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Painful periods

Premenstrual syndrome (PMS)

PMS is the name given to the physical and psychological symptoms that appear regularly before a period, but improve when bleeding begins. It’s widely accepted as a recognised medical condition that affects one in three women.

What are the symptoms?

There are more than 150 symptoms associated with PMS and a woman’s individual symptoms can vary from month to month.
The most common symptoms include:

  • Depression and agitation
  • Breast tenderness
  • Fluid retention and bloating
  • Irritability and mood swings
  • Headaches
  • Skin and hair changes

Some women’s lives are badly disrupted by these symptoms, which can appear up to two weeks before a period.

What causes it?

No one knows the exact cause of PMS, although it’s thought to be linked to the fluctuations in hormone levels that occur throughout the menstrual cycle.

Women with low levels of the chemical serotonin have been found to be particularly sensitive to levels of the hormone progesterone, which is thought may lead to symptoms of PMS.

Who’s affected?

Women of all ages suffer from PMS, but it can be more of a problem at these times:

  • After childbirth
  • During your 30s and 40s
  • During times of stress

PMS is often worse at either end of a woman’s reproductive life, around puberty and before the menopause.

What’s the treatment?

If you think you’re suffering from PMS, it may be helpful to keep a diary of symptoms so you can identify patterns and possible triggers.
Keeping to a diet that’s low in salt, fat and caffeine but high in fibre, and eating small, regular meals, can be beneficial. Make sure you put aside time for regular exercise and relaxation.

Vitamins B6 and E, gamma-linolenic acid (GLA), calcium and magnesium have all been recommended for PMS. Many women find them helpful, but studies have mixed results. Flower oils such as evening primrose and starflower (which contain GLA) have also been advocated by some sufferers.

Your doctor can give advice if these simple measures don’t work. They may recommend hormone treatments – either the contraceptive pill or progestogen may be helpful.

Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant drug often used to treat depression and anxiety, may also be prescribed.

Hysterectomy and PMS

Sometimes doctors advise removing the ovaries during a hysterectomy because this can be effective for PMS. Such advice, however, is controversial.

Removing the ovaries is a big step. It causes the menopause in women who haven’t yet reached it and increases the risk of osteoporosis unless women take hormone replacement therapy (HRT) for some years, which carries its own risks.

Women who keep their ovaries during a hysterectomy may not escape their PMS as the ovaries continue the hormonal cycle until the menopause, even though they can’t have periods.

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