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Introduction
In the days leading up to their period, many women experience abdominal pain or a headache, are sad and irritable or feel bloated and generally uncomfortable. The medical term for this is “premenstrual syndrome” (PMS), also known as “premenstrual tension” (PMT). PMS symptoms are usually not very severe, and most women cope well with them. But in some women it is so bad that they are unable to go about their everyday lives during that time. Various treatments and measures can help to relieve PMS.
At a glance
- In the days leading up to their period, many women experience abdominal pain, breast tenderness or mood swings.
- The medical term for this is “premenstrual syndrome” (PMS).
- PMS symptoms are usually not very severe, and most women cope well with them.
- Various treatments and measures can help to relieve PMS if the symptoms are more severe.
Symptoms
Premenstrual syndrome is a set of physical and psychological symptoms that start anywhere from a few days to two weeks before a woman gets her monthly period (menstruation).
Many women experience breast tenderness and abdominal pain, for instance. Other symptoms include headaches, back pain and joint or muscle ache. Water retention, sleep problems or digestion problems, skin blemishes and food cravings may occur too.
Women who have PMS often feel exhausted, insecure, down, listless, irritable or angry in the days leading up to their period. Some have problems concentrating and experience mood swings. They might feel like they are losing control over their body and emotions. Severe PMS can really affect your everyday life and your relationships with friends, family, partners and colleagues.
PMS that is so bad that it significantly affects mental health – leading to things like depression or anxiety – is known as premenstrual dysphoric disorder (PMDD).
Causes
The causes of PMS are not completely clear. But it is thought that hormonal fluctuations during a woman’s monthly cycle play a role. Although women who have PMS don’t necessarily have abnormal hormone levels, they might react particularly sensitively to the substances that are produced when progesterone is broken down. This hormone is mainly released in the second half of the menstrual cycle, before the woman’s period starts.
It is also thought that progesterone might affect neurotransmitters (chemical messengers) in the brain. Serotonin apparently plays an important role here. Genes and environmental factors probably affect the likelihood of getting PMS too.
Prevalence
Most girls and women have mild PMS every now and then in the time leading up to their period. But it hardly affects their lives.
About 20 to 40% of all girls and women have several more severe PMS-related problems that clearly affect them.
In 3 to 8% of them, these problems – particularly the psychological problems – are so bad that they are unable to go about their everyday lives. The medical term for this is premenstrual dysphoric disorder (PMDD).
Outlook
Women get PMS in the second half of their monthly cycle, after ovulation. During this phase of the cycle their body produces more of the hormone progesterone, and less of the female sex hormone estrogen (oestrogen).
When women get their period and a new cycle begins, their PMS starts getting better. It goes away completely by the end of the period at the latest, and can only start again after the next ovulation.
Some women have PMS during some cycles, but not during others. The severity of PMS can vary greatly from month to month too, and change over the years. But it isn’t possible to predict how PMS will develop over time. The only thing that is certain is that it will stop after menopause.
Diagnosis
To be sure that it is PMS, the doctor will ask exactly what symptoms you have and when you have them. He or she will also want to rule out medical conditions that can cause similar symptoms, such as depression, thyroid problems or irritable bowel syndrome.
A diary can help you keep track of the PMS symptoms you experience during the monthly cycle. Ideally, all of the symptoms and related problems should be recorded for at least two to three months.
Treatment
There isn’t much good research on what can help reduce PMS. So it isn’t clear how effective many of the PMS treatments are.
Girls and women with PMS often try out different things to reduce their symptoms. For instance, some women with mild PMS try out relaxation techniques, acupuncture, getting more exercise, drinking less alcohol and coffee, or eating less salt. Others use herbal products and dietary supplements such as chaste tree extracts (Vitex agnus castus), St. John’s wort, calcium or pyridoxine (vitamin B6).
More severe PMS can be treated with a number of medications. But many of these medications haven’t been approved for the treatment of PMS, and they can have side effects:
- Hormone medications like the birth control pill or hormone patches affect women’s hormone levels and lead to an improvement in PMS or PMDD.
- Antidepressants: SSRIs (selective serotonin reuptake inhibitors) can help reduce severe psychological problems caused by PMS or PMDD.
- Painkillers can effectively relieve severe period pain and are usually well tolerated. There is very little research on whether they also help in PMS, though.
- Women who have problems with PMS-related water retention can take diuretics (water pills).
If PMS causes psychological problems, cognitive behavioral therapy (CBT) is an option. But it isn’t clear whether it helps in PMS.
Everyday life
Many women who have PMS try to take it easy on the days leading up to their period, and make a conscious effort to take more breaks and relax more – for instance, by having a hot bath, going on a walk, or spending a quiet evening curled up on the sofa with a book or watching TV.
Some find that talking to their partner or family about their PMS leads to more understanding, consideration and support.
But they might be afraid to say that they have PMS in case people stop taking them seriously when they are irritable or angry, and put it down to PMS instead. Some also have a hard time because of prejudiced views that women are irrational and unpredictable at certain times of the month due to their hormones.
Further information
When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your visit to the doctor.
Sources
- Beckermann MJ. Das prämenstruelle Syndrom - ein Konstrukt? In: Beckermann MJ, Perl FM (Ed). Frauen-Heilkunde und Geburts-Hilfe. Band 1. Basel: Schwabe; 2004. S. 502-527.
- Busse JW, Montori VM, Krasnik C et al. Psychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials. Psychother Psychosom 2009; 78(1): 6-15. [PubMed: 18852497]
- Canning S, Waterman M, Dye L. Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy. J Reprod Infant Psychol 2006; 24(4): 363-378.
- Dante G, Facchinetti F. Herbal treatments for alleviating premenstrual symptoms: a systematic review. J Psychosom Obstet Gynaecol 2011; 32(1): 42-51. [PubMed: 21171936]
- Dennerstein L, Lehert P, Heinemann K. Global epidemiological study of variation of premenstrual symptoms with age and sociodemographic factors. Menopause Int 2011; 17(3): 96-101. [PubMed: 21903713]
- Ford O, Lethaby A, Roberts H et al. Progesterone for premenstrual syndrome. Cochrane Database Syst Rev 2012; (3): CD003415. [PMC free article: PMC7154383] [PubMed: 22419287]
- Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid 2015: 0806. [PMC free article: PMC4548199] [PubMed: 26303988]
- Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev 2012; (2): CD006586. [PubMed: 22336820]
- Marjoribanks J, Brown J, O'Brien PM et al. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev 2013; (6): CD001396. [PMC free article: PMC7073417] [PubMed: 23744611]
- Mooney-Somers J, Perz J, Ussher JM. A complex negotiation: women's experiences of naming and not naming premenstrual distress in couple relationships. Women Health 2008; 47(3): 57-77. [PubMed: 18714712]
- O'Brien PM, Bäckström T, Brown C et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14(1): 13-21. [PMC free article: PMC4134928] [PubMed: 21225438]
- Sveinsdóttir H, Lundman B, Norberg A. Whose voice? Whose experiences? Women's qualitative accounts of general and private discussion of premenstrual syndrome. Scand J Caring Sci 2002; 16(4): 414-423. [PubMed: 12445112]
- Van Die MD, Burger HG, Teede HJ et al. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med 2013; 79(7): 562-575. [PubMed: 23136064]
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
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- Overview: Premenstrual syndrome - InformedHealth.orgOverview: Premenstrual syndrome - InformedHealth.org
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