Premenstrual Syndrome

Premenstrual syndrome (PMS) is a prevalent condition experienced by numerous women, typically occurring one to two weeks before their menstrual period. The symptoms can range from mild to severe and often disappear shortly after the period begins. 

A more severe form of PMS, known as premenstrual dysphoric disorder (PMDD), affects a small percentage of women and is characterised by intense emotional symptoms.

 In this article, we will explore what PMS is, its symptoms, and the differences between PMS and premenstrual dysphoric disorder (PMDD).

What is Premenstrual Syndrome?

Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that occur in the days leading up to menstruation. These symptoms can vary in severity and may include mood swings, breast tenderness, bloating, and fatigue. 

While the exact cause of PMS is unknown, hormonal fluctuations and chemical changes in the brain are thought to play a role (Gudipally & Sharma, 2023).

It is important to note that PMS is different from premenstrual dysphoric disorder (PMDD), which is a more severe form of PMS. PMDD symptoms can significantly disrupt daily activities and may include severe mood swings, breast swelling, and joint pain. 

Understanding the symptoms and available treatment options for PMS and PMDD is crucial for managing these conditions effectively.

Some of the early signs and symptoms of PMS include:

• Breast swelling and tenderness
• Abdominal bloating and fluid retention
• Acne flare-ups
• Headaches and migraines
• Joint and muscle pain
• Constipation or diarrhoea
• Changes in appetite
• Irritability and mood swings
• Depression and anxiety
• Insomnia or oversleeping
• Changes in sexual interest
• Difficulty concentrating
• Crying spells

If you experience a combination of these symptoms consistently before your menstrual period, it may indicate that you have PMS.

The symptoms of Premenstrual Syndrome can vary from woman to woman, but some of the most common symptoms include: (NHS, 2025)

• Bloating: A common symptom of PMS, causing abdominal discomfort and a feeling of fullness or swelling.
• Breast tenderness: Many individuals experience breast tenderness, which can result in increased sensitivity or pain in the breasts.
• Headaches: Headaches frequently occur during PMS, often linked to hormonal changes that affect neurotransmitter levels in the brain.
• Fatigue: Another prevalent symptom, leading to decreased energy levels and difficulty in performing daily activities.
• Gastrointestinal issues: Gastrointestinal problems, such as constipation or diarrhoea, may also arise during this time, affecting digestive comfort.
• Mood swings: A notable symptom, leading to rapid changes in emotional state and increased irritability.
• Anxiety: Feelings of anxiety can intensify before menstruation, causing heightened worry or tension.
• Sadness: Many individuals experience feelings of sadness or depression, which can be more pronounced in the days leading up to their period.
• Difficulty concentrating: Difficulty concentrating is common during PMS, making it challenging to focus on tasks or maintain attention.
• Changes in appetite: Appetite changes may occur, with some experiencing increased cravings for certain foods, while others may have reduced desire to eat.

Some specific factors that may contribute to the development of PMS include:

• Hormonal changes: Fluctuations in oestrogen and progesterone levels throughout the menstrual cycle may contribute to PMS symptoms. These hormonal changes can affect brain neurotransmitters, leading to mood disturbances and other symptoms.
• Brain chemicals: Serotonin, a neurotransmitter that regulates mood, appetite, and sleep, may also play a role in the development of PMS symptoms. Low levels of serotonin have been linked to depression, anxiety, and other mood disorders, which are common PMDD symptoms.
• Individual sensitivity: Some women may be more sensitive to hormonal changes, leading to more severe PMS or PMDD symptoms. This sensitivity may be due to genetic factors or other underlying health conditions.
• Stress and lifestyle factors: High levels of stress, lack of exercise, and an unhealthy diet may worsen PMS symptoms.

Although Premenstrual Syndrome cannot be completely prevented, there are several strategies that women can use to manage and reduce their symptoms. These include:

• Exercise: Engaging in regular exercise, such as brisk walking or yoga, can alleviate physical and emotional symptoms of PMS.
• Balanced diet: A diet rich in fruits, vegetables, whole grains, and lean proteins can help reduce bloating and improve mood, while limiting processed foods, caffeine, and alcohol.
• Adequate sleep: Ensuring sufficient sleep is crucial for overall well-being and can help manage PMS symptoms.
• Stress reduction techniques: Practising stress-reduction techniques, such as meditation or deep breathing exercises, can help alleviate emotional symptoms.
• Medications: For mild to moderate PMS, over-the-counter pain relievers like ibuprofen or acetaminophen can provide relief. Diuretics may assist with fluid retention. In more severe cases, prescription medications like selective serotonin reuptake inhibitors (SSRIs) or hormonal birth control can be effective.
• Complementary therapies: Some women may find relief through complementary therapies, such as acupuncture, herbal remedies, or vitamin supplements. It’s important to discuss these options with a doctor to avoid potential drug interactions with medications.

Diagnosing premenstrual syndrome typically involves a comprehensive evaluation by a doctor to rule out other conditions and confirm the diagnosis. This includes:

• Medical history: The doctor will begin by taking a detailed medical history, including information about menstrual cycles, symptoms, and their severity. This helps identify whether symptoms align with PMS criteria.
• Symptom tracking: Patients may be encouraged to keep a symptom diary over a few menstrual cycles. This diary should note the timing, duration, and intensity of symptoms, as well as any impact on daily activities. Tracking symptoms can help confirm the diagnosis and assess severity.
• Physical examination: A physical exam may be conducted to check for any underlying health issues that could mimic PMS symptoms. This may include evaluating vital signs and general health.
• Laboratory tests: In some cases, blood tests may be ordered to rule out other medical conditions, like thyroid disorders or hormonal imbalances. These tests help ensure that the symptoms are not related to other health issues.

Treatment for premenstrual syndrome often involves a combination of lifestyle modifications, medications, and complementary therapies. These include:

1. Pain and Inflammation Relief Medications 

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen help alleviate menstrual cramps, headaches, and general body pain associated with PMS.

2. Hormonal Regulation Medications 

Combined oral contraceptives (particularly those containing drospirenone) may help regulate hormonal fluctuations and reduce PMS/PMDD symptoms.

3. Mood Stabilisers

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, citalopram, and escitalopram are prescribed for severe PMS or premenstrual dysphoric disorder (PMDD) to stabilise mood and reduce anxiety and depression.

4. Fluid Retention Medications

Diuretics like furosemide, chlorthalidone, and hydrochlorothiazide help reduce bloating and swelling by eliminating excess fluid from the body.

5. Nutritional Supplements

Supplements including calcium, magnesium, vitamin B6, and omega-3 fatty acids have been shown to alleviate PMS symptoms by supporting hormonal balance, reducing fatigue, and improving mood stability.

Living with premenstrual syndrome can be challenging, but several strategies can help manage the symptoms and minimise their impact on daily life. Here are some key pointers to consider:

• Track your symptoms by recording them daily for at least 2-3 months, along with the dates of your periods. This can help identify patterns and assist in diagnosis.
• Engage in regular physical activity, maintain a balanced diet, and avoid substances like caffeine and alcohol, which can exacerbate PMS symptoms.
• Stress can worsen PMS symptoms, so practice stress-reducing techniques such as meditation or yoga to help alleviate the impact.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve physical symptoms like pain and bloating.
• If your symptoms are severe and interfere with daily activities, consult an obstetrician-gynaecologist (OB-GYN) who can determine if the symptoms are due to PMS or another underlying condition like premenstrual dysphoric disorder (PMDD).

If you experience PMS symptoms that significantly impact your daily life, it's essential to consult a doctor. Persistent symptoms that don’t improve with lifestyle changes or severe mood swings, depression, or anxiety warrant professional help. 

In some cases, symptoms may indicate premenstrual dysphoric disorder (PMDD), characterised by more intense emotional and behavioural disruptions. If you suspect PMDD, discuss your concerns with a doctor who can evaluate your condition and recommend effective treatment options, such as hormonal medications or cognitive behavioural therapy.

• Premenstrual syndrome (PMS) is a common condition that affects many women, causing a range of physical and emotional symptoms in the days leading up to menstruation.
• Lifestyle modifications, such as regular exercise, a balanced diet, adequate sleep, and stress reduction techniques, can help alleviate PMS symptoms.
• Over-the-counter pain relievers and dietary supplements may provide relief for some individuals, but it is important to consult with a doctor before starting any new medications.
• Keeping a symptom diary can help identify patterns and provide valuable information for doctors in diagnosing and managing PMS.
• If PMS symptoms are severe, persistent, or significantly impacting daily life, it is crucial to seek medical advice for proper evaluation and treatment.
• Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that requires professional attention and may benefit from specialised treatments like hormonal medications and cognitive behavioural therapy.