Premenstrual syndrome

Premenstrual syndrome is caused by hormone levels dropping after ovulation and usually happens in the second half of your monthly menstrual cycle.

PMS symptoms, including bloating, period pain, irritability, mood swings and breast pain, affect most women at some point in their lives. You may notice different PMS symptoms from month to month, with the intensity of your symptoms varying from mild to severe.

It’s not fully understood why some women are more affected by PMS symptoms than others. However, PMS symptoms are often at their worst when you’re a teenager or approaching the menopause.

If your emotional symptoms are very severe, you may have premenstrual dysphoric disorder (PDD), which affects two in 100 women.

In most cases, lifestyle changes and medical treatments can successfully relieve PMS.

Common PMS symptoms include:

• Feelings of depression, anxiety, irritability and aggression
• Mood swings and low self-esteem
• Bloating and/or stomach pain
• Constipation or diarrhoea
• Food cravings, feeling hungrier than normal – or not wanting to eat
• Tiredness and/or insomnia
• Nausea

If you’re unable to relieve your PMS symptoms and they’re interfering with your daily life, see a GP. If possible, for three months before making an appointment, record your PMS symptoms, including frequency, severity and impact.

Your GP will have a chat with you about your PMS symptoms and how they’re affecting you. They may also discuss any pregnancy plans with you as this can influence the treatment they suggest.

To rule out conditions which can cause similar symptoms, your GP may do a blood test and arrange other tests. They may refer you to a gynaecologist (a specialist in the female reproductive system) for further assessment, diagnosis and treatment.

You should be able to reduce the severity of your premenstrual symptoms. Before seeing your GP, try:

• Adopting a healthy lifestyle – eat a balanced diet, take regular exercise, sleep for 7-9 hours every night, don’t smoke, avoid alcohol and lose any excess weight
• Finding a way to reduce stress, such as yoga, Pilates or mindfulness
• Taking over-the-counter pain relief such as ibuprofen or paracetamol

If these remedies don’t make a difference to your PMS symptoms, your GP or consultant will recommend treatment. Treatments for PMS include:

• The combined contraceptive pill – which prevents ovulation
• Cognitive behavioural therapy – where you’ll learn positive ways to cope with your symptoms
• Anti-depressants – to relieve the emotional symptoms of PMS
• Diuretics – to relieve bloating and painful breasts
• Hormone medication – to balance your hormone levels

In rare cases, and if you don’t want any more children, your consultant may suggest surgically removing your ovaries.