Pre-Menstrual Syndrome: The telltale signs

What causes PMS, and how can you deal with it? Dr Michelle O'Driscoll has some answers...
Pre-Menstrual Syndrome: The telltale signs

PMS is characterised by a cyclical change in mood which coincides with the second half of the menstrual cycle (days 15 to 28)

ARE you aware of recurring changes in mood and uncomfortable physical symptoms that typically present once a month, just before your period? Ever noticed tell-tale signs that serve to remind you that your period is on its way?

What you’re probably experiencing is Pre-Menstrual Syndrome, or PMS.

As well as the inconvenience and discomfort of a bleed, there are a range of other unpleasant symptoms that up to 90% of women deal with on a monthly basis. It can be comforting to know that you’re not alone, and that there are ways to manage it.

PMS is characterised by a cyclical change in mood which coincides with the second half of the menstrual cycle (days 15 to 28 of a textbook cycle). Symptoms are usually most obvious in the last 5- 7 days of the cycle, and typically subside 48 hours after menstruation begins.

What causes PMS?

The cause of PMS has not been definitively identified, but it is thought that it must be linked to the flux of hormones that occurs in the body (reduced oestrogen and progesterone) in the lead-up to menstruation.

There is also a theory that it’s the nneurotransmitters in a woman’s brain and the way that they respond to those hormones that determines how severe symptoms become.

What are PMS symptoms?

Symptoms divide roughly into physical and psychological.

The most common physical symptoms of PMS include:

Pelvic pain – this usually occurs the days before a period and for a couple of days after it begins

Bloating and water retention

Constipation, nausea or other stomach issues

Acne – can occur anywhere, but many women report breakouts around their chin, or the lower part of the face

Headaches or migraines

Breast pain or tenderness.

Psychological PMS symptoms that may present include:



Feelings of sadness exhaustion

Food cravings

Are any of these familiar to you? It’s definitely common to feel drained and have a much shorter fuse around this time!

The severity of presenting symptoms vary, tending to increase in the 30s and 40s. Thankfully, the majority of women find the symptoms manageable, but for others, symptoms can be severe for two weeks out of four, and sometimes even lead to them altering plans or avoiding certain activities.

When PMS disrupts daily life, it’s worth investigating possible ways to alleviate the symptoms. Note that very severe psychological symptoms are known as Pre Menstrual Dysphoric Disorder (PMDD) and require prompt medical intervention.

Dealing with PMS

The initial step to take would be to keep a diary of symptoms for two to three months, while also marking in the dates/details of your cycle. This helps to confirm whether or not the symptoms are definitely cycle related.

The most proactive thing you can do to address PMS is a lifestyle audit – look at key areas of your health and wellbeing that have been proven to impact upon PMS symptom severity and see if any of these could be addressed:

Stress - one of the key contributors to PMS symptoms. Identify any home, work relationship or financial pressures that can be reduced or removed and seek to act on these.

Exercise – well known as a vital part of healthy living, getting in five days of 30 minutes moderate exercise can work wonders for PMS.

Nutrition – what you fuel your body with is very impactful. Lots of fresh fruit and veg, eating regularly throughout the day, and including enough complex carbohydrates to keep blood sugar levels stable will all help with symptom severity.

Fluids – adequate water (2L per day), and avoiding caffeine and alcohol in excess when you can will boost mood and physical energy.

There are also some products that you can choose to try over the counter to counteract PMS. Evening primrose oil is a rich source of omega-6 fatty acids and is thought to improve several symptoms such as mood swings and breast tenderness, with more research needed to expand our knowledge on this.

Non-Steroidal Anti-Inflammatories (NSAIDs) may be suitable pain relief to take for pelvic pain, but you need to check with your doctor or pharmacist first. Vitamin B6, calcium, vitamin E and magnesium are also useful supplements to consider for combatting PMS.

If symptoms are very severe, your GP may prescribe suitable treatment based on your medical history and presenting symptoms. Physical symptoms may be alleviated by hormonal contraception.

Psychological symptoms may benefit from taking an antidepressant eg SSRI, which can be prescribed throughout the cycle or for particular timeframe leading up to your period. Often, it can be the case that once psychological symptoms have been addressed, you are then in a better position to clearly assess lifestyle options and make positive changes to improve physical symptoms too.

PMS is a common occurrence, experienced in varying degrees. It can occasionally become very disruptive to productivity, relationships and personal wellbeing. If you find that any of these are being negatively impacted on a regular basis think about which of the above steps could improve your experience of your menstrual cycle, as we women have enough to contend with without facing into extra challenges like PMS!

When PMS disrupts daily life, it’s worth investigating possible ways to alleviate the symptoms.

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