What is PMS?

PMS stands for premenstrual syndrome. It refers to a combination of physical and emotional symptoms that many women can experience in the two weeks leading up to their menstrual period. These symptoms usually get better once the period has started and often disappear by the end¹.

These symptoms vary from person to person, and can include:

• mood swings
• feeling irritable or depressed
• tiredness or trouble sleeping
• feeling emotional, upset, or anxious
• fluid retention and bloating or cramping
• acne
• greasy hair
• headaches
• food cravings or changes in appetite
• breast tenderness
• feeling clumsy

What causes PMS?

The exact cause of PMS is not fully understood, but it’s believed to be related to hormonal changes during the menstrual cycle. Fluctuations in hormones, such as oestrogen and progesterone, may contribute to the development of PMS symptoms.

Neurotransmitters like serotonin, which affect mood, may also play a role.

Other factors such as stress, diet, and lifestyle can influence the severity of PMS symptoms.

PMS can affect anyone who has periods.

How can I manage PMS symptoms?

Everyone’s experience with PMS can differ, so it's important to consult with your healthcare professional for personalised information and advice before looking for ways to manage it.

There are several things you can try to ease your PMS symptoms, including: 

• Regular exercise: Physical activity can help reduce bloating, fatigue and mood swings.
• Eating smaller, healthier, more frequent meals: This can provide a steady source of nutrients and help stabilise blood sugar levels, potentially reducing mood swings, irritability, and food cravings associated with PMS. Individual responses to dietary changes can vary, so it's important to find an eating pattern that works best for personal wellbeing. Consulting with a healthcare professional or a registered dietitian can provide tailored dietary advice for managing your PMS symptoms.
• Managing stress: It can help to practice relaxation techniques such as yoga, meditation, or deep breathing.
• Getting plenty of sleep: Getting enough rest and maintaining a regular sleep schedule can help improve overall wellbeing.
• Taking pain relief: Which can help reduce pain.
• Keeping a diary of your symptoms for at least two menstrual cycles will create a helpful record to take to your GP if your symptoms are negatively affecting your mental / physical health and relationships². 
• Avoid smoking and drinking too much alcohol. This can help stabilise hormone levels and reduce disruptions to normal hormonal fluctuations. Nicotine and chemicals in tobacco smoke can exacerbate PMS symptoms, while alcohol can affect hormones and neurotransmitters, which can worsen mood swings and irritability.

When to get in touch with your GP

If you’ve made lifestyle changes and they haven’t helped, and your PMS is affecting your daily life, your GP can advise you on treatments that can help. For example:

• hormonal medicine, such as the combined contraceptive pill
• cognitive behavioural therapy
• antidepressants

Should your symptoms persist after trying these treatments, you may be referred to a specialist, such as a gynaecologist, psychiatrist, or counsellor.

Complementary therapies and dietary supplements may also help with PMS, but there isn’t much evidence to prove they work. These can include: 

• reflexology
• acupuncture
• supplements such as vitamin B6, calcium, vitamin D and magnesium.

>Read more about the vitamins and minerals you need for good health.

Always check with your GP or pharmacist if you’re also taking medicines before starting to take regular supplements.

Is PMS similar to PMDD?

Premenstrual dysphoric disorder (PMDD) is a very severe form of PMS. It can significantly interfere with your daily activities and have a much greater negative impact on your everyday life. Symptoms can get worse during the luteal phase of a woman’s menstrual cycle, which can last around two weeks between ovulation and the start of your period.

PMDD can trigger a range of emotional and physical symptoms every month, including:

• headaches
• joint and muscle pain
• overeating
• problems sleeping
• feeling very anxious, angry or depressed or
• in some cases, suicidal thoughts

PMDD symptoms can make it hard to work, socialise and have healthy relationships.

What causes PMDD?

It's not clear what causes PMDD, but it's been linked to being very sensitive to changes in hormones, or certain differences in the genes you inherit from your parents³.

Research also suggests that factors such as smoking can cause PMDD, or make it worse, as it impacts your hormone sensitivity. It’s also suggested that PMDD could be linked to stressful and traumatic past events, such as emotional and physical abuse⁴.

Dr Pallavi Bradshaw, Deputy Chief Medical Officer at AXA Health explains, “Many symptoms of PMDD overlap with health issues including depression, anxiety, and thyroid conditions. It’s vital to ensure you can provide as much detail as possible about your symptoms when visiting a medical professional, so the diagnosis can be as accurate as possible. Noting down any correlations to your period will also help to distinguish if it is PMDD too. A symptom diary can be invaluable.”

Dr Bradshaw highlights the importance of PMDD sufferers consulting a medical professional, “PMDD is a severe long-term women’s health condition, which affects each person differently. Getting a diagnosis as soon as possible is essential for easing symptoms, getting the right support, and making life more manageable.”

PMDD may need more specialised treatment, so it's important to consult with your healthcare professional for an accurate diagnosis and appropriate management.

Helpful resources:

• Mind
• NHS website
• Period health: What you need to know
• NAPS – National Association for Premenstrual Syndromes
• The International Association for Premenstrual Disorders (IAPMD) website has more information on hormones and PMDD.

If you have specific concerns about PMS or PMDD, it's always a good idea to consult with a healthcare professional for personalised advice.

If you have symptoms of PMDD and are feeling suicidal, call 999 or go to A&E. Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance. Bring any medicines you take with you.

References

1. Managing premenstrual syndrome (PMS) – RCOG
2. Managing premenstrual syndrome (PMS) – RCOG
3. PMS (premenstrual syndrome) – NHS
4. What is PMDD? – Mind