Most women who have reached the age of menstruating know what premenstrual syndrome (PMS) is, because they will have experienced it to some degree. An unlucky 5–8% have it so badly that it is really distressing, and significantly interferes with their life. It often starts to come on about 6 days before the next period is due, and gradually worsens until bleeding starts. Some women find the worst time is about 2 days before the actual period. As soon as the period starts, most women suddenly feel better, but sometimes the symptoms can linger on.
Symptoms of premenstrual syndrome
- Feeling depressed
- Feeling anxious and tense, angry and irritable, overwhelmed by everything
- Mood swings
- No energy, no interest in usual activities
- Difficulty concentrating
- Overeating (especially chocolate)
- Sleeping a lot, or unable to sleep
- Breast tenderness, bloating
The cause of premenstrual syndrome
How you can help yourself
Before you see your doctor
How your doctor can help
If PMS is affecting you badly, your doctor might suggest medication. These may take several months to make a difference.
- Probably the best medications for PMS are the so-called ‘serotonin-uptake inhibitors’ (such as citalopram, escitalopram, fluoxetine, paroxetine, sertraline), or a similar drug called venlafaxine. Usually, these medications are taken from the middle of the monthly cycle until the period starts. They can cause nausea initially, but this usually wears off. Some women notice reduced desire for sex while taking the medication.
- Hormone treatments are another possibility. In the past, it was wrongly thought that PMS meant a shortage of progesterone hormone before the period, so there was a fashion for taking extra progesterone at the end of the monthly cycle. In fact there is almost no evidence that this helps (Lancet 2008;371:1200–10). Now, hormone treatments are targeted at preventing ovulation from occurring in the menstrual cycle. Ovulation is the release of the egg from the ovaries at the middle of the monthly cycle; this release triggers the hormone changes that cause PMS in the second half of the cycle. There are various types of hormone treatment to prevent ovulation, and your doctor will be able to choose the method that is best for you.
If you feel bloated, you might think that water retention is occurring, and that a diuretic tablet (which makes you pass more urine) would be the answer. Generally, they do not work; only one diuretic (spironolactone) seems to have any effect.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Saturday, February 13th 2010
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