Everything you need to know about PMS

Reviewed by our clinical team

If you have periods, then you probably have noticed that sometimes they days leading up to a period can be a bit challenging. If this sounds familiar, you might be experiencing PMS (premenstrual syndrome), also known as PMT (premenstrual tension).

Everyone experiences PMS differently, and symptoms might vary from one cycle to the next: sometimes it's hardly noticeable and sometimes it can affect you and the people around you quite badly. To learn more about PMS, including why it happens and how to manage it, read on for our straightforward guide.

Why does PMS happen? 

We don’t know exactly why PMS happens, but it’s thought to be triggered by ovulation and related to changing levels of hormones before menstruation.

Women who experience PMS aren’t thought to have an imbalance of hormones as such but may have an increased sensitivity to changing hormone levels – and, in particular, progesterone. 

Common PMS symptoms

There are lots of symptoms associated with PMS but the most common are:

• Feeling more emotional or snappy than usual 
• Anxiety or feeling low 
• Tiredness 
• Bloating 
• Breast tenderness 
• Spotty skin 
• Greasy hair 
• Changes to your appetite and sex drive 
• Headaches

If you have a pre-existing condition like migraines, eczema, acne, epilepsy or asthma you might find that your symptoms flare up in the days before your period. 

Lifestyle changes for PMS

For mild PMS, there are simple things you can do at home to make your symptoms easier to manage. These include:

• Exercising more regularly – this will help you sleep better, improve your mood, and give your general health a boost 
• Eating a healthier diet – as explained by the Eatwell Guide your daily meals should be varied and balanced   
• Working on getting better sleep – if you struggle to sleep generally, check out this NHS guide for some tips 
• Trying relaxation techniques like yoga and meditation – these will help reduce stress levels 
• Taking over-the-counter painkillers to ease any pain you’re experiencing 
• Quitting smoking and cutting back on alcohol

If you notice your symptoms getting worse, it can be helpful to keep a diary across two or three menstrual cycles. Note down relevant details e.g. how you’ve slept, what you’ve eaten, whether you’ve been exercising and your stress levels. If symptoms persist you can take the diary to your GP for their advice. 

PMS treatment options

The NHS advises seeing your GP about your PMS if lifestyle changes haven’t made a difference and your symptoms are really affecting you. There are a few things that your GP might recommend, including the following.

Hormonal treatments

The combined contraceptive pill can be helpful for women experiencing PMS as it prevents ovulation, which is thought to be the trigger for symptoms. Another benefit of the combined pill is that it can make your periods lighter and less painful.

Another hormonal treatment that may help is an oestrogen patch or gel. If you still have your uterus, you’ll need to use this in combination with a progestogen tablet or the intrauterine system (IUS). 

Psychological treatments

Cognitive behavioural therapy is a good option if you find that your worst PMS symptoms are psychological e.g. you feel very anxious and have mood swings. 

You may also be recommended antidepressants like SSRIs – these have been found to improve PMS symptoms even if you’re not depressed. 

Supplements

Many women try dietary supplements such as vitamin B6, calcium, vitamin D, magnesium, agnus castus (chaste berry) or evening primrose oil. Whilst it's not known yet whether they really work for PMS, some women do find them helpful. As they are unlikely to be harmful (as long as you don't exceed the doses on the labels) they might be worth a try.

Complementary therapies

Some women find that acupuncture and reflexology help with their symptoms. 

Treatment for severe PMS

In rare cases, PMS is very severe and causes serious mental and behavioural changes – this is known as premenstrual dysphoric disorder (PMDD). Normally, PMDD will require the same treatment approach as PMS, however you may need more focused help for your psychological symptoms.

In extreme cases, PMDD can lead to suicidal thoughts, so it’s important to reach out for help if you feel your symptoms becoming severe. The NHS recommends:

• Asking your GP for an urgent appointment 
• Calling 111 
• Calling the Samaritans (116 123) or another suicide helpline

More guidance on PMDD can be found at the Mind website. 

References

https://www.nhs.uk/conditions/pre-menstrual-syndrome/
https://patient.info/womens-health/periods-and-period-problems/premenstrual-syndrome
https://www.nhs.uk/conditions/atopic-eczema/causes/
https://www.webmd.com/women/pms/default.htm