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Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) is sometimes also known is also known as premenstrual tension (PMT).

PMS occurs in the two weeks before a woman's period and can cause physical, psychological and behavioural symptoms.

The degree and type of symptoms can vary significantly from woman to woman.

Symptoms of PMS usually start to improve when the woman's period begins.

What causes PMS?

The exact cause of PMS is unknown but it seems to be related to the fluctuating levels of hormones, including oestrogen and progesterone, that occur in preparation for menstruation.

What are the symptoms of PMS?

There are many symptoms of PMS, and the number and severity of symptoms vary from woman to woman. In addition, the severity of the symptoms can vary from month to month. Common symptoms of PMS include:

Up to 85% of menstruating women experience some of these symptoms related to their period, while only two to 10% experience severe symptoms.

How is PMS diagnosed?

There is no single test to diagnose PMS. However, there are some strategies your doctor may use to help make the diagnosis. These include:

Thyroid test. Because thyroid disease is common in women of childbearing age, and some of the symptoms of PMS - such as weight gain - are similar to symptoms of thyroid disease, your doctor may do a test to evaluate how well your thyroid is functioning. This can help to rule out a thyroid problem as a cause of your symptoms.

PMS symptoms diary. Your doctor may ask you to keep a diary of your PMS symptoms for two or three consecutive months, when they occur, and how long they last. By doing this, you can see if your symptoms correspond to certain times in your monthly cycle. While your symptoms may vary from month to month, a trend is likely to appear after tracking your symptoms for a few months. Experts generally agree that you have PMS if:

  • Your symptoms occur during the last two weeks of your menstrual cycle (the two weeks before your period).
  • Your symptoms impair your quality of life.
  • Your doctor has excluded other conditions that cause similar symptoms. Those conditions include thyroid disease, depression, migraine headaches, irritable bowel syndrome, and chronic fatigue syndrome.

Can PMS be prevented?

PMS itself cannot be prevented, but through education and appropriate treatment of symptoms, most women can find relief. A healthy lifestyle - including exercise, adequate rest, and a healthy diet - also can help a woman better manage symptoms of PMS.

Is there a treatment for PMS?

PMS treatment is based on relieving symptoms. Treatment begins with a thorough assessment of your symptoms, as well as their impact on your daily life. Treatments for PMS include the following:

  • Education. You will be better able to deal with your symptoms if you can relate how you're feeling to your menstrual cycles, knowing that you will feel better once your period starts. Keeping a monthly symptom diary will help you track your PMS symptoms, as well as their severity and how long they last. While symptoms may vary from month to month, this diary can give you a good idea of how your periods affect your physical health and moods. Learning how to cope with the problems in your life may help relieve the stress and irritability you feel before your period. If you experience severe anxiety, irritability, or depression, counselling and medication may be helpful.
  • Nutrition. A healthy diet is important for overall physical and mental wellness. Making changes in your diet - including reducing the amount of caffeine, salt, and sugar you eat - may help relieve symptoms of PMS. In some cases, nutritional supplements may be recommended. These include vitamin B6, vitamin E, calcium, and magnesium.
  • Exercise. Like a healthy diet, regular exercise, especially aerobic exercise like walking, can improve your overall health. It also can help relieve - and help you cope with - PMS symptoms.
  • Medication. Over-the-counter non-steroidal anti-inflammatory drugs ( NSAIDs) - such as aspirin and ibuprofen - may help relieve symptoms such as headache, backache, cramps, and breast tenderness. Medication may be prescribed in cases of severe depression or anxiety. Certain antidepressants may be useful to treat severe PMS. Oral contraceptives have been prescribed to treat PMS and may be helpful, but there is little data to support their effectiveness. The diuretic spironolactone (available on prescription) can reduce the fluid retention of PMS.

Many women find a benefit from using complementary therapies for PMS. Herbal products registered with the regulator MHRA for menstrual cramps and symptoms associated with PMS include agnus castus, horsetail and St John's wort. Registration does not mean the products have been tested and found to work but does mean they are made to a high standard and have been in traditional use for many years. Seek medical advice before taking any supplement as it may interfere with other medications.

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