PMS risks and benefits for patients

Overview

Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that many women experience in the days before their period starts. It usually goes away once the period begins.

Yes, PMS is very common. Up to three in four women who menstruate have some symptoms before their period, but for many they are mild.

PMS affects women and people who menstruate, usually from their late teens to their 40s. It is most common in the 30s and may be worse at certain times of life.

Symptoms

Common symptoms

• Mood swings
• Irritability
• Fatigue
• Bloating
• Breast tenderness
• Headaches
• Food cravings
• Trouble sleeping

Symptoms in children

• PMS does not usually affect girls who have not yet started their periods. Once periods begin, some teenagers may have symptoms similar to PMS, such as cramps or mood changes.

Symptoms in older adults

• As women approach menopause, PMS symptoms may change or become less predictable. Some women find symptoms improve after menopause.

Causes

Main causes

• The exact cause of PMS is not fully understood, but it is linked to changes in hormone levels in the days before your period.
• These hormone changes can affect brain chemicals called serotonin, which help regulate mood, appetite, and sleep.

Risk factors

• Being in your 30s or 40s
• A history of depression or anxiety
• A family member with PMS
• High stress levels
• Not getting enough sleep or exercise

When to see a doctor

See a doctor urgently if:

• If your symptoms are severe and stop you from working, studying, or seeing friends.
• If you have thoughts of self-harm.

Book a routine appointment if:

• See a healthcare provider if PMS is affecting your quality of life and self-care is not enough.
• They can help you find ways to manage symptoms and rule out other conditions.

Diagnosis

There is no single test for PMS. Your healthcare provider will usually ask you to keep a diary of your symptoms over at least two menstrual cycles, noting when they start and stop.

Tests that may be done

• Your provider may do a physical exam.
• They may order blood tests to check for other conditions such as thyroid problems or anaemia.

What to expect at your appointment

Your provider will ask about your cycle, your symptoms, and how they affect your life. You may be asked to track symptoms for a month or two before a diagnosis is confirmed.

Treatment

Treatment for PMS focuses on relieving symptoms. For many people, lifestyle changes are enough. If not, your healthcare provider can talk about other options that might help.

Self-care at home

• Regular exercise such as walking or swimming
• Eating small, frequent meals with plenty of fruit and vegetables
• Reducing salt, caffeine, and alcohol
• Getting enough sleep
• Stress reduction like yoga or meditation
• Using a hot water bottle for cramps

Medical treatments

Medical treatments for PMS are available if symptoms are severe. These may include certain types of contraception, medicines that help with mood, or supplements such as calcium or vitamin B6. Your doctor can explain what might suit you. Some people find cognitive behavioural therapy (CBT) helpful.

When is surgery considered?

Surgery is not a treatment for PMS. It is only considered in very rare and severe cases, and only after full discussion with a specialist.

Living with this condition

Living with PMS means learning to manage your symptoms. Keeping a symptom diary can help you predict when symptoms will come and plan activities around your cycle.

Lifestyle tips

• Take time for yourself in the days before your period
• Break big tasks into smaller steps
• Talk to friends or family about how you feel
• Try to keep a routine for sleep and meals

Diet and exercise

Regular exercise, like brisk walking, can boost your mood and reduce bloating. A balanced diet with plenty of water and limiting salty snacks and sugary foods may also help.

Mental health and emotional wellbeing

PMS can affect your mood and emotions. It is normal to feel irritable or low. If you feel anxious, tearful, or hopeless, talk to your healthcare provider. You are not alone.

Prevention

There is no sure way to prevent PMS. But a healthy lifestyle may reduce how much it affects you. Tracking your cycles can help you prepare.

Screening programmes

There is no routine screening for PMS. If you are concerned, talk to your healthcare provider.

Complications

If left untreated

• PMS can be uncomfortable and distressing, but for most people it does not cause serious health problems.
• If severe, it can harm relationships, work, and wellbeing.
• A more serious condition called premenstrual dysphoric disorder (PMDD) can cause severe depression and anxiety. If you think you have this, seek help.

Long-term outlook

With the right support and self-care, most women manage their PMS symptoms well. Symptoms often improve with age and stop completely after the menopause.

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