Premenstrual syndrome

Premenstrual syndrome is a set of physical and psychological symptoms that start anywhere from a few days to two weeks before a woman gets her monthly period (menstruation).

Many women experience breast tenderness and abdominal pain, for instance. Other symptoms include headaches, back pain and joint or muscle ache. Water retention, sleep problems or digestion problems, skin blemishes and food cravings may occur too.

Women who have PMS often feel exhausted, insecure, down, listless, irritable or angry in the days leading up to their period. Some have problems concentrating and experience mood swings. They might feel like they are losing control over their body and emotions. Severe PMS can really affect your everyday life and your relationships with friends, family, partners and colleagues.

PMS that is so bad that it significantly affects mental health – leading to things like depression or anxiety – is known as premenstrual dysphoric disorder (PMDD).

The causes of PMS are not completely clear. But it is thought that hormonal fluctuations during a woman’s monthly cycle play a role. Although women who have PMS don’t necessarily have abnormal hormone levels, they might react particularly sensitively to the substances that are produced when progesterone is broken down. This hormone is mainly released in the second half of the menstrual cycle, before the woman’s period starts.

It is also thought that progesterone might affect neurotransmitters (chemical messengers) in the brain. Serotonin apparently plays an important role here. Genes and environmental factors probably affect the likelihood of getting PMS too.

Most girls and women have mild PMS every now and then in the time leading up to their period.  But it hardly affects their lives.

About 20 to 40% of all girls and women have several more severe PMS-related problems that clearly affect them.

In 3 to 8% of them, these problems – particularly the psychological problems – are so bad that they are unable to go about their everyday lives. The medical term for this is premenstrual dysphoric disorder (PMDD).

Women get PMS in the second half of their monthly cycle, after ovulation. During this phase of the cycle their body produces more of the hormone progesterone, and less of the female sex hormone estrogen (oestrogen).

When women get their period and a new cycle begins, their PMS starts getting better. It goes away completely by the end of the period at the latest, and can only start again after the next ovulation.

Some women have PMS during some cycles, but not during others. The severity of PMS can vary greatly from month to month too, and change over the years. But it isn’t possible to predict how PMS will develop over time. The only thing that is certain is that it will stop after menopause.

To be sure that it is PMS, the doctor will ask exactly what symptoms you have and when you have them. He or she will also want to rule out medical conditions that can cause similar symptoms, such as depression, thyroid problems or irritable bowel syndrome.

A diary can help you keep track of the PMS symptoms you experience during the monthly cycle. Ideally, all of the symptoms and related problems should be recorded for at least two to three months.

There isn’t much good research on what can help reduce PMS. So it isn’t clear how effective many of the PMS treatments are.

Girls and women with PMS often try out different things to reduce their symptoms. For instance, some women with mild PMS try out relaxation techniques, acupuncture, getting more exercise, drinking less alcohol and coffee, or eating less salt. Others use herbal products and dietary supplements such as chaste tree extracts (Vitex agnus castus), St. John’s wort, calcium or pyridoxine (vitamin B6).

More severe PMS can be treated with a number of medications. But many of these medications haven’t been approved for the treatment of PMS, and they can have side effects:

• Hormone medications like the birth control pill or hormone patches affect women’s hormone levels and lead to an improvement in PMS or PMDD.
• Antidepressants: SSRIs (selective serotonin reuptake inhibitors) can help reduce severe psychological problems caused by PMS or PMDD.
• Painkillers can effectively relieve severe period pain and are usually well tolerated. There is very little research on whether they also help in PMS, though.
• Women who have problems with PMS-related water retention can take diuretics (water pills).

If PMS causes psychological problems, cognitive behavioral therapy (CBT) is an option. But it isn’t clear whether it helps in PMS.

Many women who have PMS try to take it easy on the days leading up to their period, and make a conscious effort to take more breaks and relax more – for instance, by having a hot bath, going on a walk, or spending a quiet evening curled up on the sofa with a book or watching TV.

Some find that talking to their partner or family about their PMS leads to more understanding, consideration and support.

But they might be afraid to say that they have PMS in case people stop taking them seriously when they are irritable or angry, and put it down to PMS instead. Some also have a hard time because of prejudiced views that women are irrational and unpredictable at certain times of the month due to their hormones.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your visit to the doctor.