- Our views on premenstrual syndrome (PMS)
- Causes and common PMS symptoms
- How to relieve PMS
- What can I do to feel better?
- What if lifestyle changes are not helping?
- Premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)?
- When to see your doctor
- Treatment options
- Does PMS get better as you get older?
- Key points
Our views on premenstrual syndrome (PMS)
If we were to conduct a survey and ask people about symptoms they associate with PMS, the most common answers would probably be: mood swings, irritability, or crying spells. It's interesting that out of all physical and emotional symptoms, these ones are the most known and have even become stereotypes with time. I won't get into details of medical sexism or how women’s health is often overlooked and neglected in various medical fields, but it's worth doing some research around it. I know many women who, when asked about it, would immediately deny experiencing any form of PMS, to avoid being seen as “hormonal” or “unstable”. Recently I've seen many conversations happening around normalising periods, but still not much is being said about premenstrual symptoms, especially considering how many menstruating people experience them to some degree. That's why we should have those conversations and work on destigmatising PMS — there's no shame in going through hormonal changes, even when they do cause mood swings!
Causes and common PMS symptoms
Scientists are still unsure what exactly causes PMS, but we know that estrogen and progesterone levels drop about a week before your period starts and that may contribute to changes in mental and physical wellbeing. We also know that menstruating people don't experience PMS before puberty or after menopause, so there is a direct correlation between the condition and menstrual cycles. It's likely that rather than one direct cause of PMS, we have a multitude of factors that affect how severe our premenstrual syndrome will be. If you’ve ever looked it up, you'll know that the list seems to be endless. Indeed, there are about 150 known symptoms. The most common PMS symptoms include:
changes in appetite and sex drive
You will find that different lists include different symptoms. For example, the American College of Obstetricians and Gynecologists lists social withdrawal amongst symptoms of PMS; their list of physical symptoms includes gastrointestinal issues and swelling of hands and feet. Of course, all menstruating people with PMS experience it differently. It's entirely possible to experience mood swings but no physical symptoms, and vice versa. They can also be on opposite ends of a spectrum — you may experience insomnia or extreme fatigue and sleepiness. Your symptoms may differ in each menstrual cycle as well.
How to relieve PMS
For most people, symptoms of PMS are usually manageable. Although PMS may be annoying and uncomfortable, most of the time we're able to carry on with our daily activities. Gentle exercise can help with low energy levels or bloating. Eating healthy and drinking plenty of water may also help relieve PMS. The Mayo Clinic suggests even acupuncture can be a form of treatment. Recently I've seen people using CBD oil, while some women report that herbal remedies (for example ginger) work for them. Even though these claims are not fully backed by research, we recommend listening to your body and just doing what feels right. If you're sad or experience mood swings, maybe a gentle walk in the sun would help you feel more grounded. If you have mainly physical symptoms such as tender breasts or bloating, remember to wear comfortable clothes, stay hydrated, avoid salty snacks, caffeine, and alcohol. It's valid to feel frustrated, but remember your body is going through hormonal changes and is likely to need more rest. Treat yourself with kindness and, if you're feeling guilty about not being productive, remind yourself that the amount of work you do doesn't define your worth and honouring your body's needs is equally important.
What can I do to feel better?
Are you trying to eat healthy, avoid caffeine and sugary foods, and yet experience lots of discomfort before your period? I've combined a checklist of various (less known) aspects worth paying attention to when you're trying to relieve some symptoms of PMS.
Vitamin D deficiency can make your cramps and fatigue worse — supplements may help.
Make sure you're getting enough B vitamins, especially B1 and B2, as well as calcium.
Avoid not only sugars and alcohol, but also caffeine, cigarettes, fried food, and even beans (especially if your symptoms of PMS include bloating, constipation, or diarrhoea).
Eat foods rich in fibre (to help digestion) and lots of green vegetables (they are an important source of magnesium and folic acid, which can help regulate hormones).
Try consuming less salt than you normally would, as it increases water retention.
We know it's not possible to avoid stress completely (life is stressful!), but try practising meditation, yoga, or muscle relaxation techniques.
Get plenty of sleep — some people actually need a bit more sleep when they're going through PMS.
Make sure you get enough exercise — as tempting as it is to stay in bed when you're experiencing low mood, even going for a walk is likely to help you feel less lethargic.
What if lifestyle changes are not helping?
If you experience really severe PMS and levels of discomfort that interfere with your daily life, it may be a good idea to see a professional who can provide medical advice, diagnosis, or treatment. According to the Mayo Clinic website, it's important to keep in mind that certain conditions share similar symptoms (for example thyroid disorders, irritable bowel syndrome, chronic fatigue syndrome, chronic migraines or depression, anxiety, and other mood disorders) — you may actually have another disorder that in turn makes your premenstrual syndrome worse. There is some evidence that an undiagnosed STI may also exacerbate your PMS symptoms. In terms of mental health, even if you don't have a diagnosed condition but have been experiencing increased stress or anxiety in the weeks leading up to your period, this might be why you're feeling extra awful.
Premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)?
Premenstrual dysphoric disorder is a more extreme version of PMS. Many symptoms overlap, but the difference lies in their severity and how they affect the daily life of people who suffer from it. PMDD is also characterised by significant mood disturbances — this can mean mood swings, irritability, anger, extremely low mood, crying spells, and even suicidal feelings. For this reason, it's sometimes described as a mental health issue as well. There is still not much research on premenstrual dysphoric disorder specifically (I can't stress it enough: there isn't enough research and funds going into women's health), but we know that genetics and being very sensitive to hormone changes can make you more prone to this condition. Sometimes it can be tricky to distinguish between premenstrual dysphoric disorder (PMDD) and a mental health condition (such as depression) which may be affected by premenstrual syndrome. If you suffer from a mental health condition and think you may also have PMDD, we encourage you to seek help from a medical professional.
When to see your doctor
In general, you should see your doctor if you're experiencing severe symptoms if they changed drastically, if your menstrual cycles became very irregular or different, or if there are any other changes that you think are worrying. The doctor may ask you about the severity and timing of your symptoms or if anything makes them better or worse. There is no blood test that can diagnose premenstrual syndrome or PMDD — the only reliable method is keeping a menstrual chart / journal where you keep track of your symptoms. Diagnostic criteria can differ slightly, but generally you're likely to be diagnosed with premenstrual syndrome if:
symptoms last during the five days before your period (they may start earlier than that)
once your period starts, they end within four days
they reoccur for at least three consecutive menstrual cycles.
Whether you experience premenstrual dysphoric disorder (PMDD) or just PMS symptoms that affect your daily life, it may be a good idea to ask a medical professional about health information, diagnosis, or treatment options. There is no “cure” (apart from hysterectomy) but there are many ways of managing the symptoms. When lifestyle changes are not enough, a doctor may prescribe you medication. It can be in the form of hormonal treatment (birth control) to suppress ovulation. Another way to treat PMS is with SSRIs — selective serotonin reuptake inhibitors such as fluoxetine (prozac). Unlike in depression, it's possible to take it only when experiencing PMS symptoms. Of course, it's good to be aware that these therapies may also cause side effects. For example, common side effects of SSRIs include feeling drowsy, anxious, and a lower sex drive. As always, when your wellbeing doesn't improve, your doctor will be able to provide medical advice.
Does PMS get better as you get older?
The short answer is: yes and no. Not many people experience severe symptoms of PMS in the first few years of menstruating. Research shows they usually become more severe in the late 20s to early 30s. It's less common to start experiencing premenstrual syndrome in our teenage years. Some people report their PMS symptoms get worse during perimenopause (the transition to menopause), likely because of hormone changes. Keep in mind that symptoms of both premenstrual syndrome and premenstrual dysphoric disorder are likely to get worse in more stressful periods of your life.
Premenstrual syndrome is a condition some people experience between one and two weeks before their period, but the severity of it differs. Symptoms usually stop within four days of getting your period.
For most of us, eating a balanced diet, avoiding stress, staying hydrated, and exercising may help. However, if your symptoms of PMS include extreme mood swings, sadness, anger, or significantly affect your daily life, you should probably see a doctor for advice, diagnosis, or treatment.
There are many known symptoms of PMS which can differ between menstrual cycles (even in the same person).
Of course, there are equally as many ways to help relieve symptoms, which we encourage you to try, to see what works for you.
Symptoms of PMS can often overlap with other chronic conditions, which can be important when choosing the right approach.
Medical treatment usually includes birth control or SSRIs.
PMDD is a more extreme version of premenstrual syndrome and can be characterised by significant mood disturbances occurring alongside physical symptoms, which is why it's sometimes referred to as a mental health condition.