Premenstrual Syndrome (PMS)

PMS means premenstrual stress – that feeling of overwhelm, both physically and emotionally, in the lead up to our period.

Premenstrual syndrome (PMS)

It’s estimated that 85% of women and people who menstruate will experience PMS at some point in their lives.

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PMS

PMS means premenstrual stress – that feeling of overwhelm, both physically and emotionally, in the lead up to your period.

Whilst for some, symptoms simply include feeling bloated or more tearful than usual, for others PMS can be a lot more debilitating. So what’s going on with our hormones during this time?

Symptoms of PMS vary and affect each person differently. They will always occur in the last two weeks of the menstrual cycle between day 14 and day 28 (the luteal phase).

These days will vary depending on how long your cycle is. You can read more about this in our period resource.

PMS symptoms can be physical, psychological or behavioral. Whilst you may never be able to get rid of your symptoms entirely, there are lots of ways to improve PMS symptoms. This includes changing your diet, reducing your caffeine and alcohol intake, addressing your stress levels, using particular supplements, or even trying medications like birth control pills or antidepressants. Some people find cognitive behavioral therapy (CBT) really helpful in allowing them to feel more in control when PMS is at it’s worst.

If you find PMS is stopping you from living your life normally, you might have a condition called premenstrual dysphoric disorder (PMDD). People with PMDD experience PMS symptoms in a severe way. This is particularly the case when it comes to the mental and emotional symptoms. If you think you have PMDD, speak to your healthcare provider about how to get support. You should keep a record of your symptoms and record how symptoms change during the month. Track your symptoms for a few months and bring any notes to an appointment with your doctor. They will be able to use this to assess whether you may have PMDD.

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Further reading

PMDD

Mental Health & Hormones

Mental Health Life Hacks

Supplements

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There are over 150 symptoms of PMS

that have been linked to hormone changes in the second half of a menstrual cycle. Here are a few of the common psychological and behavioral PMS symptoms:

Common PMS symptoms

  • Changes to your mood, particularly feeling sad or more depressed than usual.
  • Tiredness or lethargy (that feeling of not wanting to do anything).
  • Feeling extremely anxious, stressed, or worried.
  • Feeling tearful or more emotional than usual.
  • Feeling irritable or annoyed by the people close to you.
  • Difficulty controlling your emotions. You may find yourself raising your voice or snapping at those around you more often.
  • Feeling angry or emotionally out of control.
  • Feeling bad about yourself including having negative thoughts about the way you look.
  • Feeling more forgetful.
  • Not sleeping well and waking more often than usual during the night.

PMDD symptoms

Some of the physical symptoms of PMDD are:

  • Sore, ‘full’ or painful breasts.
  • Bloating in your stomach.
  • Constipation.
  • Cramps in your lower abdomen. These can cause pain that interfere with your daily activities.
  • Headaches or migraine episodes.
  • Worsening acne or pimple breakouts. You may find you struggle with cystic acne around your jaw. This is where there is no visible ‘head’ to your pimple. These lumps can be sore and painful to touch.
  • Allergy flare ups.
  • Feeling clumsier and struggling with spatial awareness.

You may find you only get one or two of these symptoms or find that you experience lots of them. This can also change from cycle to cycle. Some women’s symptoms continue until their period starts, or when they have the heaviest day of bleeding on their period.

When PMS may be worse

There may be ‘flash points’ in your life when your PMS is worse. This is usually during periods when your hormones are in flux such as:
– during puberty
– after pregnancy
– when you start, stop or change hormonal contraception methods
– during perimenopause or approaching menopause.

Perimenopause is a time when your hormone levels are constantly in flux. PMS can get worse in your mid to late 30s and many women find that their once-manageable PMS symptoms become even more severe in their mid to late 40s, as they approach menopause.

During perimenopause, women who have never experienced PMS, or have only had mild symptoms, may start to struggle more. Many of the lifestyle changes listed here will help to improve PMS symptoms but will not necessarily help them go away completely. For that, you will want to investigate hormone therapy (HT).

Premenstrual Syndrome or Disorder

Premenstrual syndrome or disorder may be diagnosed if your PMS symptoms are bad enough that they impact your daily responsibilities (including work or school) or have a negative impact on your relationships. The symptoms are the same as those listed above and they usually happen in the luteal phase of your cycle. You’ll then have at least one week of feeling symptom free immediately after your period – some women describe getting their period as an enormous relief.

If you experience serious PMS symptoms, you may want to think about talking to a doctor who can help treat your hormone sensitivity. There are no blood tests to diagnose premenstrual syndrome so if you want help, it’s important to keep a log of your periods and record your symptoms each month.

There are plenty of apps to do this and it’s worth tracking your symptoms for at least 3 months so you have a good idea of what your cycles are like.

The timing of your symptoms and how much they may have an effect on your life are the main things your healthcare provider will want to understand. If you’re worried about remembering all the information, bring your symptom diary to your doctor’s appointment to jog your memory.

For more information on PMDD check out our resource here.

Pill-free intervals
in birth control

There is a theory that one of the reasons the pill-free interval in birth control was developed, was as a way to make it more acceptable to the Catholic church. This is because it would mimic a natural cycle.

While some evidence suggests having a period every few months helps to ensure your womb stays healthy, it is perfectly safe to take your birth control without a break if that’s what works for you.

Help with PMS

Lifestyle changes can make a big impact on your hormones. Whilst they won’t fix everything, the following can be helpful to explore:

  • Limit how much caffeine and alcohol you consume.
  • If you smoke, try to reduce the number of cigarettes you have each day or ideally, quit altogether. Cigarettes impact our reproductive health and are also linked to infertility.
  • Try to address and manage any external stress you have in your life.
  • Any exercise that raises your heart rate, like fast walking or jogging. This will boost endorphins that can help relieve stress and pain.
  • Exercise like yoga may help with bloating and improve your energy and mood too.

If you have more severe PMS and have been diagnosed with a premenstrual disorder, your doctor may suggest the following in addition to lifestyle changes:

Low dose antidepressants (SSRIs)

that help to raise the level of serotonin in the brain which can help to improve mood, emotional stability, and sleep.

  • Women who struggle more with PMS have been shown to have lower serotonin levels. Zoloft and Celexa are good options to try. You can take these everyday throughout the month or just during the luteal phase. Your doctor can advise on what’s best for you.

Cognitive Behavioral Therapy (CBT)

has been shown to have similar benefits to antidepressants when it comes to improving low mood, anxiety, and other related symptoms.

  • CBT is a type of talking therapy where you try to look at and change the ways you react and behave in certain emotionally difficult situations. It takes practice but is a good way to help with negative thought patterns.
  • If talking to a CBT therapist is not possible because of cost, there are lots of helpful online resources you can try. Maybe start with our mental health life hacks .

The combined oral contraceptive pill (COCP)

is the most commonly used birth control that can help ease PMS symptoms.

  • It works by stopping ovulation and keeps your hormone levels more constant and stable throughout the month.
  • PMS symptoms are most improved when you take your birth control without a break. This is when you skip the ‘placebo pills’ at the end of your monthly pack and move straight to your next month of pills that contain hormones.
  • You don’t have to have a period break when you’re on birth control, and many types can be taken continuously, helping to keep your hormones stable PMS at bay.
  • Some women react to the progestin in birth control no matter which ‘type’ of progestin it is, so while it’s worth trying the pill to help PMS, it might not suit you and you may need to explore other ways to help your symptoms.

If none of the above treatments help, some physicians prescribe estrogen therapy to help balance out your progesterone in the luteal phase of your cycle. This is the same medication as used in HT but you may need to see a specialist in premenstrual disorders if you are interested in exploring this option.

PMS-friendly diet changes can include:

  • Cutting down on excess salt and sugar, particularly those found in processed foods.
  • Reducing white refined carbohydrates (like white bread) and incorporating wholegrain options. These have a slower release of glucose.
  • Increasing your essential fats and Omega 3 oils (you can use supplements to achieve this).
  • Including vegetables into your diet that are rich in fiber, magnesium, folic acid, and B vitamins. Broccoli, peppers and kale are some good options.
  • Making sure your diet is rich in calcium and vitamin D.
  • Using some of the following supplements: calcium, vitamin D, chasteberry (Vitex), magnesium, isoflavones, or St John’s Wort. There’s a lack of evidence to say these definitely help with treating PMS, but some women report finding them helpful.

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