Premenstrual syndrome (PMS) is the name given to the physical and psychological symptoms that can occur in the two weeks before menstruation. Symptoms usually improve when menstruation starts and disappear a few days afterwards [1].

The exact cause of PMS isn’t fully understood (this is what Menstrual Matters is trying to find out!). However, it’s thought to be linked to the changing levels of sex hormones (interacting with other hormonal systems) during the menstrual cycle [1].

PMS is also a slightly controversial topic, in that it isn’t exactly a medical syndrome, it isn’t well-defined, and is a term that is frequently misused, and misunderstood:

• A syndrome is a set of medical signs and symptoms that are correlated with each other, whereas PMS is actually a range of responses to natural physiological changes that occur during the menstrual cycle [2].
• PMS is not a precise diagnosis, in the way that many other health conditions are. For example, professional guidelines on the diagnosis and treatment of PMS differ in how they define the condition, tend to have a bias towards psychological/ emotional symptoms over physical ones, and nobody really knows which symptoms are the most common, or how many people experience them on a regular basis [3].
• In addition, ‘PMS’ has become associated with sexist depictions of femininity (i.e. the irrational female myth) that imply that ‘all women’ are somehow dangerous/ irrational/ of less value than ‘men’ [4]- even though not all ‘women’ experience PMS, and of those that do, none become any of these things!

So, whilst everyone agrees that some people experience various uncomfortable symptoms in relation to their menstrual cycle, there remains some confusion over whether ‘PMS’ is a useful and objective medical diagnosis, or simply reflects the negative framing of the menstrual cycle in society [2][4]. (Again, this is precisely why Menstrual Matters exists–  to better understand what is happening to the body during the menstrual cycle, and to expose the ways in which the menstrual taboo has prevented effective clinical research into health issues that affect millions of people in the UK).

In a nutshell, PMS refers to any symptom that is experienced cyclically (typically just before and/ or during the first couple of days of menstruation) that affects an individual’s ability to carry out normal daily activities. If you experience the similar ‘symptoms’ but not to such a severe level (i.e. you can get on with your usual activities), this is not ‘PMS’ but what is referred to as ‘menstrual changes’. Either way, the following tips and tricks can help you!

Main symptoms: anxiety; backache; bloating; breast pain; clumsiness; diarrhoea; difficulty concentrating; poor body temperature control; fatigue; headache/ migraine; irritability; changes in libido; low mood/ self-esteem; muscle/ joint pain; nausea/ vomiting; period pain; restlessness; sensitivity to light/ noise/ certain foods; shortness of breath; sleep problems; or tearfulness.

Note: Many of these symptoms are also common side effects of hormonal medications (not a coincidence!).

Conditions that are known to be triggered/ worsened premenstrually: anxiety, asthma, auto-immune disorders (e.g. fibromyalgia, psoriasis, or Multiple Sclerosis etc.); chronic fatigue syndrome/ ME; depression; endometriosis; epilepsy; fibroids; irritable bowel syndrome; and migraine.

Notes: If your symptoms are caused by your hormonal medication, we suggest that you discuss your options with a doctor. These steps may reduce symptom severity, but are unlikely to be able to stop them completely whilst you remain on the same medication.

If your PMS is mood-based and severe, please read our page dedicated to PMDD (Premenstrual Dysphoric Disorder).

Managing PMS:

The great news is that PMS symptoms respond very well to the four steps outlined on our ‘all symptoms‘ page- it is not an ‘inevitable’ part of having a menstrual cycle!

Try a hormone-balancing diet– As outlined in this blog, a vegetable-based ‘anti-inflammatory’ diet will significantly improve most PMS symptoms [1] (See individual symptom pages for symptom-specific advice):

1. Eat lots of fresh fruit and vegetables
2. Eat lots of fibre (and drink plenty of water, too)
3. Eat oily foods (mainly unsaturated fats)
4. Reduce meat and dairy products
5. Avoid sugary foods and drinks
6. Avoid caffeine
7. Avoid alcohol (and smoking)
8. Take nutritional supplements- Research suggests that Calcium (400- 800 mg daily) [5], Vitex Agnus Castus (200-500 mg of extract daily) [6], non-heme iron (plant based rather than animal product based) (20 mg per day) [7], or zinc (8 mg per day) [7] may reduce PMS (and can be used in combination with conventional anti-depressants, if needed).

Notes: Vitex Agnus Castus is not suitable for those who are under 18; using hormonal medication (or devices); are pregnant, trying to conceive, or breast-feeding; or have a pituitary problem.

TOP TIP! It is best to try nutritional supplements one at a time to see which one makes a difference!

Exercise regularly–

Regular exercise, particularly aerobic exercise, may help you combat stress and release tension. It also encourages your brain to release serotonin, which can improve your mood [8].

Research has shown that regular exercise, (more specifically cardio-respiratory fitness), and a healthy BMI (Body Mass Index), significantly reduces the risk of PMS, especially low mood [9].

Self-esteem– It is very easy to develop negative feelings towards your menstrual cycle, or body, if you experience PMS. You may also find it difficult to work, socialise, exercise, care for others, or do the things you usually enjoy. This can lower your mood and self-esteem, and increase anxiety levels.

Try Cognitive Behavioural Therapy- CBT involves noticing any negative internal thoughts, and analysing them to prove to yourself that they are not actually true, or reflective of who you really are (i.e. a human being of equal worth to all other human beings) [10]. Some people might benefit from the support of a professional counsellor, but a good (and cheap) starting point is this amazing booklet from the Oxford Cognitive Therapy Centre; ‘Building Self-Esteem‘.

TOP TIP! Using a menstrual cup, and tracking  hormone-related symptoms over time, can also help boost self-esteem. For example, a menstrual cup encourages the user to get to know (and like!) their reproductive anatomy better, and to observe menstrual fluid up close.  Just like symptom tracking, cup use helps people to know what is normal for them, and so feel more in control of their (menstrual) health and well-being.

Reduce stress hormones– Although we have become used to differentiating between ‘mental’ and ‘physical’ health, this is actually an artificial separation, especially when thinking in terms of PMS [11].

For example, it is known that changing levels of ‘sex’ hormones interact with the HPA (Hypothalamic–Pituitary–Adrenal) axis, better known as the ‘stress axis’ [12]. If you experience an increase in stress hormone levels, you will feel anxious- your ‘fight or flight’ response is triggered. This is what we have evolved to do, regardless of the fact that this response might have been triggered by your menstrual cycle [13], or hormonal medication, rather than a scary, dangerous, or otherwise stressful situation.

Interestingly, research shows that PMS is strongly affected by external (stress) factors, as well as internal hormonal changes [14]. For example, a triggering  factor for irritability/ PMS-related anger is nearly always an experience of ‘injustice’ of some sort- e.g. whilst trying to get children ready for school, if your partner does not equally share this responsibility. In fact, one study shows that being single, or having a supportive partner can significantly improve PMS symptoms, by simply reducing the sense of ‘injustice’ regarding personal responsibilities during the premenstrual phase [14]!

By tracking symptoms over time, and getting to know when you are likely to feel more anxious, or sensitive to stress,  you can feel more in control, and ‘resist’ those first fluttery feelings in the pit of your stomach.  Take note of any triggering experiences- this will help you to identify the cause(s) of your stress e.g. work, home, or finances etc.

Relaxation techniques or mindfulness practice can help to calm your breathing, and body, to break out of a downward spiral of emotional distress. Talk to others in your life about the triggers that contribute to your stress levels. Perhaps they could help in some way e.g. provide childcare support, help you to manage debt, or simply allow you some more space (e.g. at certain times in your cycle)?

If you have tried the suggested tips and tricks for at least 3 months, and your symptoms do not improve, please consult your doctor.

If you have any additional suggestions, or tips, for managing PMS- please let us know- we can share them with others!

Further information;

• NHS information on PMS; http://www.nhs.uk/Conditions/Premenstrual-syndrome/Pages/Symptoms.aspx
• National Association for Premenstrual syndrome: http://www.pms.org.uk/

Page last reviewed and updated: June 2018

References:

1.  NHS (2015) Premenstrual Syndrome. [ONLINE] Available at: http://www.nhs.uk/Conditions/Premenstrual-syndrome/Pages/Introduction.aspx. [Accessed 4 August 2017].

2. Knaapen, L & Weisz, G. (2008) The biomedical standardization of premenstrual syndrome Stud. Hist. Phil. Biol. & Biomed. Sci. 39 pp 120–134

3. King, S, (2017). What counts as a premenstrual symptom? Exploring contradictory medical definitions of PMS (Premenstrual Syndrome). Conference paper presented at Menstrual Health: Research, Representation, and Re-education. Atlanta, GA. USA, 22nd – 24th June 2017. Society for Menstrual Cycle Research. Also available online: https://menstrual-matters.comhttps://menstrual-matters.com/wp-content/uploads/2016/10/What_counts_as_PMS-SMCR_2017.pdf

4. Ussher, J. (2001) The madness of women: myth and experience, London, Routledge pp 153-184

5. Shobeiri F, Araste FE, Ebrahimi R, Jenabi E, Nazari M. (2017) Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. Obstet Gynecol Sci. Jan;60(1):100-105. doi: 10.5468/ogs.2017.60.1.100.

6. Atmaca, M., Kumru, S., & Tezcan, E. (2003) ‘Fluoxetine versus Vitex Agnus Castus extract in the treatment of Premenstrual Dysphoric Disorder’ Human Psychopharmacology 18(3): 191-5. PubMed PMID 12672170

7. Chocano-Bedoya PO, Manson JE, Hankinson SE, Johnson SR, Chasan-Taber L, Ronnenberg AG, Bigelow C, Bertone-Johnson ER. (2013) Intake of selected minerals and risk of premenstrual syndrome. Am J Epidemiol. May 15;177(10):1118-27. doi: 10.1093/aje/kws363.

8. NHS. (2016) Clinical depression. [ONLINE] Available at: http://www.nhs.uk/Conditions/Depression/Pages/Introduction.aspx. [Accessed 17 April 2017]

9. Haghighi ES, Jahromi MK, Daryano Osh F. (2015) ‘Relationship between cardiorespiratory fitness, habitual physical activity, body mass index and premenstrual symptoms in collegiate students’ J Sports Med Phys Fitness Jun;55(6):663-7. PubMed PMID: 26205766

10. Mind. (2016) Self-esteem. [ONLINE] Available at: http://www.mind.org.uk/information-support/types-of-mental-health-problems/self-esteem/self-esteem/#avoid. [Accessed 22 March 2017].

11. Marchant, J. (2016). Cure: a journey into the science of mind over body. Canongate; Edinburgh

12. Goel N, Workman JL, Lee TT, Innala L, Viau V. (2014) ‘Sex differences in the HPA axis’. Comparative Physiology 4(3):1121-55. doi:10.1002/cphy.c130054. Review. PubMed PMID: 24944032.

13. Kirschbaum C, Kudielka BM, Gaab J, Schommer NC, Hellhammer DH. (1999) ‘Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis’. Psychosomatic Medicine 61(2):154-62. PubMed PMID: 10204967.

14. Ussher, JM, Perz, J & Mooney-Somers, J (2007) ‘The Experience and Positioning of Affect in the Context of Intersubjectivity: The Case of Premenstrual Syndrome’. International Journal of Critical Psychology (now Subjectivity), 21: 144-165