Factsheet

Premenstrual Syndrome (PMS)

Date   18 January 2008

WHAT IS PREMENSTRUAL SYNDROME?

Premenstrual Syndrome (sometimes called Premenstrual Tension or PMT) are symptoms that some women experience in the second half of their menstrual cycle before their period begins. Most women will get some of these symptoms, even if they are only mild. Other women have such severe symptoms that their lives are disrupted for a week or two every month. The most common symptoms of PMS include:

• Tiredness
• Mood changes - feeling down, tearful, irritable, anxious, angry
• Nausea
• Food cravings
• Aches and pains
• Sore breasts
• Abdomen bloating and constipation
• Headaches (or even migraines)
• Difficulty concentrating
• Clumsiness

PMS settles completely once the period is over, so there is always a time in the cycle when a woman has no symptoms at all. If a woman's symptoms continue after her period, then the cause may be something other than PMS, like depression, approaching menopause or thyroid problems. PMS symptoms can often get worse when a woman is in her thirties and may continue to be a problem until menopause.

WHAT CAUSES PMS?

The exact cause of PMS is not known but it seems to have something to do with the way hormonal changes in the last part of the menstrual cycle affect a woman's body, particularly the nervous system.

WHAT CAN I DO TO HELP REDUCE PMS?

As long as your symptoms are not too severe there are many things you can try which are said to help with the symptoms of PMS. It may be useful to keep a calendar record of your menstrual cycle. This will help you to know when your symptoms usually start, so you can avoid the things that cause you to stress around that time.

Try explaining the situation to the person or people you live with. This will help them to be more understanding of you at this time. It can be more difficult to do this at work since some people do not take PMS seriously.

Take some Calcium supplements (1200mgs daily-preferably last thing at night). There is now good evidence that this reduces PMS. Try using Vitex Agnus Castus (Chasteberry extract). There is also good evidence that this natural therapy, which has been used by women for thousands of years, is effective at reducing PMS symptoms.

Make some changes to your lifestyle. A healthy lifestyle also seems to help with PMS symptoms. Make sure you eat plenty of fruit, vegetables and whole grains and cut down on salt, coffee, alcohol, sugar and cigarettes. Some women find that eating smaller meals more frequently helps as well. Get some regular aerobic exercise - aim for half an hour every day. Get plenty of sleep. Try to lower your general stress level. Consider learning relaxation techniques, yoga, meditation or tai chi, or have a regular massage.

Anti-inflammatory medications such as Naprogesic, Nurofen or Ponstan are all available from the pharmacist without a script. They can be useful where headaches or other aches and pains are the main symptoms of PMS.

In the past, high doses of Vitamin B, Evening Primrose Oil, and progesterone creams and tablets have all been suggested as treatments for PMS. There is very little evidence that any of these are effective.

WHAT TREATMENTS ARE AVAILABLE FROM MY DOCTOR?

If none of the simple treatments described above help you or if your symptoms are very severe, you should discuss other treatments available for premenstrual symptoms with your doctor. These are only available on prescription.

The Oral Contraceptive Pill This might be an especially good option if you need contraception as well. Because the Pill stops ovulation and tends to make periods lighter and less painful many women find that it improves their symptoms of PMS. Some of the newer Pills actually reduce fluid retention as well, so if this is a problem for you, the doctor may suggest one of these Pills in preference to others on the market. Other hormonal contraceptive methods such as the contraceptive injection or implant may also work to reduce PMS.

Mild diuretics (fluid tablets) Where bloating and fluid retention are the main symptoms sometimes doctors will prescribe a mild diuretic for the last half of the menstrual cycle.

Selective Serotonin Reuptake Inhibitors (SSRIs) These medications have been used for many years to treat depression. We now know that when they are taken in low doses in the last half of the cycle, they are very effective at treating the mood changes that are a problem for some women with PMS. These medications can have side-effects eg some women complain of sleeplessness, nausea and dizziness while using them.

The most important thing to remember about PMS is that the symptoms are not all in your head. Treat yourself kindly and do the things that help you best. You should not have to put up with symptoms that make your life miserable. If you would like to talk with someone, contact your local doctor, Family Planning NSW, or another family planning centre.

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For further information

Contact the Healthline on 1300 658 886.