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Premenstrual syndrome (PMS)
General Gynaecology 


What is PMS?


Premenstrual syndrome, or PMS, refers to the range of physical and emotional symptoms that many women experience in the lead up to a period (menstruation). Symptoms generally resolve during the woman’s period and there is usually at least one symptom-free week before the symptoms return. It is thought that most women who menstruate have premenstrual symptoms, ranging from relatively mild to severe.


PMS is a complex condition that includes physical and emotional symptoms.  Some studies have revealed that women with PMS are hypersensitive to their own normal cyclic hormones (progesterone and progestogens) during a menstrual cycle. The ovulation is required with release of oestrogen and progesterone hormones, oestrogen related genes are involved and brain chemicals play a role. Although the cause isn’t conclusively known, PMS can be managed with medication and other strategies.



Since the most characteristic feature of PMS is the relation between symptom appearance and menstrual cycle, researchers have long insinuated that ovarian hormones are involved in the cause but the full mechanism remains to be understood. Many researchers suggest that premenstrual complaints are a result of a drop in progesterone concentration.


The importance of progesterone compared with oestrogen in triggering symptoms is equally unclear. Evidence suggests that women with and without PMS do not differ with respect to the production of ovarian hormones indicating that PMS might instead be associated with enhanced responsiveness to normal, fluctuating concentrations of these hormones.


Moreover, as in anxiety and mood disorders, changes in circadian rhythms have been noted in PMS. Some studies thus suggest that the absolute levels of hormones such as melatonin, cortisol, thyroid-stimulating hormone, and prolactin are not altered but that the timing of their excretion might be aberrant in women with PMS.


What are the symptoms of PMS?


PMS differs from one woman to the next. PMS symptoms can be divided into three groups: psychological, physical and behavioural.


Psychological: mood swings, anxiety, feeling upset, emotional or out of control, tearfulness, depression, forgetfulness and poor concentration, feelings of irritability or anger, changes in sleep patterns, sex drive, and appetite

Physical: headaches, fluid retention and feeling bloated, weight gain, tender breasts, abdominal pain and discomfort, diarrhoea, backache, and painful joints, nausea, acne, long-running (chronic) conditions, such as epilepsy, asthma, and migraine may worsen

Behavioural: poorer spatial awareness, difficulty thinking straight, aggression, more accident-prone,

PMS symptoms usually start sometime after ovulation, when levels of progesterone rise. Some women have PMS for the whole two weeks before their period begins. Others only suffer in the last few days. Many women find that symptoms get worse as they get closer to the start of their period. At its worst, PMS can make a woman feel suicidal. This sort of PMS, where the symptoms are severe and mostly emotional or behavioural, is sometimes called premenstrual dysphoric disorder (PMDD).

Factors contributing to PMS


The cause of PMS is unknown. Factors that may contribute to PMS symptoms include stress, psychological state, poor physical health, overweight and obese, smoking , family history, and cultural and social environment.

PMS management


While there is no cure for PMS, the symptoms may be successfully managed with lifestyle changes, dietary modifications, supplements, hormone treatments, and other therapies.


Lifestyle changes and PMS

Recommended lifestyle changes include:

  • Exercise regularly, at least three times a week
  • Avoid smoke habit.
  •     Reduce caffeine and alcohol in the two weeks before menstruation.
  • Good sleep.
  • Management of the stress.


Dietary changes for PMS

Women experiencing PMS symptoms may crave high-fat and high-sugar foods like chocolate, biscuits and ice cream, and may consequently increase their food intake significantly. Women affected with this condition might like to try:

  • eating smaller meals more often
  • reducing  intake of salty foods
  • including more fresh fruits and vegetables, and wholegrain foods in daily diet
  • boosting  daily food intake, but switching to reduced-fat or non-fat versions
  • not keeping high-fat and high-sugar foods in the house
  • making sure  to have tasty and healthy snack alternatives on hand


Medication and hormone treatments for PMS


A range of medications and hormone treatments are available to help the management of the symptoms. There are different types available.


Treatments that have been proven to relieve symptoms include:

  • SSRIs (selective serotonin reuptake inhibitors) fluoxetine, sertraline, paroxetine, and escitalopram – these medications are mood stabilisers and antidepressants, which can improve PMS

symptoms significantly by boosting brain chemicals (neurotransmitters).

  • Agents that suppress ovulation – including GnRH analogues and danazol
  • An oral contraceptive pill containing drospirenone and ethinyloestradiol.
  • Alprazolam – considered a second-line treatment for PMS. It is used only in the last two weeks of the menstrual cycle.

Treatments that might improve symptoms include other oral contraceptive pills, spironolactone, oestradiol patches or implants.

Complementary medicine and PMS


Many women feel they benefit from a variety of natural therapies, such as cognitive behaviour therapy, and complementary therapies such as vitex cactus agnus.

Therapies that can help reduce PMS symptoms include calcium, vitamin D and vitex cactus agnus. Gingko Biloba, evening primrose oil, lemon balm, curcumin, vitamin B6, isoflavones, St John’s wort, and wheat germ have been shown to provide some benefit.

Many herbal or complementary medicines can have side effects, so make sure you are well informed about them before you and your doctor decide on your treatment.


You can make an appointment with Dr Kenny on 07 3188 5000.

This article is written to be informative and does not substitute seeking a professional consultation from a medical professional.

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