Premenstrual Tension (PMS)
If you dread the week or so before your period, you're not alone. Nearly all women of childbearing age have some symptoms of premenstrual syndrome (PMS) to some degree or other, say experts. According to the NHS, those who are most likely to experience PMS symptoms are aged between their late 20s and early 40s.
Meanwhile five percent of women are thought to experience severe symptoms that affect their daily lives significantly. This extremely debilitating form of PMS is called premenstrual dysphoric disorder (PMDD).
There are, however, many different symptoms of PMS and these can vary wildly from one woman to another. Many experts believe PMS is associated with around 200 physical, psychological and behavioural symptoms, the most common of which include the following:
Inability to concentrate
Emotional and psychological symptoms are thought to cause the most severe problems, and case studies of women having severe emotional difficulties when they’re premenstrual are far from unusual. In fact, PMS has been used – successfully in some cases – as a criminal defence for a range of offences in the UK.
What causes PMS?
Despite it being a common problem, experts still aren't sure what causes PMS. It’s thought that fluctuating hormone levels may be the biggest contributing factor to many of the symptoms. For instance, the two important female hormones progesterone and oestrogen are at their highest levels during the premenstrual period. But during pregnancy and after the menopause the levels of these hormones are stable – it’s also the time when most women find their PMS symptoms improve.
Low levels of brain chemicals (or neurotransmitters) called serotonin and gamma-aminobutyric acid (GABA) are also thought to be involved, as both help protect against some of the emotional PMS symptoms. Serotonin, for instance, is thought to help regulate mood and behaviour, and taking antidepressants that boost serotonin levels called serotonin reuptake inhibitors (SSRIs) helps some women who have PMS.
There are also theories that stress hormones including cortisol and norepinephrine play a part, but it’s not exactly clear how these or other hormones cause PMS symptoms.
What is clear, however, is that having a family history of PMS may make you more likely to have it too. Women who have – or have had – emotional problems such as depression may also have an increased risk of PMS and PMDD.
Thankfully, for most women PMS doesn’t usually last for long, and when or shortly after your period begins the symptoms disappear.
How hormones work
PMS symptoms are thought to be triggered by fluctuating levels of hormones, including oestrogen and progesterone, during the second half of the menstrual cycle.
The average woman has around 400 menstrual cycles during her lifetime. During this cycle, which can last anything from 21 to 35 days, your reproductive organs and hormones are in a constant state of activity. Here's what happens:
The day your period starts marks the beginning of the cycle. In terms of hormones, your levels of two key players – oestrogen and progesterone – are low while your brain starts producing follicle-stimulating hormone (FSH), which stimulates the growth of new egg follicles. If you have PMS, you’ll start feeling much better during this phase – unless, of course, you suffer from painful periods (dysmenorrhoea) or migraine. You can learn more about some of the problems periods may cause in our helpful guide.
For four or five days after your period finishes, your hormone levels are still relatively low and you should feel good because your energy levels and your concentration are at their peak. During this time, your brain continues to produce FSH while the follicles in your ovaries start producing more oestrogen.
For the next three or four days your oestrogen levels start to rise while tiny amounts of testosterone increase your sex drive. Your body is preparing to release an egg, and you should feel more confident and assertive than usual.
Over the next few days your hormones production goes into overdrive. Your oestrogen levels remain high and your brain produces a surge of lutenising hormone (LH). This triggers the release of an egg from one of your follicles – which is the process of ovulation – usually around day 14 of your cycle. This is when you’re at your most fertile, and your sex drive should be at its peak.
After ovulation, the follicle that released the egg during ovulation is now empty and turns into a gland called a corpus luteum. This gland secretes high levels of progesterone and oestrogen in preparation for the egg – which is travelling down one of your fallopian tubes – to be fertilised. This explains why your progesterone level starts to increase while your oestrogen levels get even higher (the combination, say some experts, may be one of the things that triggers PMS symptoms).
During the next five or six days, oestrogen stays high and progesterone peaks. If you suffer from PMS, it's likely your symptoms will now be at their worst. If the egg hasn’t been fertilised at the end of the premenstruation phase, oestrogen and progesterone production stops and your period starts, marking the beginning of another cycle.
Six ways to manage PMS symptoms
There’s currently no cure for premenstrual syndrome (PMS). But there may be things you could do to manage your symptoms and take back control of your life. Here are some of the things you could try that may help
While exercise may be the last thing on your mind when you’re premenstrual, being active can help life your mood because it can help boost your brain’s levels of feel-good chemicals called endorphins. Indeed, some experts think low endorphin levels may play a part in triggering PMS symptoms, so aim to get moving for 30 minutes or more on most days of the week. Try anything that leaves you slightly out of breath for half an hour or so, such as walking, jogging, swimming or even dancing.
Manage your weight
Being physically active on a regular basis can also help you to maintain a healthy weight. And that’s a good idea because it’s thought that women who are overweight or obese may be more likely to suffer from PMS.
Give up smoking
If you smoke, you could be making your PMS symptoms worse. While the reasons why smoking and PMS may be related aren’t clear, some experts believe that quitting could relieve your symptoms or even prevent them altogether. And remember, there are lots of products available these days that could give you the support you need to quit, including patches, gum and lozenges.
Steer clear of stimulants
Some women crave alcohol and caffeine – especially chocolate – when they are premenstrual. But both substances may contribute to PMS symptoms, so try to switch to non-caffeinated drinks and limit the amount of alcohol you drink throughout your cycle.
Try to relax
It may be easier said than done, but taking some time out to relax when you’re premenstrual could help to improve feelings of anxiety and keep you calm. Get into the habit of relaxing throughout your cycle, and you may find it easier to chill out when you’re premenstrual. Try yoga, meditation, deep breathing exercises or t’ai chi, or go for a massage – or anything that helps to keep you cool and collected.
Write it down
Keep track of your PMS symptoms from day to day by recording everything in a symptom diary. This may help you to recognise when your symptoms start coming into play, so you can schedule important things such as going for a job interview or taking your driving test at a more helpful time of the month.
Diet and PMS
Pre-menstrual syndrome (PMS) is closely linked with diet, and can produce a variety of food-related symptoms, such as carbohydrate cravings, bloating and comfort eating associated with mood changes. No single treatment is consistently successful, but making a few relatively simple dietary changes may help.
Eat little and often to keep your blood sugar levels topped up during the premenstrual phase. For example, go for three small-but-well-balanced meals a day with nutritious snacks in between. This may help you to manage food cravings.
Cut down on salt, sugar, coffee and alcohol, all of which have been linked with PMS symptoms. Salt, for instance, makes your body retain water, which causes bloating, while alcohol is a nervous system depressant that may worsen your mood. Caffeine, on the other hand, has been linked with breast tenderness not to mention anxiety and irritability, while sugar may make food cravings worse.
Low levels of serotonin may play a part in PMS, so try eating foods that contain an amino acid called tryptophan, such as bananas, turkey, chicken, fish, cottage cheese, eggs, nuts, wheatgerm, avocados, milk, cheese and pulses. Tryptophan is converted in the brain to serotonin. Carbohydrate-rich foods such as wholemeal bread, pasta and peanut butter may help tryptophan to get into the brain where it’s needed, so try combining tryptophan-rich foods with carbs.
Substances called isoflavones – or phytoestrogens – are widely believed to be oestrogen-mimicking adaptogens, which means they could either boost flagging levels or reduce excessive levels of the hormone. So to help keep your oestrogen levels on a more even keel, try eating isoflavone-rich foods, such as soya foods (soya milk, yoghurt etc). Fermented soya foods such as tofu, miso and tempeh may be even more effective, say experts who believe Japanese women have fewer hormone-related health issues because of their diet.
Omega-3 fatty acids are also thought to be needed for good hormone balance, so make sure your diet includes oily fish such as mackerel, salmon, herring, sardines and pilchards. But be aware that women of childbearing age shouldn’t eat more than two portions of oily fish a week because pollutants in oily fish may affect the development of a baby in the womb in the future. Plant-based foods that contain omega-3 fatty acids include flaxseeds, chia seeds, hemp seeds and dark leafy green vegetables.
Finally, try to drink plenty of fluids, especially water, as it can help to reduce bloating and fluid retention, and make sure you get plenty of fibre in your diet by eating at least five portions of fruit and vegetables each day.
Natural PMS Remedies
Medical treatments for PMS include painkillers for stomach cramps, headaches and muscle and joint pain. But if you have severe PMS symptoms or premenstrual dysphoric disorder (PMDD), you may be prescribed oral contraceptive pills, oestrogen patches or implants, antidepressants called selective serotonin reuptake inhibitors (SSRIs) or injected synthetic hormones that block your production of oestrogen and progestogen. Extreme pain before, and during, your periods could also be a sign of something more substantial, such as PCOS. To learn more, see our guide to understanding whether your period pain is a sign of PCOS.
However, there are several natural treatments you could try:
Many women with PMS respond to magnesium supplements, which may help reduce symptoms of irritability, depression, anxiety, tension, bloating, tiredness and headaches. Researchers also believe magnesium could significantly improve PMS-related mood changes (i). Meanwhile, a small study suggests taking magnesium supplements may help prevent headaches associated with the menstrual cycle, called menstrual migraines (ii).
Supplements of vitamin B6 are widely used for PMS and may be helpful for fatigue and emotional symptoms such as depression and irritability. Vitamin B6 may also be useful as it’s thought to help the brain make serotonin, a feel-good hormone that helps to regulate mood. Some experts also suggest that B6 taken alongside magnesium may be more effective than either supplement taken on their own (iii).
Please note: never take high doses of vitamin B6 in the long term without seeking medical advice
Many women also report relief of PMS symptoms when taking a supplement of gamma-linolenic acid (GLA) – an omega-6 fatty acid – such as starflower oil. Richer in GLA than evening primrose oil, starflower oil may help with symptoms involving inflammation, such as abdominal cramps and breast tenderness, because it blocks inflammatory prostaglandins.
St John’s Wort
Since the herb St John’s Wort is believed to work in a similar way to SSRIs, it’s often recommended to women with PMS who prefer a more natural approach. There is some evidence that it may be helpful for PMS-related mood changes (iv), while another study claims it may be effective for the most common physical and behavioural symptoms associated with PMS (v). It may also be useful for PMS where depression or anxiety are the main symptoms. One study, for instance, suggests the herb is as effective at treating depression as conventional antidepressants (vi).
Check with your GP before taking St John’s Wort as it isn’t suitable for everyone (it may interact with medicines including the oral contraceptive pill, tricyclic antidepressants, statins and warfarin).
A supplement called 5-HTP (5-hydroxytryptophan) may also be helpful for PMS-related depression. This non-essential amino acid is converted in the brain to serotonin, with studies suggesting it may be as effective at treating depression and low mood as some antidepressants (vii).
Meanwhile, if you find therapies useful, some that may be worth a try for relieving PMS symptoms include reflexology, chiropractic, massage therapy and acupuncture.
Premenstrual tension can have an impact on your everyday life, but these steps should help to make it a little easier to manage. To discover more articles on a range of other common health conditions, simply visit our health library.
Facchinetti. F, Bolrella. P, Sances. G, et al. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991;78:177-181.
Facchinetti. F, Sances. G, Borella. P, et al. Magnesium prophylaxis of menstrual migraine: effects on intracellular magnesium. Headache. 1991;31:298-301.
De Souza. MC, Walker. AF, Robinson. PA, et al. A synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover study. J Womens Health Gend Based Med. 2000;9:131-139.
Stevinson. C, Ernst. E. A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome. BJOG. 2000;107:870-876.
Canning. S, Waterman. M et al. The efficacy of Hypericum perforatum (St John’s wort) for the treatment of premenstrual syndrome” a randomized, double-blind, placebo-controlled trial. CNS Drugs. 2010 Mar;24(3):207-25.
Singer. A, Schmidt. M, Hauke. W, Stade. K. Duration of response after treatment of mild to moderate depression with Hypericum extract STW 3-VI, citalopram and placebo: a reanalysis of data from a controlled clinical trial. Phytomedicine. 2011;18(8-9):739-742.
Byerley. WF, Judd. LL, Reimherr. FW, et al. 5-hydroxytryptophan: a review of its antidepressant efficacy and adverse effects J Clin Psychopharmacol. 1987;7:127-137.
Poldinger. W, Calanchini. B, Schwarz. W. A functional-dimensional approach to depression: Serotonin deficiency as a target syndrome in a comparison of 5-hydroxytryptophan and fluvoxamine. Psychopathology. 1991;24:53-81.
Disclaimer: The information presented by Nature's Best The Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.