Some women experience severe symptoms in the days leading up to their period. Find out more about PMS and how it can be treated.

Many women experience a few uncomfortable symptoms in the days leading up to their periods. Normally these are fairly easy to cope with. However, if you are having symptoms that are severe enough to interfere with your daily life and prevent you from doing the things you normally do, you have PMS – premenstrual syndrome. While PMS is common, it can take a toll on you, as physical and emotional symptoms of PMS can be challenging to manage. Leading a healthy lifestyle, and working with your doctor to manage your symptoms can dramatically improve PMS.

What is PMS?

Most women experience some symptoms in the days before their period starts. Most commonly these include tender breasts, changes in bowel habits and menstrual cramps, and you may be a little moody. Usually these symptoms are mild and can be eased with dietary modification, perhaps a warm pack, and over the counter pain relievers. If your symptoms are severe, or are affecting your usual activities, you may have Premenstrual Syndrome (PMS). It is important to see your doctor if you suspect you may have PMS. PMS is related to the hormonal changes that happen in the days leading up to your period. PMS can affect your body, your mood, and your behaviour.

What are the symptoms of PMS?

Physical symptoms:

  • Tender breasts
  • Bloating, fluid retention
  • Muscle aches
  • Joint pain
  • Headaches
  • Abdominal cramps
  • Diarrhea or constipation
  • Lower back pain
  • Hot flashes
  • Trouble sleeping
  • Sleeping too much
  • Low energy, fatigue
  • Low sex drive
  • Changes in appetite
  • Food cravings – sweet, salty

Mood and behaviour-related symptoms:

  • Irritability
  • Anxiety
  • Difficulty focusing
  • Sadness
  • Crying spells
  • Anger
  • Not wanting to talk to anyone

What causes PMS?

Your period is controlled and regulated by a complex orchestra of hormones, secreted by your pituitary gland, hypothalamus, and ovaries. These hormones also interact with the hormones that regulate mood in the brain, and can have effects on many of your bodily functions, contributing to the uncomfortable symptoms of PMS. Your brain chemistry changes in response to different hormone levels. For example fluctuations in the mood-related neurotransmitter serotonin can cause changes in mood and sleep. However, there are many other factors at play, and it isn’t clear why some women have very severe premenstrual symptoms and others do not.

How is PMS diagnosed?

To diagnose PMS it is important to keep a symptom diary .

The symptom diary will enable your doctor to not only identify the typical pattern of PMS, it will also help to determine the type of PMS symptoms – there is more than one type. PMS symptoms occur in the latter half of the menstrual cycle, resolve within a few days of the onset of menstruation, and do not return until the second half of the next cycle.

Women who are suffering with other mental health disorders may notice symptoms throughout the month, but that some symptoms worsen premenstrually. Keeping a symptoms diary will help to sort these out.

How can you manage PMS?

Leading a healthy lifestyle can make a big difference in how your body reacts to menstruation. Your symptoms may improve if you eat a healthy diet, exercise regularly, and cut down on caffeine, alcohol, and salt. A healthy diet means eating more vegetables, fruit, whole grains, dairy, seafood, legumes and nuts, and less red and processed meats, less sugary drinks and fewer refined grain products (white bread and rice/cookies/donuts/cakes etc.). Many women experience cravings for sugar pre-menstrually. Avoid those cravings by eating regular balanced meals with snacks, avoiding sweet foods and choosing foods with low glycemic index.

In addition to taking note which days of the month are more symptomatic, take note of the time of day. Many women find late afternoon difficult. This may be a time when you yourself are tired and hungry. Planning a balanced snack before you become symptomatic, or a rest, a walk or other restorative activity may help. Advanced planning and understanding your own personal needs may make all the difference.

The hormones of the second half of the menstrual cycle can cause many women to have constipation, and around the time of the period, diarrhea. Having plenty of fibre and fluid in your diet will help with these symptoms.

Getting enough sleep and doing what you can to reduce stress can also help alleviate some of the mood and behaviour-related symptoms. Pain symptoms can be treated with ibuprofen. Some women require prescription medications to help cope with either physical or mood-related symptoms.

When should I talk to my doctor about PMS symptoms?

If a healthy lifestyle and over-the-counter pain relief medications are not enough to prevent PMS from disrupting your daily life, it’s a good idea to talk to your doctor. Birth control pills or other hormonal birth control methods (e.g., the patch, shot, vaginal ring, or IUD) can help provide some relief. There are medications available that can treat various physical and mental symptoms, such as selective serotonin reuptake inhibitors (SSRIs), diuretics, or nonsteroidal anti-inflammatory drugs. It will be helpful to your doctor if you bring your symptom diary, tracking your symptoms and bleeding for 2-3 cycles (see this ‘menstrual diary‘ ).

What is premenstrual dysphoric disorder?

Premenstrual dysphoric disorder (PMDD) is a rare, very severe form of PMS where women experience severe disruptions in mood (depression, irritability, anxiety) prior to menstruation. There are several options for treatment of PMDD, including medications like antidepressants or birth control pills, and cognitive behavioural therapy.

If you are having thoughts of suicide, phone 911 or a local crisis line.