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Experiencing a variety of physical and emotional symptoms around the menstrual cycle is quite common and is known as premenstrual syndrome (PMS).
These physical and emotional symptoms typically occur 4 days prior to and during the first 1 to 3 days of the menses.
Some women experience the symptoms 7-10 days prior to the first day of menstrual flow.
These symptoms include a roller coaster of physical and emotional changes. Bloating, and fatigue are the most common, but breast tenderness and headaches can occur too.
The emotional symptoms are usually described as mood swings, but irritability, anger outbursts, anxiety, and tension may also be present.
The presence of menstrual cramps and pelvic pain is not strictly related to PMS, but may occur around the same time. These symptoms could be associated with a variety of other gynecological conditions.
While PMS may be mild in some females who may just shrug the symptoms off, it may be moderate to severe in others, sometimes impacting on productivity during those days.
Severe PMS is experienced by 20%-40% of females, with visible symptoms affecting their performance. (1)
At the other extreme, 3-8% of women with PMS are likely to experience psychological problems to such an extent that they affect their quality of life.
Such a severe form of PMS is called premenstrual dysphoric disorder (PMDD). Although rare, PMDD is a severe form of PMS that can be debilitating and can leave women distraught for 1-2 weeks a month.
If your doctor suspects you have PMDD, you will likely be referred to a mental health professional who can help you cope with the emotional and psychological stress associated with this condition.
PMS may be exhibited in one cycle and may not be present in the next. The severity of symptoms and occurrence may vary over the months and years and stop altogether after menopause. The association and prevalence of PMS cannot be predicted with respect to age, achievement, and social status. (2)
PMS: Causes and Risk Factors
There is no clear reason for the occurrence of PMS, besides the sudden surge of the ovarian hormones in the female body 1 week prior to her period.
This change may reflect upon the action of neurotransmitters, such as serotonin. However, it must be noticed that women with PMS may have a normal level of sex hormones.
Evidence also suggests that women who are highly prone to PMS-related discomfort may have low levels of serotonin and an increased sensitivity toward the progesterone hormone. .
But the exact risk factors that can increase one’s likelihood of experiencing frequent or intense PMS symptoms are not clearly understood, and are subject to further investigation.
Factors that may contribute to the appearance of these symptoms include:
- A diet that lacks the inclusion of essential nutrients.
- Women between the ages of 25 and 40.
- Obesity, high BMI, and having weight more than the average. Women who have a high BMI greater than 30 are more likely to experience PMS than a normal-weighing woman.
- Stress and depression.
- Being physically weak.
- A woman who smokes is at a greater risk of severe PMS symptoms. The risk is twice as much as that of a nonsmoking female.
- Genetic predisposition.
- Environmental toxins.
Signs and Symptoms of PMS
PMS typically manifests in the form of the following physical symptoms:
The physical symptoms include:
- Skin problems such as acne
- Muscle cramps
- Breast tenderness
- Swelling in the feet and hands
- Excessive thirst
- Pelvic pain
- Stomach problems such as constipation
- Abdominal pain
- Back pain
- Diarrhea (In some cases)
- Water retention
The emotional symptoms appear in the form of:
- Mood swings
- Social anxiety and isolation
- Difficulty concentrating
- Frequent spells of anger
- Changes in sexual desire
- Altered sleeping patterns, either excessive sleep or a lack of sleep
- Crying phases
- Food cravings
- Loss or increase in appetite
Diagnosis of PMS
Identifying PMS is difficult because of the lack of any particular diagnostic test.
The healthcare professional is likely to make you record your symptoms over two menstrual cycles and give a retrospective account of the same.
Reviewing 2-3 months of symptoms in menstrual charts is key for the health care provider to assess if symptoms can be attributed to PMS, PMDD, or not.
- It is essential to jot the details in a diary to avoid missing any symptom that can help the doctor diagnose your case correctly.
- If the symptoms recorded are inconclusive, your doctor may recommend gonadotrophin-releasing hormone (GnRH) analogues for 3 months to conclude. (3)
Medical Treatment for PMS
The standard methods of treatment are focused on ameliorating the symptoms of PMS as manifested either physically or emotionally.
These treatment methods are aimed at addressing the hormonal activity of the body to relieve the symptoms by hormonal or nonhormonal ways.
The methods of treatment are tailored depending on the condition of the patient. These medical treatments include:
- Birth control pills or hormonal patches in women suffering from severe PMS or PMDD to lower the hormonal levels.
- Antidepressants in women experiencing extreme emotional symptoms.
These include selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs), which can help curb the depression and other psychiatric symptoms of PMS or PMDD. These must be prescribed by a healthcare professional.
- Nonsteroidal anti-inflammatory drugs to reduce pain. Although this area lacks research, a few pain-relieving medications can help reduce the characteristic spasms in the abdomen during PMS.
- Women experiencing a bout of bloating may be prescribed with diuretics to prevent water retention.
- Because antidepressants affect the number of neurotransmitters that are responsible for the generation of pain, it is necessary to take them only in cases when you experience severe symptoms.
- The prescribed medications may have possible side effects and need further validation; hence, take them only when the pain is severe and ceases to go.
- Talk to your doctor if you are planning a pregnancy.
Severe symptoms that tend to last for days and disrupt your daily activities must be evaluated by a healthcare professional.
Tips and Remedies to Help You Manage Premenstrual Syndrome
Although there is no sure-fire cure for PMS, following some home remedies and adopting a few healthy habits prior to your menstrual days can help you feel better.
Implementing a few lifestyle changes in your routine can help curtail the symptoms of mild PMS to quite an extent. These include the following:
- Limit your intake of caffeine 2 weeks prior to the onset of menstruation. Increased levels of caffeine can worsen the tenderness in your breasts right before your periods.
- Cut back on the consumption of alcoholic beverages 14 days before your period to prevent your moods from going down. Alcohol consumption can make you feel depressed.
- Quit smoking.
- Try to get the required 8 hours of sleep to keep yourself relaxed and fatigue-free.
- Manage your stress through relaxation techniques such as yoga, tai chi, counseling, cognitive behavior therapy (CBT), and meditation, which can help you relax and relieve the associated stress and anxiety.
- Reduce your salt intake to avoid bloating, a common occurrence during periods.
- Reduce your intake of processed foods, dairy products, and refined sugars.
- Reduce your dietary fat intake.
- Eat a healthy, wholesome diet with generous amounts of vitamins and minerals.
- Eat fiber-rich foods to allow intestinal clearance of estrogen. You can eat raw carrots for this purpose.
- Make sure to drink sufficient water, around 6-8 glasses each day.
- Try engaging in light exercises. Exercise triggers the secretion of “happy” hormones called endorphins that help reduce the pain and give you relaxation.
In addition, exercise helps reduce your stress levels and boosts your mood and metabolism. Do aerobic exercises, such as walking, running, riding a bike, swimming, or any activity that gets your heart rate up preferably on a daily basis.
According to a randomized control trial, 20 minutes of aerobic exercises three times a week can help reduce the symptoms of PMS. (4)(5)
However, further research is required with larger sample size, consistent exercise sessions, and controlled sleep and nutrition in the subjects. (4)(5)
Diet plays a vital role in tending to any illness or ailment. What you eat will reflect on your health eventually.
Besides following a healthy balanced diet, incorporating a few dietary additions can have a positive effect on the symptoms of PMS.
1. Ensure an Adequate Intake of Vitamins and Minerals
Calcium is required to keep your hormone levels balanced. This, in turn, helps ease PMS-related symptoms. Calcium plays a key role in maintaining your overall health and exerts a significant impact on your bones and teeth.
A 2019 systematic review found that depleted levels of calcium and vitamin D were related to the aggravation of PMS symptoms. Hence, it was suggested that restoring calcium and vitamin D levels can help reduce the symptoms of PMS. (7)
However, further research is needed to evaluate the clinical outcomes of vitamin D supplementation on PMS by eliminating the limitations of small sample size, short study duration, and the lack of a control group during the intervention period.
Magnesium and vitamin B6 may help curb food cravings, reduce breast tenderness, and avoid fluid retention, bloating, and migraine-associated with PMS.
Two studies highlighted that vitamin B6 and magnesium supplementation helped reduce the symptoms of PMS considerably. (10)
Both nutrients contribute to the reduction of stress and cramps.
- Consume foods rich in calcium and magnesium, such as green leafy vegetables, beans, kelp, bananas, nuts, and seeds.
- Incorporate your diet with vitamin B-rich foods, such as eggs, milk, poultry, fish, soybeans, leafy greens, whole grains, wheat germ, oatmeal, and various nuts and seeds.
- Eat pistachios, garbanzo beans, and potatoes to incorporate vitamin B6 in your diet.
- You can also consult your doctor for an appropriate supplement.
There is scientific evidence that vitamins and minerals may help provide relief from the symptoms of PMS.
2. Consider Chasteberry Extract
Chasteberry (Vitex agnus-castus) is a remedy touted for its effects on diseases related to hormonal imbalances. It may help regulate the synthesis of hormones and fix the hormonal surges during PMS.
Chasteberry is a herb that works by arresting the release of a hormone called prolactin, which dominates during PMS.
According to the findings of a 2017 study published in the Archives of Women’s Mental Health, the use of chasteberry extract is a safe alternative to get relief from the symptoms of PMS or PMDD. (12)
Although the pooled results of the effects of chasteberry on PMS were reportedly positive, the results cannot be established definitely due to associated risks of biases and the heterogeneity of the studies included in the review. (13)(14)
Chasteberry may help bring your hormonal levels back on track and quell the symptoms of PMS, such as tender breasts and hot flashes, to quiet an extent.
- Take 400 mg of the standardized extract of this herb daily. As with all supplements, consult your doctor first.
Several studies supported the positive role of chasteberry in relieving PMS symptoms, but still, there is a need for high-quality trials with a larger participant number to draw definite conclusions.
3. Use Fennel to Relieve Bloating
Fennel may help alleviate the stomach cramps experienced during PMS. Also, the natural digestive and diuretic properties of fennel may help reduce the associated bloating.
A 2011 randomized clinical trial published in the Journal of Reproduction and Infertility concluded that the administration of fennel extracts might help relieve the symptoms of PMS. (16)
Another randomized clinical trial conducted on students aged 16–18 years found that a combination of fennel and exercise helped lessen the severity of the PMS-related symptoms. (17)
Also, this combination can help relieve stress and depression, some of the causes of PMS. However, the results of the study remain inconclusive due to the short intervention period and the small number of participants. (17)
Multiple studies corroborated the benefits of fennel seeds on PMS. Pairing fennel intake with exercise may help magnify the results.
4. Up Your Omega-3 Fatty Acid Intake
Eating food sources rich in omega-3 fatty acids may also help curtail the symptoms of PMS.
A randomized clinical trial found that the supplementation of omega-3 helped reduce the symptoms of PMS in women and improve their quality of life. (19)
The only shortcoming of the study was the short intervention period, which hindered the evaluation of the side effects of omega-3. (19)
Omega-3 fatty acids are a natural dietary alternative for the treatment of cyclical mastalgia.
A randomized controlled trial conducted on 184 women suggested the possible role of omega-3 fatty acids in averting both emotional and physical PMS symptoms such as nervousness, depression, breast tenderness (mastalgia), headache, and bloating. (20)
- Incorporate foods rich in essential fatty acids in your diet. These include fatty fishes, coconut oil, eggs, almonds, walnuts, pumpkin seeds, and chia seeds.
- Ditch the regular processed flour bread and cookies and opt for bread containing flaxseeds before the onset of menstrual bleeding.
- Add ground flaxseeds to your meals. You can add 1 tablespoon of ground flaxseeds twice daily to your oatmeal, smoothies, salads, cereals, dough, or dressing or your sautéed vegetables.
Although several studies have shown omega-3 to provide symptomatic relief from PMS, further research may help produce further information on this subject.
5. Choose Turmeric to Manage Stomach Cramps
Turmeric has been used extensively as an anti-inflammatory in traditional medicine. The curcumin present in it may help reduce the pain due to inflammation.
A 2015 study published in Complementary Therapies in Medicine highlighted the anti-inflammatory and neurotransmitter-modulating effects of curcumin. It was found that curcumin helped significantly decrease the severity of symptoms of PMS in women. (15)
However, the results of the study are limited due to its small sample size and the inclusion of only university students. (15)
- Consider taking curcumin capsules upon the approval of your doctor.
The anti-inflammatory effects of curcumin in reducing PMS symptoms lack enough evidence, which calls for further studies for better evaluation.
6. Drink Ginger Tea to Pacify the Cramps
Renowned for its healing properties in alternative medicine, ginger may help reduce menstrual problems, including cramps, PMS, and irregular menstruation.
According to a clinical trial published in ISRN Obstetrics and Gynecology, ginger may be used in preventing the worsening of the behavioral and physical symptoms of PMS. (11)
While there were no side effects reported from consuming ginger, further studies are required to support its dosage, safety, and effectiveness in treating PMS. (11)
Although lacking sufficient evidence, ginger has been immensely used due to its anecdotal relevance to lessen the discomfort of PMS. Further studies with larger sample sizes and longer intervention periods are required to establish the safety and efficacy of ginger to treat PMS.
7. Use St John’s Wort to Manage Mood Swings
St. John’s wort is a herb that has been accredited with medicinal relevance by the ancient traditional medicine systems of Greece and Europe.
It has been used to relieve conditions such as insomnia, depression, and mood disorders and to speed up wound healing.
A randomized controlled trial suggests that St. John’s Wort can help improve both the physical and behavioral symptoms of PMS to significant levels. Further research is required to highlight the role of this herb in the long treatment of symptoms and pain management of PMS. (18)
- You can consider taking 300 mg of the herb extract (standardized to 5% hyperforin) three times daily to help relieve the symptoms of PMS. Always take supplements upon your doctor’s approval.
St. John’s wort has been used to tend to mood disorders since ages; hence, it can be used to tame the behavioral symptoms of PMS. However, the dearth of evidence calls for further research to support the use of this herb to relieve the symptoms associated with PMS.
When to See a Doctor
Severe PMS symptoms can disrupt your daily activities and thereby hamper the overall quality of your life.
Thus, if you experience extreme discomfort that is hard to manage, it is essential that you visit a gynecologist, nurse practitioner, physician assistant or midwife for proper medical evaluation.
Only a specialist will be able to understand the underlying factors responsible for your distress, and suggest the appropriate medication or treatment to relieve the symptoms.
Consult your doctor if:
- Self-help tips and home remedies do not seem to work for you.
- You have suicidal and self-harming thoughts.
- You feel increasingly sad and hopeless.
- The symptoms are so bad that they aggravate your routine activities.
- The symptoms exist even after the first few days of your periods.
Premenstrual syndrome is a monthly occurrence in the lives of many females during their childbearing years.
Incorporating some lifestyle changes and dietary additions a week before your period, will help diminish the intensity of PMS symptoms and allow you to perform your best even in those difficult days.
Expert Answers (Q&A)
Answered By Dr. Shalanda Webb, MD (Obstetrics and Gynecologist)
According to the American College of Obstetrics and Gynecology (ACOG), premenstrual syndrome (PMS) is characterized by physical or mood changes in women a few days before their period starts.
PMS diagnosis must occur monthly for at least 3 months. The symptoms of PMS are repetitive and affect 12% of women.
Depending on the clinician and/or resource you use, PMS is used to describe a collection of symptoms occurring prior and immediately after your menses.
PMS symptoms normally occur for several days to 2 weeks before your menses (period). The patient generally gets relief once her period starts.
The timing varies with everyone. Other medical conditions, such endometriosis stress, etc., affect how long and severity of symptoms.
PMS and PMT are the same. PMT is a term that was used by World Health Organization (WHO) in the past.
PMS prevalence is not related to age. Age has no relationship to PMS even in menopause.
Perimenopausal women report symptoms consistent in their 20-30s (bloating, breast tenderness, mood swings, etc.).
Postmenopausal women symptoms generally are weight gain and mood swings. The severity is dependent on multiple factors regardless of age.
Depending on the severity, PMS can be treated conservatively or with medical management. However more research is needed to prove the efficacy of the natural supplements as a treatment option.
Lifestyle changes can improve symptoms. Exercising 30 minutes including walking, running, swimming, yoga, meditation, and relaxation techniques have proven to lessen symptoms.
Eating complex carbohydrates such as whole grains help improve cravings and mood swings. Bloating can be improved by reducing salt and sugar. Limiting caffeine and alcohol intake may reduce symptoms.
Medically managed PMS includes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and Midol. These should be used with caution and discussed with your primary care provider or gynecologist.
Some people with more moderate to severe symptoms may need prescribed medication like birth control pills or high dose NSAIDs. I recommend talking to your doctor for either of these methods.
Premenstrual dysphoric disorder (PMDD) is a severe type of PMS. According to multiple studies, 5–8% of women have been found to be suffering from severe PMS that affects the quality of life.
Some women may further have the premenstrual dysphoric disorder (PMDD). Both PMS and PMDD have physical and emotional symptoms. PMDD symptoms are more extreme and cause mood to change dramatically.
The physical or emotional symptoms generally affect your work, social life, and everyday functions. PMDD risk may be higher if you have a history of anxiety, depression, and other behavioral issues.
Patients suffering from PMS should consult their primary care physician or gynecologist.
Their clinician needs to ensure that their symptoms are consistent with PMS and not another disease (endometriosis, PID, etc.).
People who suffer moderate to severe emotional distress may benefit from anti-depressants or anti-anxiety medication.
About Dr. Shalanda Webb, MD: Dr. Webb is a Board-Certified Obstetrics and Gynecologist and has almost 10 years of experience treating patients.
She also served as a Clinical Professor at Michigan State School of Medicine. Her area of interest includes minimally invasive surgeries. She currently resides in Maryland and practices throughout Maryland, DC, and Virginia.