PMS symptoms and how to manage them

Leading consultant gynaecologist Mr Narendra Pisal at London Gynaecology clinic delves into the causes of pre-menstrual tension (PMT), also known as pre-menstrual syndrome (PMS).

How do PMS symptoms affect quality of life?

With PMS, the symptoms often start with ovulation and increase during the second half of the cycle. Symptoms improve when the period begins, plus there often is a symptom-free week (or two weeks) during and after the period. During the premenstrual two weeks phase, most women get some symptoms. Around 20 to 30 per cent of women will experience PMS symptoms that are significant. The symptoms, which can be physical and psychological, can be severe enough to affect your well-being, quality of life, performance at work and relationship.

How long do PMT symptoms last?

PMS symptoms can start right from teenage years and can continue right through to menopause. There’s a connection between intensity of period symptoms (heaviness and pain) and PMS. Women with endometriosis also tend to have more PMS related symptoms. In our clinic, we have seen women in their early 20s with these symptoms and also women in the perimenopause, so the spectrum can be quite varied.

What causes PMS symptoms?

What’s often responsible for symptoms is the balance between oestrogen and progesterone. After ovulation (which tends to occur midcycle) oestrogen level goes down and progesterone level starts rising. This imbalance then gives rise to PMS symptoms. Before making a diagnosis, it is important to keep a symptom diary and establish a firm correlation between menstrual cycle and symptoms.

PMS symptoms include physical symptoms such as breast tenderness, tiredness, bloating, headaches, hot flushes and sleep disturbances. Psychological symptoms can include anxiety, low mood, sometimes sadness or depression with mood swings and irritability. Some women describe feeling ‘foggy’ with inability to make decisions. All these symptoms can make life a bit difficult to navigate.  

Why do some people experience more PMS symptoms than others?

We don’t know why some people have more symptoms in comparison to other people. It may be to do with sensitivity to some of the ovarian hormones and also the level of fluctuation of hormone levels.

How can you manage PMT symptoms?

One of the most common ways of over-riding ovarian hormone fluctuations is using the combined contraceptive pill. It’s often useful in reducing (and sometimes completely eliminating) symptoms of PMS. Vitamin B-6 (pyridoxine) and herbal supplements like ‘evening primrose oil’ tablets are also helpful. It’s also advised by nutritional experts to cut out caffeine, sugar and dairy. Other stress-reducing strategies such as yoga, exercise and avoiding stressful situations at work and home will also help. It’s useful to be aware of when symptoms may arise, and surround yourself with supportive family and colleagues.

Arrange a consultation with Mr Pisal via his Top Doctors profile.