Managing PMS

Dr Jo Coldron explains how PMS symptoms can affect some women and suggests ways of dealing with them.

Pre-menstrual syndrome (PMS) is common with about half of women experiencing significant cyclical symptoms, and somewhere in the region of 10% of those women have symptoms so severe that they impact significantly on school life, work performance or relationships. However, I have far fewer consultations discussing PMS than these figures would suggest. It’s likely that this is such a ‘normal’ part of being a woman that many of us just feel we should ‘get on with it’. I worry a little however, that some women have been met with either a complete blank from their doctor when they tried to seek medical help, or indeed a wealth of completely contradictory advice and treatments.

The reason for this is that it’s pretty complicated, and it’s true, that for quite a while we have been suggesting treatments that were probably fairly ineffective, and in many cases even made things worse! However, research has been trundling on in the background and we now have, although not a complete understanding of the complexities, at least a relatively robust set of guidelines that we can all work from (RCOG Green Top Guideline No 48, Nov 2016).

So now that there seems to be something that can actually make a difference to around half of us women, let’s talk about PMS! PMS encompasses an array of psychological symptoms such as depression, anxiety, irritability, loss of confidence, low libedo and mood swings. There are also physical symptoms, typically bloatedness, fatigue and mastalgia. However, it is the timing, rather than the type or severity of symptoms, that supports a diagnosis of PMS. If your recurrent monthly symptoms are worse in the second half of your cycle and relieved by menstruation then it is likely to be PMS. PMS also tends to be worse when we are stressed, and also seems to get worse as we get older and move towards perimenopause.

Now for the science bit, and there’s a lot of it, but essentially all we need to know is that it is to do with the cycle and the relative levels and balance of progesterone and oestrogen, and the way an individual’s body and brain react to differing levels of progesterone and its related hormones. Progesterone is closely linked to serotonin and cortisol hence the link to mood and stress. In the second half of the cycle both the oestrogen and the progesterone are higher than in the first half, and it’s the balance between the two that makes us feel either well or less well.

Rather than see our GP, most women with PMS symptoms just want to know what the evidence tells us we can do about it ourselves - so here is a list of things proven in clinical studies to help, so far:

1. Decrease stress – easier said than done but whatever works for you, do it. Get enough good quality sleep at night. Prioritise relaxing, non-screen time activities before bed.
2. Increase exercise and activity. If possible, aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity every week.
3. Eat healthily and avoid high sugar and salty foods, keep well hydrated, avoid alcohol and limit caffeine. Increase your calcium rich foods.
4. Complementary therapies with a proven benefit and endorsed by the NHS are vitamin B6, calcium and vitamin D, Vitus agnus castus (chasteberry herb), all available without prescription.
5. Symptomatic treatments such as paracetamol, ibuprofen and evening primrose oil.
6. Cognitive behavioural therapy – you can access this online, privately or via the NHS at the self-referral Depression and Anxiety Service (DAS).

If your symptoms are more severe you may well benefit from seeing your GP. The points above plus the following treatment options are likely to come up in discussion and you’ll get the most out of the consultation if you go prepared; to make sure you get the right diagnosis, bring in a symptom sheet detailing at least two cycles - the Daily Record of Severity of Problems (DRSP) is the most widely used and you can find it online.

There are two main treatment options:

1. Turning off ovulation with hormones
2. Improving the balance of hormones in the brain with antidepressants either continuously, or just for half of the cycle when you have the PMS

If the course of action suggested by your GP doesn’t work then there are other options which the GP can refer you for.