Pre-Menstrual Syndrome (PMS)

SYMPTOMS
Over 100 symptoms have been described. Many experience minor symptoms, but a few women suffer from severe symptoms which may affect daily functioning. The common symptoms are:

• Depression, anxiety, irritability, anger
• Cravings for salty/sweet food
• Breast tenderness/swelling, weight gain, fluid retention
• Fatigue, headache, sleep disturbances
• Feeling out of control, overwhelmed, tense or on edge
  

PREMENSTRUAL DYSPHORIC DISORDER
Sometimes the emotional symptoms premenstrually can be very severe and this is called Pre-menstrual Dysphoric Disorder. This occurs in 3-8% of women, more often in women whom have a past history of depression, have a family history of PMDD or who have had mood changes with the oral contraceptive pill.

CAUSE
This is unknown at present. There is no evidence of high or low levels of hormones. There may be an abnormal response to normal levels of hormones and this may involve a chemical in the brain called serotonin.

DIAGNOSIS
There is no laboratory test to make the diagnosis of PMS or PMDD. The diagnosis comes from the cyclical nature of the symptoms, in other words they start just before a period and stop once a period begins. Your doctor may ask you to chart your symptoms for at least 2 months.

MANAGEMENT
There is no one single treatment that will cure PMS or PMDD. However a number of different things may help to reduce or prevent the symptoms. Often this means changing aspects of your lifestyle.

DIET
Don't go on a diet but try to change your eating pattern. Eat frequently and never go without food for more than 5 hours:

Increase:

• the amount of water
• the amount of green vegetables and salad
• the amount of fruit and nuts
• the amount of pasta, brown rice, and dried beans
• the amount of chicken and fish

Reduce:

• intake of sugar including honey, additives with '-ose' at the end and sweeteners
• intake of junk food - fast foods, burgers, crisps
• intake of salt since this may reduce bloating
• amount of tea and coffee since caffeine causes irritability
• intake of cigarettes and alcohol
  

EXERCISE
Exercise will reduce physical and emotional symptoms. It releases built up stress and enhances your sense of well being. If you do no exercise at the moment, then do some gentle exercise such as going for a short walk. Start exercising slowly, don't push yourself and listen to your body. Try to exercise for 20-30 min 3 times a week. Remember exercise should be fun. As well as exercising, make sure you get enough rest each day.

STRESS REDUCTION
Think about your life at home and at work. Identify things that cause you stress. Often it is not possible to eliminate all stress but try reducing it if possible. You may find anxiety management and relaxation techniques useful. Take time to care for yourself. Make space for yourself. Enjoy a warm bath or a massage. Try using aromatherapy oils.

MEDICATION

• Vitamins - Some women find vitamin B complex and evening primrose oil useful. If you want to try them check with your doctor that this is all right
  
• Oral Contraceptive Pill - Often your GP may prescribe the pill for PMS. The pill stops the periods and therefore should stop symptoms of PMS
  
• Antidepressants - These can be used if depressive symptoms are common. Sometimes some tablets have side effects. You may wish to discuss this with a member of staff at your surgery