpleasant PMS symptoms.1 Keep a diary1
One of the best ways is to discover what triggers your symptoms.1 Record your symptoms in a diary for three months.1 The National Association for Premenstrual Syndrome, a UK charity devoted to PMS awareness, has an interactive diary on its website for anyone who suffers PMS. 1 (Go to 1 It aims to reveal when your symptoms first arise, when they’re most severe and when they start to decline.1You can then show the diary to your GP or consultant if you need to seek treatment.1 Look at your diet1
Although there isn’t any clinical evidence to show that a healthy diet can improve symptoms, there is plenty of anecdotal evidence to say that it can.1 And there is no doubt that a healthy, balanced diet can lead to a sense of well being.1 • Cut back on sugar, salt, caffeine and alcohol • Eat at least five portions of fruit and vegetables day • Increase the amount of water you drink • Some women find that three hourly carbohydrate snacks, where you eat food such as rice cakes, crackers, bread sticks help. These are slow releasing energy foods which help to keep up energy levels.1 Release stress
Try and do at least 30 minutes of exercise every day.1 Although there is no evidence
to say that exercise improves symptoms of PMS, there is plenty of evidence to show
that it boosts levels of endorphins, the body’s own happy hormones. Also make time
for yourself.1 Do something you enjoy just for yourself, even if it’s just going for a long
walk, or a hot bath.1
Your GP can only make a diagnosis of PMS based on the description of your symptoms.1,2 That’s why it’s best to keep a diary over three periods so that you can show your GP if symptoms are related to your periods, and not other problems.1 Treatment
Headaches, lower back pain and stomach pain1
Over-the-counter painkillers will help you cope with pain.1,2 Your GP may prescribe mefenamic acid, a prescription anti-inflammatory drug, which may reduce pain, but can cause side effects, such as nausea.1,2 Migraines
If you think your migraines are associated with your menstrual cycle, talk to your GP about drugs available to treat them, including stronger painkillers.4 You may be offered the contraceptive pill or hormone replacement therapy, where treatment will focus on stabilising your oestrogen levels.4 Some people are offered beta-blockers, anti-epilepsy drugs, which are thought to stabilise activity in the brain.4 Again, with migraine, it’s good to keep a diary to help you recognise any other triggers that may cause migraines apart from your menstrual cycle.4 If you have this extreme form of PMS, your GP may prescribe anti-depressant medicines called selective serotonin reuptake inhibitors (SSRIs).1 Fluoxetine is one anti-depressant that appears to improve the physical and behavioural symptoms, but does cause side effects, such as nausea, tiredness, vomiting, diarrhoea or constipation and difficulty sleeping.2 Bloating, breast tenderness and mood
A diuretic (water tablet) called spironolactone, may ease bloating and breast tenderness as well as improve mood.2 Anti-anxiety drugs called alprazolam or e severe anxiety symptoms, although they carry potential side effects which you need to ask your GP about.2 General symptoms
An exotic fruit extract called Agnus castus has been proved to be very effective in
treating most PMS symptoms - irritability, mood alteration, anger, headache, and
breast fullness, but not bloating.3 A study looking into its effectiveness was published
in the British Medical Journal (BMJ) in 2001.3 It found that over half the women, who
took part, had significant improvement in their symptoms. 1Treatment was also
found to be safe and generally free of side effects.3 You may need to take it for at
least one year to see improvements and you should stop taking it if you become
Vitamin B6 has also been found to be effective in easing symptoms over a period of
two to six months.2
There still needs to be more evidence to prove that calcium supplements and
Evening Primrose Oil, one of the most popular self-help remedies, ease
Some women take magnesium supplements but there is no evidence to suggest it
eases symptoms.2
There needs to be more research into how effective the oral contraceptive pill and
hormone treatments with progesterone are in easing symptoms.1,2 However,
there is limited evidence to say that they do improve some mood and physical
However, both treatments have potential side effects, including excessive bleeding, abdominal pain, nausea, headache, breast discomfort and irregular periods. 2In fact, progesterone may induce PMS symptoms in some women.1,2 More information:
National Association for Premenstrual symptoms

Migraine Action Association

1.National Association for Premenstrual symptoms

Clinical Review

3. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo

4. Migraine Action Association
A wide range of women's health resources are available at Disclaimer: This article is for general information only and is not intended to replace a consultation with a healthcare professional, nor is it intended to provide specific medical advice and should not be used for the diagnosis or treatment of medical conditions. Copyright Bayer plc 2009 Last reviewed: April 6th 2009 Doc ID: Oi112 Version: 1


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