Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS) describes a cluster of physical and emotional symptoms that occur in a predictable pattern during the luteal phase of the menstrual cycle, typically the one to two weeks before a period, and resolve within a few days of bleeding starting. Most women of reproductive age experience at least some premenstrual symptoms, and for most, they are mild and manageable. A smaller proportion experience symptoms severe enough to disrupt daily functioning, and an even smaller group meet criteria for Premenstrual Dysphoric Disorder (PMDD), a more severe form involving significant mood disturbance. PMS is a normal hormonal response for most women, but when symptoms are disabling, effective treatment is available and should be sought rather than endured.

Physical symptoms: • Bloating and fluid retention • Breast tenderness • Headache • Fatigue • Joint or muscle aches • Changes in appetite or food cravings • Acne flare-ups Emotional and behavioural symptoms: • Irritability or mood swings • Anxiety or tension • Low mood or tearfulness • Difficulty concentrating • Sleep disturbance • Social withdrawal Symptoms follow a cyclical pattern, appearing in the days before a period and resolving once bleeding begins, which is a key feature distinguishing PMS from other mood or physical conditions.

The exact cause of PMS is not fully understood, but it is thought to result from normal cyclical fluctuations in oestrogen and progesterone interacting with brain neurotransmitters, particularly serotonin, in susceptible individuals. Unlike an excess or deficiency of any single hormone, PMS appears to reflect an increased sensitivity to normal hormonal changes rather than an abnormality in the hormones themselves.

• High levels of stress • Personal or family history of depression or other mood disorders • History of postpartum depression • Poor sleep, low physical activity, or high caffeine and alcohol intake • Family history of PMS

• Recurrent disruption to work, school, and relationships each month • Progression to, or overlap with, Premenstrual Dysphoric Disorder (PMDD) in a smaller subset of women, involving more severe and disabling mood symptoms • Worsening of pre-existing mood disorders such as depression or anxiety in the premenstrual phase

PMS cannot be entirely prevented, given its link to the normal menstrual cycle, but symptoms can be significantly reduced: • Regular aerobic exercise reduces both physical and emotional PMS symptoms • Reducing caffeine, salt, and alcohol intake in the days before your period can ease bloating and irritability • Adequate sleep and stress management techniques help reduce symptom severity • Calcium and vitamin B6 supplementation have modest evidence for reducing symptoms in some women For more severe symptoms, hormonal contraceptives can stabilise cyclical hormone fluctuations, and SSRIs (taken either continuously or only during the luteal phase) are effective for significant mood symptoms, including PMDD.