Understanding PMS (Premenstrual Syndrome): Symptoms and Relief

Premenstrual Syndrome (PMS), often referred to as PMT (premenstrual tension), is a collection of physical and emotional symptoms that occur in the lead-up to a menstrual period. These symptoms typically develop after ovulation (the 'luteal phase' of the menstrual cycle) and disappear once the period begins or shortly after.

While most women and people who menstruate experience some mild premenstrual symptoms, PMS is diagnosed when these symptoms are recurrent and significant enough to affect daily life, work, or relationships. In the UK, it is estimated that nearly 3 in 4 menstruating women experience some form of PMS, with roughly 5% to 8% suffering from a more severe form known as Premenstrual Dysphoric Disorder (PMDD).

Symptoms of PMS vary widely between individuals and can even change from month to month. They are generally categorised into physical symptoms and emotional or behavioural symptoms.

• Abdominal bloating and weight gain.
• Breast tenderness or swelling.
• Headaches or migraines.
• Changes in appetite, such as food cravings (often for sweets or salty foods).
• Skin flare-ups or acne.
• Fatigue and disrupted sleep patterns.
• Muscle or joint pain.

• Mood swings and sudden tearfulness.
• Irritability or anger.
• Increased anxiety or feelings of being 'on edge'.
• Depressed mood or feeling low.
• Difficulty concentrating or 'brain fog'.
• Social withdrawal.

The exact cause of PMS is not fully understood, but it is widely believed to be linked to the fluctuating levels of hormones (oestrogen and progesterone) during the second half of the menstrual cycle. When these hormone levels drop after ovulation, they can affect chemicals in the brain, most notably serotonin.

Serotonin is a neurotransmitter that plays a crucial role in mood regulation, sleep, and digestion. Lower levels of serotonin triggered by hormonal shifts are thought to contribute to the mood swings, cravings, and insomnia associated with PMS. Some individuals may be more sensitive to these normal hormonal fluctuations than others due to genetics or environmental factors.

There is no specific blood test or scan to diagnose PMS. Instead, diagnosis is based on patterns. A GP will usually suggest keeping a 'symptom diary' for at least two to three menstrual cycles. This involves recording the timing and severity of symptoms daily.

To qualify as PMS under clinical guidance:

• Symptoms must occur during the two weeks before your period starts.
• Symptoms must improve or disappear once your period begins.
• The symptoms must be severe enough to affect your quality of life.
• There must be a 'symptom-free' week in the first half of your cycle.

If symptoms are present all month long but get worse before a period, it may be a 'premenstrual exacerbation' of an underlying condition like depression or anxiety, rather than pure PMS.

For many, mild to moderate PMS can be managed effectively through lifestyle adjustments. According to NHS and NICE guidance, these first-step measures include:

• Dietary Adjustments: Eating smaller, more frequent meals can help reduce bloating. Reducing salt intake can lower water retention, while cutting down on caffeine and alcohol may improve mood stability and sleep quality.
• Regular Exercise: Aerobic exercise, such as brisk walking, cycling, or swimming, can boost endorphins and reduce fatigue.
• Stress Management: Practicing yoga, mindfulness, or deep breathing exercises can help manage the irritability and anxiety facets of PMS.
• Supplements: Some evidence suggests that Calcium, Vitamin B6, and Magnesium may help with certain PMS symptoms, though you should consult a healthcare professional before starting new supplements.

If lifestyle changes are insufficient, a GP may suggest medical interventions. These aim to either balance hormone levels or manage specific symptoms:

• The Combined Pill: This stops ovulation and can help some women manage symptoms by keeping hormone levels steady.
• SSRI Antidepressants: In cases of severe PMS or PMDD, Selective Serotonin Reuptake Inhibitors (SSRIs) may be prescribed. These can be taken every day or only during the two weeks before the period.
• Cognitive Behavioural Therapy (CBT): CBT is a talking therapy that can help manage the psychological impact of PMS.
• Hormone Patches or GnRH Analogues: In rare and severe cases, specialist treatments that temporarily induce a menopause-like state may be considered.

You should consider booking a consultation if your premenstrual symptoms make it difficult to carry out your daily activities, attend work, or maintain healthy relationships. If you find yourself feeling hopeless or experiencing suicidal thoughts during this time, it is vital to seek medical help urgently.

An online GP can review your symptom diary, discuss the impact on your life, and recommend appropriate treatments. They can also help rule out other conditions such as perimenopause or thyroid issues that may mimic or worsen PMS symptoms. Seeking help early can prevent the monthly distress from becoming unmanageable.