10 questions about PMS (premenstrual syndrome)
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So what are the symptoms, tests and treatments for PMS? Get the lowdown here in our 10 questions about PMS.
1. What is PMS?
PMS (also know as PMT, or premenstrual tension) describes all the symptoms that occur regularly in some women before their period. These symptoms most often appear a few days before a period starts, but can sometimes occur as early as the middle of the menstrual cycle. The symptoms vary in nature and intensity, depending on each woman.
2. What happens during PMS?
Three symptoms occur particularly frequently: sore breasts, bloating and mental-emotional tension. However, there can be a number of other symptoms such as heavy legs, headaches or migraines and digestive problems... In total, more than 100 clinical manifestations have been reported as part of PMS.
3. Do you need any specific medical tests to diagnose PMS?
No. Diagnosis is made simply through the regular recurrence of symptoms during the premenstrual phase. The woman herself is able to recognise these symptoms and when they occur in her cycle. Checking hormone levels gives no specific indications. The three major features of PMS are:
One or more emotional symptom (irritability, unhappiness etc….)
Symptoms appear shortly before the period is due
Symptoms are severe enough to disrupt the woman’s daily life
4. Are there any risks of an error in the diagnosis of PMS?
Yes, as some illnesses such as asthma, epilepsy, migraines and depression can be exacerbated or show up during the premenstrual phase. They are considered to be menstruation-related in these cases. These illnesses require medical investigation and should be treated as such. Usual treatments for premenstrual syndrome can sometimes be beneficial.
5. Isn’t PMS just a psychological problem?
Yes and no. No, because PMS is linked to hormonal changes which take place at the end of the menstrual cycle. Yes, because the extent of these symptoms and their repercussions are often regulated by a woman’s mental and emotional state. These mental and emotional symptoms can often be a big issue.
6. Is PMS a serious disorder?
No, if you only take the risk of physical complications into consideration. However, the monthly occurrence of sometimes very distressing symptoms, leading in the most severe cases to having to stop usual activities, can be considerably detrimental to quality of life - work and relationships.
7. How many women suffer from PMS?
Eight out of ten women feel changes and discomfort before their period, 20 to 50% are bothered by these changes; but only 2 to 5% suffer from significant premenstrual syndrome that regularly disrupts their lives.
8. Is there recommended lifestyle advice to either prevent or minimise PMS?
The American College of Obstetricians and Gynaecologists gives specific recommendations for the premenstrual phase, including:
Physical exercise;
Avoiding alcohol or stimulants such as tea or coffee;
Reducing intake of sugar, salt and saturated fats;
Taking calcium, magnesium and vitamin E supplements.
However, it’s difficult to prove how effective these measures are. It’s also important to note that PMS symptoms are known to respond well to placebo treatment. See below for more in Combatting PMS with food
9. Could hormone treatment help in PMS?
The contraceptive Pill is often prescribed to treat PMS, as are local or oral progestin treatments. However, the effectiveness of these hormone treatments remains controversial.
10. How can you relieve the symptoms of severe PMS?
In most cases ordinary painkillers, or possibly a short course of tranquilisers if mental and emotional tension is severe, are enough to improve symptoms. A diuretic called spironolactone can also be useful when water retention is a big issue.
Given that PMS appears to be accompanied by changes to serotonin levels (a chemical substance secreted in the brain), anti-depressants that inhibit these changes have recently been proposed for serious forms of PMS with serious mental and emotional symptoms, giving good results.
When symptoms are very incapacitating and don't improve with the measures detailed above, it is possible to try GnRH treatment which inhibits ovarian secretions. However this treatment causes artificial menopause and leads to other significant side effects, and as such would only be prescribed for extremely severe cases of PMS.
Dr Chantal Guéniot
More information:
Combatting PMS with food
Premenstrual syndrome
Couples discussions
