Pregnancy – and motherhood – wouldn’t be possible without that monthly visitor we all know so well, but we definitely could do without those premenstrual symptoms that come knocking on our door like clockwork. We’ve teamed up with the Royal College of Obstetricians and Gynaecologists (RCOG) to bring you trusted medical information, and they’ve recently updated their guidelines on how to best manage those PMS symptoms. So, we’re bringing their latest recommendations directly to you so you can live your best life even when that time of the month rolls around. Here are their guidelines:
Let’s start with the basics: What is PMS?
PMS is the name given to the physical and emotional symptoms affecting your daily life in the 2 weeks before you have your period. These symptoms usually get better once your period starts and often disappear by the end of your period.
Nearly all women have some premenstrual symptoms. Each woman’s symptoms are different, but the most common include:
- Mood swings
- Feeling depressed, irritable or bad-tempered
- Feeling upset, anxious or emotional
- Tiredness or having trouble sleeping
- Changes in appetite and food cravings
- Feeling clumsy
- Fluid retention and feeling bloated
- Changes in skin or hair
- Sore or tender breasts
Symptoms can vary from month to month, although they tend to form a pattern over time.
Between 2 and 4 in 100 women get PMS that is severe enough to prevent them from getting on with their daily lives. A very small number of women get an even more intense form of PMS known as Premenstrual Dysphoric Disorder (PMDD), which is not covered here, but if you do have questions about this you should discuss it with your healthcare professional.
I know that PMS is related to my period, but what actually causes it?
The exact cause of PMS is not known. It could be linked to changes in the levels of your hormones and body chemicals.
The levels of your hormones change during your menstrual cycle. Some women are more sensitive to these hormonal changes, which can lead to the symptoms described. Women who use some forms of hormonal contraception are less affected by PMS. PMS has also been linked to a variety of chemical substances in your blood called neurotransmitters, such as serotonin and gamma-aminobutyric acid (GABA).
How do I know if what I’m experiencing is PMS?
If you are getting regular symptoms, you should write them down in a diary for at least two menstrual cycles in a row. Your healthcare professional will then review your diary with you to see whether your symptoms fit the pattern of PMS.
If your symptom diary alone is not enough for diagnosis, you may be offered treatment with gonadotrophin-releasing hormone (GnRH) analogs for a period of 3 months. This will temporarily stop your ovaries producing hormones, which may help with your diagnosis.
What are my options for managing PMS?
There is a wide range of options to help you manage your symptoms and get on with your busy life! Aside from the usual suspects–ibuprofen, a hot water bottle, and ice cream–here are a few easy things you can try:
- Cut down on your salt intake–and yes, this means avoiding pre-packaged food! There’s a surprising amount of added salt and sugar in processed food, and cooking your own meals at home will automatically cut down on your sodium consumption.
- Reach for full-fat dairy products. Some studies have shown that increasing your calcium and vitamin D can reduce severity of PMS symptoms. We love to reach Greek yogurt for breakfasts and snacks as it’s high in protein, too!
- Keep an eye on your caffeine consumption. PMS can disrupt your sleeping patterns, and excess caffeine consumption won’t help! If you’re a normal tea or coffee drinker, just stick to your usual daily amount… resist the urge to drink an extra cup if you’re feeling lethargic. Trust us, it really does help!
- Eat the chocolate–seriously! Studies have shown that magnesium can act as a treatment for some PMS symptoms, and dark chocolate is an excellent source of this key mineral. The important thing to remember here is dark chocolate (sorry, a Hershey bar won’t do the trick!). Balance out your magnesium consumption by getting it from other sources like spinach, lentils, and almonds.
- Take a walk. Even if you feel lousy, getting in a short bout of cardiovascular exercise–even if it’s just a brisk walk–will make you feel better. Exercise releases endorphins, which will instantly elevate your mood and ease physical discomfort!
- Pump some iron. One study found that women are able to make greater gains in strength and power during the first two weeks of their menstrual cycle–so don’t be afraid to pick up the weights!
- Roll out your mat. Right now is a great time to practice some gentle yoga. You can follow a set routine, or simply stretch out and listen to your body. A few downward-facing dogs and a long rest in child’s pose will help ease muscle soreness and fatigue.
Psychological support for managing PMS:
Cognitive behavioral therapy (CBT) is known to help PMS symptoms and should be offered to you as a treatment option. This involves discussing your symptoms with a therapist. It can help you learn new ways of managing some of your symptoms to reduce their impact on your daily life.
Complementary therapies for managing PMS:
There are several alternative (complementary) therapies for PMS. Many women find these helpful, although there is little evidence to show that they are effective. You should inform your healthcare professional if you are taking any medicine or supplement–this is because some complementary therapies may react with other medicines. Supplements of calcium, Vitamin D, Vitex agnus-castus (a herb known as chaste berry) or Ginkgo biloba may be helpful. Evening primrose oil can reduce breast tenderness.
Medical treatment for PMS:
1. Non-hormonal medical treatment: Two types of antidepressant medications have been shown to help PMS symptoms, namely selective serotonin reuptake inhibitors (SSRIs) and serotonin–noradrenaline reuptake inhibitors (SNRIs).
- Antidepressants should only be prescribed by a healthcare professional. These can be taken on a daily basis for 2 weeks before your period or all the way through your cycle.
- Side effects may include nausea (feeling sick), insomnia (difficulty sleeping), tiredness and low libido (not being interested in having sex).
- SSRIs are recommended as one of the first-choice treatments for severe PMS.
2. Hormonal medical treatment
Combined oral contraceptive pill: Some women find using the combined oral contraceptive pill helps with PMS symptoms. Newer types of contraceptive pills containing a progestogen called drospirenone have been shown to improve PMS symptoms. These are considered as first-choice treatments. You may be advised to take these pills continuously, without a break, for better symptom control.
Estrogen hormone patches or gel: Using estrogen hormone patches or gel can improve the physical and psychological symptoms of PMS.
Note: estrogen hormone patches or gel must be used in combination with a low dose of the hormone progestogen to prevent abnormal thickening of the lining of your womb.
Further information you may find helpful:
PMS is common and many women are affected by its symptoms. Treatment, information, and support are available to enable you to manage your symptoms.
- National Association for Premenstrual Syndrome (NAPS)
- Women’s Health Concern (WHC), the patient arm of the British Menopause Society (BMS):
- NHS Choices – Premenstrual dysphoric disorder (PMDD)
- Mind – Premenstrual dysphoric disorder (PMDD)
- A full list of useful organizations is available on the RCOG website