Pre-Menstrual Syndrome (PMS) - an overview
Author: Dr. med. univ. Martin Kiebler
Hello there!
My name is Martin and I’m excited to welcome you to this blog article series about Premenstrual Disorders, or PMD in short! As a gynaecologist working in one of Switzerland's largest women's clinics, I come into contact with a wide variety of issues related to the female reproductive organs on a daily basis, including disorders within the menstrual cycle. While we will focus on PMD in this blog series, I also aim to address other important topics in the area of women’s health including menstrual health, reproductive issues and contraception methods in coming articles. So let’s get started with the first blog article about Premenstrual Syndrome.
Have you at any point felt like your emotional episodes are excessively intense and unforeseeable? Do you encounter extreme irritability, depression, or anxiety in combination with other physical symptoms that appear to be cyclical or only occur during a certain time of the month? If so, you may be suffering from Premenstrual Syndrome or in short PMS. This condition affects up to 75% of menstruating women and can fundamentally impact a woman's mental health and overall well-being. In this article, we will dive into the topic of PMS, including its causes, symptoms, diagnostics, and potential treatment options.
Symptoms
Let's begin with the basics. PMS is a collection of emotional and physical symptoms that arise in the days or weeks before your period. Bloating, headaches, breast tenderness, fatigue, mood changes, and depressive feelings are just a few among other symptoms that can range from mild to severe. While the precise origin of PMS is unknown, it is thought to be related to the hormonal changes that occur during the menstrual cycle and usually go away as the menstruation begins.
Furthermore, PMS can lead to a variety of emotional symptoms that can significantly impact your mental health and general wellbeing. These symptoms include difficulties concentrating, mood swings, depression, and anxiety, among others. Additionally your appetite or libido may vary while you are experiencing PMS.
PMS symptoms might as well vary in severity between women and as well in between menstrual cycles. While others may experience severe symptoms that profoundly impact their everyday life, some may simply experience moderate symptoms that are barely noticeable.
Diagnostics
Because there is no specific test for PMS, diagnosis can be difficult. Instead, doctors typically determine if you have PMS based on the symptoms you report and how closely those symptoms coincide with your menstrual cycle.
During the luteal phase of a woman’s menstrual cycle, which is the two weeks prior to menstruation, women must suffer from at least one physical or emotional symptom for three consecutive menstrual cycles in order to be diagnosed with PMS. The symptom(s) must start a few days before the onset of menstruation, be severe enough to interfere with everyday activities and disappear within a few days after the start of menstruation.
It's also important to keep in mind that some women who complain of PMS symptoms may actually be suffering from a different condition, such as premenstrual dysphoric disorder (PMDD), depression, or anxiety (see next blog post!). Working with your gynecologist will help you rule out other diseases and receive a precise diagnosis. For example, keeping a PMS diary can help you become more conscious of your symptoms. Additionally, if necessary, it helps the attending gynecologist in making a PMS diagnosis. If you smoke, drink large amounts of coffee or alcohol, and have a diet high in sugar and refined carbohydrates (white bread, pizza dough, pasta) you may be more likely to develop PMS symptoms.
Other factors that influence the probability of developing PMS include stress, a history of depression or other mental health issues, and a family history of the condition.
Therapy
So, what treatment options do we have at hand to manage PMS symptoms? There are a variety of options, including medication, dietary adjustments, and natural therapies including phytotherapy (herbal medicine). Let's take a closer look at each of these options:
1. Lifestyle changes: Adapting a healthy lifestyle can also help you control PMS symptoms. These include:
Eating a healthy, balanced diet with lots of fruits, vegetables, and whole grains. Add calcium-rich foods, like milk and leafy green vegetables (e.g. spinach), to your diet.
Getting regular exercise, which can help lower stress and lift your mood.
Getting enough sleep, which is crucial for your overall health and wellbeing.
Practicing stress-reduction routines like meditation, yoga, or deep breathing exercises.
Avoiding coffee, alcohol, and tobacco, which can make PMS symptoms worse.
2. Medication: The most prescribed medications for PMS are nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, which can help ease physical symptoms such as cramps and headaches. Additionally, hormonal birth control such as the pill, ring, or IUD can help balance hormones and reduce PMS symptoms. To help manage mood changes, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may occasionally be prescribed. (Please contact your gynecologist first if you plan to take such medications)
3. Phytotherapy: Utilizing plant-based medicines to address a variety of medical issues, phytotherapy can be a successful all-natural treatment for PMS symptoms. Among the plants frequently used for PMS are:
Chaste tree berry (Vitex agnus-castus): This herb has been used for centuries to treat PMS symptoms like irritability, mood swings, and breast tenderness. It is thought to work by increasing levels of progesterone and decreasing levels of prolactin.
Evening primrose oil: This oil has a high concentration of omega-6 fatty acids, which act anti-inflammatory and may help reduce PMS symptoms like mentioned above.
Black cohosh: This herb has long been used to treat the symptoms of menopause, but it may also be useful for treating PMS symptoms like hot flashes.
Ginger: Due to its anti-inflammatory and pain killing qualities, ginger may be useful for easing PMS symptoms including menstrual cramps.
If you’re looking for a supplement that will help combat PMS symptoms - check out Hey Period. A protein shake specifically designed to help alleviate symptoms of PMS, including mood swings, cravings and bloating.
Finally, PMS is a common condition that many women face at some point during their premenopausal time (age 15-50). Despite the difficulty in interpreting the symptoms correctly, there are numerous potential treatment options including dietary changes, medication, and phytotherapy.
This article was written by our guest author Martin as part of his series about Pre-Menstrual-Disorders.
Stay tuned for more on this!
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Sources & further reading:
American College of Obstetricians and Gynecologists. (2021). Premenstrual Syndrome (PMS). Premenstrual Syndrome (PMS) | ACOG.
National Association for Premenstrual Syndromes, NAPS (2023) https://www.pms.org.uk/about-pms/
Greene R, Dalton K. The premenstrual syndrome. Br Med J. 1953 May 9;1(4818):1007-14. doi: 10.1136/bmj.1.4818.1007. PMID: 13032605; PMCID: PMC2016383.
Yonkers KA, Simoni MK. Premenstrual disorders. Am J Obstet Gynecol. 2018 Jan;218(1):68-74. doi: 10.1016/j.ajog.2017.05.045. Epub 2017 May 29. PMID: 28571724.
Dilbaz B, Aksan A. Premenstrual syndrome, a common but underrated entity: review of the clinical literature. J Turk Ger Gynecol Assoc. 2021 May 28;22(2):139-148. doi: 10.4274/jtgga.galenos.2021.2020.0133. Epub 2021 Mar 5. PMID: 33663193; PMCID: PMC8187976.
Do roller coaster mood swings, bloating, and cramps every time before your period, sound familiar? If you are struggling with PMS, just know you are not alone. The good news? There’s so much you can do to ease your symptoms. Naam (@thecyclicalcoach) is a certified Menstrual Cycle Coach & Functional Hormone Specialist and reveals 5 tips to get you started in this blog post: Struggling with PMS? 5 tips from a Menstrual Cycle Coach.