Do you have symptoms that seem to happen like clockwork every time you're about to get your period? Irritability, crying spells, aches, bloating, the list goes on.
But once your period arrives — poof! — these symptoms seem to disappear almost instantly or at least a day or two after. That, in a nutshell, is PMS, also known as premenstrual syndrome, and it's really, really common.
What is PMS?
Premenstrual syndrome (PMS) is super common, affecting 3 out of 4 women. It's defined as a collection of physical and emotional symptoms that cyclically occur in the second half of your menstrual cycle (called the luteal phase).
PMS affects up to 75% of women around 7 to 14 days before a period. [1]
PMS is defined as a collection of physical and/or psychological symptoms that cyclically occur in the luteal phase, which is the second half of your menstrual cycle.
The severity and type of symptoms can vary from woman to woman, and even from cycle to cycle for the same woman. The amount of pain you feel and the symptoms you experience can change from cycle to cycle and can vary greatly between women.
The causes of PMS are not yet well-defined and are a hot topic in the medical research field. In the past, this lack of understanding has led to "PMS" becoming a catch-all phrase in pop culture to describe anything related to female hormone issues and emotional episodes.
This needs to change, and thankfully, it's starting to.
As further research and conversations surface, we're beginning to understand more about PMS symptoms, why they happen, how to manage them, and when our bodies could be telling us it's something more serious.
The PMS criteria
There are over 150 symptoms associated with premenstrual syndrome, all of which can affect how we're feeling, what we're thinking, and our behaviour [2]. It's no wonder why we're often not feeling ourselves when our period approaches, but the nature and frequency of the symptoms can vary greatly.
Some women have predictable PMS symptoms every cycle, others seem to have potluck.
Roughly 80-90% of women with PMS say their most common emotional symptoms are irritability, depression, mood swings, and anxiety [3]. And 50% of women report difficulty in concentrating and forgetfulness.
On the physical side, the most common symptoms include bloating, headaches, and breast tenderness.
Here's a more comprehensive list of possible PMS symptoms:
Emotional
- Feeling sad, hopeless, or putting yourself down
- Feeling tense, anxious, or on edge
- Mood swings
- Frequent crying spells
- Persistent irritability and anger
Physical
- Marked changes in appetite where you want to binge eat sweet and/or salty foods
- Breast tenderness
- Abdominal bloating
- Water retention
- Feeling fatigued or lethargic
- Diarrhea
- Headaches
- Lower backache
Cognitive
- Difficulty concentrating
- A feeling of being overwhelmed or not in control
- Clumsiness
- Forgetfulness
Behavioural
- Decreased interest in usual activities (where you withdraw from certain social relationships and prefer watching re-runs of Sex in the City or binge-watching romantic comedies)
- Increased interpersonal conflicts (finding reasons to start arguments with people)
- Hypersomnia or insomnia (sleeping too much or not enough)
PMS symptoms start to drop in from day 14 of a regular 28-day cycle and can continue right up to a few days after bleeding has started.
There are other factors at play here too [4]. Things like travel, illness, stress, weather changes, and other environmental factors may affect ovulation, the length of your menstrual cycle and the severity of your PMS symptoms.
What causes PMS?
There's no single clear theory yet to explain exactly what causes PMS.
But there is evidence that suggests it has something to do with how much our reproductive hormones fluctuate when we ovulate and how they impact the neurotransmitter systems in the brain [5].
Let's break this explanation down.
Brain chemicals and PMS
PMS symptoms can begin in the early, mid, or late luteal phase, which as we mentioned, is from day 14 of a typical 28-day cycle.
When we ovulate, our ovaries produce high levels of progesterone to start preparing the body for pregnancy. At the same time, women become susceptible to physical and emotional PMS symptoms as the ones we listed above.
The reason why this happens is due to the small changes in oestrogen and progesterone levels in the body. Once they start fluctuating, it starts to affect 3 chemical messengers in our brains:
- Dopamine, which is involved in reward, motivation, memory, attention, and regulating body movements.
- Serotonin, which contributes to our well-being and happiness.
- Gamma-Aminobutyric Acid (GABA), which facilitates communication among brain cells and plays a big role in the body's ability to reduce the activity happening in the central nervous system. As a result, it helps increase relaxation, reduce stress, boost sleep, alleviate pain, and balance moods.
Now let's put this into context with rising levels of progesterone and falling levels of oestrogen.
Oestrogen directly influences the neurotransmitters of serotonin and dopamine. When oestrogen levels are low, this affects the levels of serotonin which can give rise to PMS symptoms around mood and behaviour.
Progesterone fluctuations have been thought to affect how the GABAergic system functions. When the GABA chemical messenger is affected by these fluctuations, it can't do its job properly in reducing stress, balancing moods, and helping the body relax.
While this does provide some answers as to what factors may contribute to certain PMS-like symptoms, the underlying cause of PMS is still unclear — but the good news is there are ways you can manage the symptoms.
The non-medical ways to help treat PMS
We may not be able to tell you exactly what causes it, but at least we can explain ways you can show PMS who's boss. PMS can generally be treated using non-medical methods.
Here is what's recommended.
Aerobic exercise (Cardio)
Studies have found that doing 3 sessions per week for 60 minutes of aerobic exercise can help ease PMS symptoms [6]. Try scheduling some brisk walks, swimming, running or cycling into your diaries.
The other benefit is that exercise increases endorphins which helps reduce stress.
Getting some Zen
We naturally want to retreat when our period approaches, which is likely the PMS at work.
Perhaps this is one where you need to give in to this urge and take up some mindfulness exercises, meditation, or practice yoga.
Fighting against insomnia
We love sleep, yet most of us struggle to get enough of it. Unfortunately, one of the PMS symptoms some women experience is insomnia.
To combat the nightly tossing and turning, focus on getting enough exercise to encourage deep sleep, avoid alcohol, and keep a sleep diary.
Knowing when you struggle with sleep might be able to help you plan your life a bit better around that. For example, if you know your brain isn't quite awake in the first couple of hours of the day, you can try avoiding early morning meetings.
Hot water bottles and warm baths
Heat provides temporary relief of physical discomforts such as abdominal cramps and back pain, and it helps the body de-stress.
Cognitive Behavioural Therapy (CBT)
CBT is a non-drug-based therapy that can help women find new ways to behave by changing their thought patterns. In this case, it helps women navigate their behaviour and emotions related to PMS.
Studies have experimented with this theory and found there was a significant difference in psychological symptoms before and after the therapy [7].
Acupuncture
While research on the effectiveness is limited, there are studies that suggest acupuncture can help with both mood and physical symptoms [8].
Supplements
Certain supplements can also be helpful for treating PMS.
Kin's Hormone Harmony was specifically created to help relieve PMS symptoms, like cramps and irregular menstruation, as well as help regulate mood and lower irritability — all thanks to a curated blend of natural ingredients, based on traditional Western Herbal Medicine (WMH).
Medical ways to treat PMS
There are 2 main ways to relieve symptoms medically:
- Increasing serotonin levels using Selective Serotonin Reuptake Inhibitors (SSRIs), also known as antidepressant medication, or
- Suppressing the changes in ovarian hormones with a Combined Oral Contraceptive Pill (COCP)
If a woman wants to be on contraception, the second approach is prioritised. If not, the first approach is used.
Increasing serotonin levels
How does serotonin targeting work? The drugs that have the best-proven efficiency and safety are SSRIs, which are a type of antidepressant medication.
Typically the benefits are seen from the first cycle and if not, the dosage is increased. SSRIs work better for combating mood-related symptoms as opposed to physical-related symptoms.
SSRIs can be taken in 3 different ways:
- Continuous: This is generally recommended for women who have severe emotional symptoms such as depression, anxiety, anger, and mood swings that happen during the entire cycle, and not exclusively during the premenstrual time.
- Luteal phase only: When the medication is taken from day 14 of the cycle (start of ovulation) until the beginning of the period.
- Symptom-onset: Taken at the first sign of PMS symptoms and continued until a few days after the bleeding starts.
What are the side effects of SSRIs?
Side effects are dependent on the dose but the most common include nausea (which usually resolves within 4-5 days of starting therapy), headaches, insomnia, and decreased libido.
You may end up trialling different ones to see which works best for you and it's entirely dependent on your specific symptoms and cycle.
Remember that your doctor can help you decide if this is the right option for you.
Taking a Combined Oral Contraceptive Pill (COCP)
The COCP is used to suppress the changes in ovarian hormones. These hormones have a direct effect on the changes to the chemical messengers in our brains that we mentioned earlier: dopamine, serotonin, and GABA.
Your doctor may suggest you start a trial using a 4-day placebo period as opposed to a 7-day, as these seem to be more effective. If that's the case, you might be put on a lower dose of COCP, to begin with. If symptoms persist or you get continuous spotting, your doctor will increase the dose.
If symptoms continue even after increasing the dose, your doctor may talk to you about taking the pill continuously without the placebo pills.
Side effects can include weight gain, breast tenderness, headaches, and nausea. To learn more about the pros and cons of the COCP, take a peek at our contraception guide.
If you decide that the pill is the way forward for you, Kin's pill subscription makes the whole process far easier. Simply take an online consultation with one of our Australian practitioners to get your prescription plan and from there, your pill is delivered to your door. And, it'll always be delivered on time so you don't have to worry about running out again.
How is PMS diagnosed?
While there is no concrete way to positively diagnose PMS, doctors still work to establish a premenstrual pattern in order to help you find a way to treat your symptoms.
They need to understand if what you're experiencing has a relationship with your menstrual cycle. To do so, they'll delve into questions related to your sexual health, menstrual cycle, and mental health.
The best way for you to be prepared for this discussion is to start tracking your symptoms in a diary (or find a period tracking app) so you have some anecdotal evidence.
Tracking your cycles gives you answers about the length and regularity of your cycles, what types of symptoms you have and the severity of them, and how they impact your everyday life.
Beyond your PMS symptoms, your doctor will also ask about your mood in general, to make sure your symptoms aren't indicating something more serious like a depressive or anxiety disorder.
A blood test may also be required to rule out any potential medical issues that could be causing the symptoms too.
It's really important that you don't put this conversation with your doctor off.
PMS has a significant impact on the lives of women worldwide, and despite the growing awareness, there's still a lack of knowledge about the necessity to consult a doctor or seek treatment for premenstrual symptoms.
Don't hold back on details
On an even more serious note, while PMS is super common, there's actually a less common (more severe) disorder that affects about 1 in 20 reproductive women worldwide [9]. It's called premenstrual dysphoric disorder (PMDD for short).
PMDD is very different from PMS and it leads to more severe symptoms. It's now officially recognised in the DSM-5 — the American Psychiatric Association's classification system which is widely used in Australia.
We strongly encourage you to learn the differences between PMS and PMDD not only for yourself but for the women around you.
Every woman's fertility journey is unique, but when it comes to dealing with something as common as PMS, the more detail we reveal, share, and discuss, the more knowledge we'll have to make informed choices about our health.
If you experience severe PMS symptoms month after month, it may be time to reach out to your doctor.
.svg)