Premenstrual syndrome (PMS)

There are various physical and emotional symptoms associated with PMS. They can also vary from month to month and are sometimes so severe that they affect the daily lives of women. Symptoms usually peak two days before menstruation and disappear within four days of menstruation. Symptoms might include:

Physical Symptoms

• Change in appetite
• Weight gain
• Back pain
• Headache
• Swelling and tenderness of breasts
• Constipation
• Tiredness
• Pain in the genital area (dyspareunia)
• Nausea
• Diarrhea
• Bloating
• Migraine
• Drowsiness
• Poor concentration
• Insomnia
• Increased nap-taking
• Swelling of the hands and feet
• Bodyache
• Joint pain
• Lower tolerance for noise or light
• Abdominal pain
• Menstrual cramps

Worried about what’s to come after PMS? Here are 6 effective ways to manage period pain. Read to know.

Emotional Symptoms

• Crying
• Mood swings
• Irritability
• Anger
• Feelings of tension
• Disinterest in daily activities
• Fatigue
• Feeling overwhelmed or out of control

In some women with PMS, severe, debilitating symptoms occur which can affect daily routine activities, known as premenstrual dysphoric disorder (PMDD). It causes extreme mood shifts such as:

• Severe depression
• Panic attacks
• Feelings of hopelessness
• Low self-esteem
• Anger and irritability
• Crying spells
• Suicidal thoughts

Did you know? Symptoms of PMS are very similar to the symptoms of early pregnancy. Listen to our experts explain PMS better. Watch this video now.

The exact cause of PMS is not known. Hormone fluctuations may play a role in the development of PMS symptoms. Some women react more strongly to these fluctuations than others, which can be linked to genetic factors or chemicals released in the brain. The following hormonal changes may contribute to PMS:

• Estrogen: Fluctuations in estrogen levels can cause mood swings. Studies suggest that decreased estrogen levels may stimulate common PMS symptoms such as insomnia, fatigue, and depression.
• Progesterone: PMS is also influenced by progesterone. Low levels or a rapid decline in progesterone during the second half of the menstrual cycle can lead to PMS symptoms.
• Serotonin: There is an increase in serotonin precursors between days 7 to 11 and 17 to 19 of the menstrual cycle. This rise in serotonin can cause mood swings, a significant symptom of PMS.
• Prolactin: Women with PMS symptoms often have elevated levels of prolactin, particularly in the premenstrual phase. Studies suggest that high prolactin levels combined with low progesterone levels can lead to anxiety and depression.

Many women have questions about their menstrual cycles, with one of the most common being: Are my periods normal? If you have questions about your periods, get answers here.

Though the exact cause of PMS is still unknown, there are an array of risk factors associated with PMS. They include:

1. Age
   PMS is a condition linked with menstrual cycles, affecting women from menarche (the first occurrence of menstruation) until menopause. It is most commonly observed between the mid-20s and late 30s.
2. Lifestyle Factors
   Various lifestyle factors can increase the chances of PMS.
   • Diet: Excessive intake of sugar, coffee, packaged, and processed foods is associated with an increased risk of PMS.
   • Sedentary Lifestyle: Some studies suggest that a sedentary and inactive lifestyle may contribute to PMS.
   • Poor Sleep Quality: Inadequate and poor-quality sleep predisposes women to PMS.
   • Stress: Stress can exacerbate menstrual pain by stimulating the body’s response.
   • Alcohol Consumption: Moderate alcohol consumption increases the risk of PMS.
3. Hormonal Disorders
   Certain hormonal disorders, such as a deficiency of serotonin—a chemical produced by the brain that aids in digestion, sleep, and mood stabilization—can increase the risk of developing PMS. An increase in the female sex hormone progesterone is also observed in women with PMS symptoms.
4. Family History
   Some studies suggest that women with a family history of depression are at a higher risk of PMS.
5. Medical History
   Women with a personal history of postpartum depression or other mood disorders are at a higher risk of PMS.
6. Certain Vitamin and Mineral Deficiencies
   Low levels of specific vitamins and minerals, particularly magnesium, manganese, vitamin E, and vitamin D, also increase the risk of PMS.

PMS cannot be diagnosed by any specific tests and it is determined through symptoms experienced by the individual. Diagnosis of PMS includes the following:

• Tracking the symptoms: PMS is diagnosed through tracking the duration, onset, and severity of symptoms. Patients are asked to maintain a diary for at least 2 to 3 months. The patient should keep a record of:
• Daily symptoms
• Details of the menstrual cycle
• First and last day of the menstrual period
• Pelvic exam: It is recommended to check for any other gynecological problems.

Emotions are a very basic trait of a human being. Therefore, every mood swing or emotional symptom may not be associated with PMS; it can be part of your behavior as well. To avoid this confusion, symptoms should be discussed with a doctor.

PMS is not life-threatening, but it can impact overall productivity and health. The following Do’s and Don'ts are helpful in preventing PMS:

Do’s

• Drink plenty of water and fluids, such as coconut water, fruit juices, soups, and herbal teas to ease abdominal bloating.
• Eat a well-balanced diet containing whole grains, fruits, vegetables, good fats, and protein.
• Consume nutritional supplements such as calcium, magnesium, omega-3 and omega-6 fatty acids, and Vitamin B complex, if required. Consult your doctor before taking these supplements.
• Engage in light, regular exercises, yoga, aerobics, swimming, or jogging for at least 30 minutes a day for physical fitness and overall well-being.
• Get sufficient sleep. Aim for around 8 hours of sound sleep, especially during the premenstrual period, to prevent and reduce PMS symptoms.
• Bask in the morning sun. Try to get sufficient Vitamin D via natural sunlight; diet or supplements can also help cover any deficiency.
• Learn healthy ways to cope with stress. Take a walk in nature, talk to friends, or write in a journal. Deep breathing exercises, massage, or meditation can also be beneficial.
• Consult a doctor if general care at home is not relieving symptoms. Sometimes, your doctor can advise medications to help manage the symptoms.

Don'ts

• Do not smoke. Women who smoke report more severe PMS symptoms than those who do not.
• Do not consume excessive alcohol. Too much alcohol can exacerbate PMS symptoms and worsen cramps.
• Do not include excessive salt or salty foods in your diet, as they can cause bloating and fluid retention.
• Do not overindulge in sugar, packaged, ultra-processed foods, and caffeine, as they can worsen PMS symptoms.
• A few studies have shown that aligning your waking and sleep times with sunrise and sunset can help manage PMS.

While mild symptoms can be managed with conservative treatment options including home care remedies, regular exercise, relaxation techniques, and vitamin and mineral supplementation, severe symptoms require medical intervention. Various treatment options include:

Medications

• Painkillers: They help in easing the pain associated with PMS and periods. Common medications include:
  • Ibuprofen
  • Naproxen
  • Aspirin
• Antidepressants: Antidepressants are prescribed to alleviate emotional symptoms. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. These include:
  • Fluoxetine
  • Sertraline
  • Paroxetine
  • Escitalopram

  Note: SSRIs are taken for two consecutive months to assess their effect. In case of therapy failure, alternative medication such as Venlafaxine is recommended.

• Birth control pills (oral contraceptives): Hormonal preparations in birth control pills prevent hormonal changes, helping to reduce mood swings. Drugs include:
  • Drospirenone
  • Ethinyl estradiol
• Gonadotropin-releasing hormone agonists: These medications temporarily stop the menstrual cycle by blocking the synthesis of hormones estrogen and progesterone, thereby improving physical symptoms such as bloating. Common examples include:
  • Leuprolide
  • Goserelin
• Diuretics: This class of drugs is used to reduce symptoms associated with fluid retention, such as bloating and breast tenderness. Spironolactone is a common diuretic used in PMS.

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For home care of PMS, adhere to all the pointers mentioned in the ‘Prevention’ section. Additionally, incorporating the following into your diet can help soothe PMS symptoms. Please consult your healthcare provider before starting any of the following:

• Nutritional supplements such as calcium, magnesium, omega-3 and omega-6 fatty acids, Vitamin B complex, and Vitamin D should be consumed in case of specific deficiencies.
• Bridging gaps in your daily diet can help manage PMS symptoms. Explore our wide range of nutritional supplements.
• Turmeric (Haldi): Turmeric helps alleviate stomach cramps due to its anti-inflammatory effect.
• Fennel (Saunf): Fennel reduces bloating due to its diuretic effect and is also found to relieve stomach cramps.
• Chamomile: This herb has antispasmodic, analgesic, and anti-inflammatory properties. Its tea relaxes the muscles of the uterus and helps relieve cramps.
• Chasteberry extract: This herb is used to manage various hormonal disorders and relieve PMS symptoms such as breast tenderness and hot flashes. It reduces the release of prolactin, a contributing factor in PMS.
• St. John’s wort: This herb is used to control behavioral symptoms associated with PMS.
• Ginkgo biloba: A well-known herb used in Traditional Chinese Medicine, some studies suggest its role in reducing the severity of PMS symptoms.

PMS can aggravate several clinical conditions such as:

• migraine
• mood disorders
• asthma
• epilepsy
• multiple sclerosis
• systemic lupus erythematosus (SLE)
• inflammatory bowel disease
• irritable bowel syndrome

Untreated PMS can also disturb sexual life, leading to relationship issues and psychological distress. Other complications of PMS include:

• Premenstrual Dysphoric Disorder (PMDD): The most severe form of PMS, characterized by intense mood swings, anger, irritability, and anxiety.
• Depression: Intense symptoms of PMS can also lead to depression.
• Substance abuse: Increased cravings for substances such as alcohol, drugs, and nicotine are observed during PMS.

Along with the general treatment, there are a few complementary therapies that have proven to be beneficial. They include:

• Cognitive and Behavioral Therapy (CBT): This therapy is effective in managing moderate to severe physical and emotional symptoms. Psychotherapists conduct sessions to normalize the individual's thoughts and behavior, focusing on memory and judgment to improve overall feelings, mood, and behavior.
• Acupuncture: An ancient technique used in China and Japan, acupuncture involves inserting fine metal needles into the skin at specific points to alleviate PMS symptoms. Sometimes, needles are stimulated by electricity, known as electro-acupuncture.
• Acupressure: This technique stimulates specific points on the body using fingers or thumbs instead of needles and can be performed by the individual themselves.
• Relaxation Response: This technique is designed to reduce stress through methods such as quiet sitting, progressive muscle relaxation, and the repetition of a specific word during inhalation and exhalation. Practicing for 10-20 minutes daily can provide emotional stability.
• Light Therapy: Exposure to light is crucial for improving mood-related symptoms. During light therapy, individuals are exposed to artificial light that mimics natural light, stimulating the release of serotonin and elevating mood. Women who are consistently exposed to bright light show a reduction in symptoms such as depression.
• Massage Therapy: Massage helps reduce cramps by relaxing the nervous system. Studies suggest that regular massages can alleviate mood swings and pain.
• Biofeedback: This technique records individuals' responses, such as heart rate, muscle tension, and brain activity, after stimulation. It helps alleviate physical and emotional symptoms by analyzing triggers.
• Homeopathy: Several homeopathic medicines are used to calm PMS symptoms, including sepia, Ignatia, pulsatilla, and Lachesis.

PMS is not a life-threatening condition, but it can take a toll on both the body and mind. PMS can be effectively managed with certain lifestyle modifications.

The physical and emotional symptoms experienced by women during PMS can negatively impact relationships. Emotional support from family, friends, and colleagues is essential for coping with PMS symptoms. The following measures can help maintain good relationships:

• Communicate: Effective communication, especially from partners, helps reduce the stress experienced by women during this period.
• Give space: Sometimes, women need emotional and physical space to tackle PMS symptoms.
• Help: Family members can ease the burden on those with PMS by assisting with routine tasks, such as household chores.

Note: The symptoms of PMS vary from woman to woman, making it important to keep a record of the timing and types of symptoms. This can help analyze triggers that may lessen the symptoms.

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