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freeLow sugarVeganDairy freePodcast

Dealing with premenstrual syndrome (PMS)

Dr Shree Datta

Reviewed byDr Shree Datta

lady hanging head out of red car window, feeling rain on face. Happy expression
If you experience headaches, bloating or moodiness in the lead-up to your period, you could have PMS. Find out more about what it is and how to combat it here.
For many, premenstrual symptoms like headaches, bloating, and moodiness are a common occurrence.

In fact, research shows that almost half of women of reproductive age experience symptoms like these, with approximately one in five encountering symptoms severe enough to impact their day-to-day lives.1

These symptoms form part of a condition called premenstrual syndrome (PMS) – a combination of various physical and emotional symptoms that people will often experience a week or two before their period.2

But why does this happen? And what can you do to relieve symptoms when they occur?

Before we can answer these questions, we first need to get a more detailed understanding of what exactly PMS is and how it impacts the body.

What is PMS?

PMS is the name given to the various physical and emotional symptoms you can experience in the time before your period starts.2

An incredibly common condition across the world, statistics show that 40% of women experience PMS symptoms and, of these, 5–8% suffer from a more severe form.3

While PMS can impact women at any age before they reach menopause, studies show that women aged between 35 and 44 years old are typically most impacted, showing the greatest symptom severity relative to other age groups in research.4,5

The symptoms experienced can also vary drastically from one person to another. Some people can get their periods with only mild symptoms, whereas others may struggle to go to work or attend school due to the severity of their symptoms.

What causes PMS?

Researchers still aren’t 100% sure what causes PMS. However, it’s thought to be linked to the different hormonal changes that your body goes through during your menstrual cycle between ovulation (when the ovaries release eggs) and the arrival of your period.

These fluctuating levels of hormones, progesterone and oestrogen, are thought to be responsible for PMS and its associated symptoms.

But, why do some people experience more intense symptoms than others?

During the build-up to your period, oestrogen levels start to decline and progesterone levels increase. When this happens, the hypothalamus in your brain triggers the release of a chemical called norepinephrine, which then leads to declined levels of various other hormones, including acetylcholine, dopamine, and serotonin.6

Some of us are believed to be more sensitive to this than others, which can then lead to the onset of more severe symptoms.

What are the symptoms of PMS?

There are many different types of PMS symptoms you might experience, and these can vary from person to person.2

Ranging from mild to severe, some people may be relatively unaffected while others may find that their symptoms are severe enough to disrupt their day-to-day life and activities.1

The most common physical symptoms of PMS include:1,2
  • breast tenderness
  • nausea
  • constipation
  • bloating
  • backache
  • headache
  • abdominal cramps
  • clumsiness
  • acne
  • insomnia and sleeping problems
  • food cravings and appetite changes
PMS can also bring a number of emotional and behavioural symptoms, including:1,2
  • irritability and anger
  • mood swings
  • tiredness
  • poor concentration
  • changes to sex drive
  • feeling anxious
  • feeling upset, sad or tearful
The PMS symptoms you experience can change throughout your life and may fluctuate from month to month,2 but you might find that you have the same few symptoms around the same time each month.

The length of time your PMS symptoms last can vary too – often anywhere from two days up to two weeks.1

For both of these reasons, some people find it useful to keep a diary of their symptoms.

Having a record of when your symptoms appear in this way, and recording how much they impact your day-to-day life, can not only help you better understand your condition but also allow your doctor to determine whether PMS is the cause.

What’s the difference between PMDD and PMS?

When researching the symptoms and causes of PMS, you may come across another condition referred to as premenstrual dysphoric disorder (PMDD). However, while this may sound similar in name, it’s a much more severe subtype of PMS.

Unlike PMS, PMDD is very uncommon, only affecting between 3–8% of women.7 It can also have a much bigger impact on your life, leading to much more extreme versions of the symptoms listed above.

For example, while women with PMS might feel low in mood, women with PMDD experience extremely low moods and feelings of hopelessness that can result in self-harm or suicidal thoughts.

PMDD can also cause extreme anxiety and intense mood swings, cycling between feelings of anger, irritability, sadness, and happiness. So if you think you could have PMDD, you should seek advice from your doctor to help address your symptoms.

Effective remedies for PMS treatment and relief

While PMS symptoms can be painful and difficult to deal with, there are several effective treatments and lifestyle changes you can make to help reduce their impact on your daily life.

The first step is to track symptoms when they occur. Using an app or writing down the timing of any symptoms you feel can make you more aware of when they start and help you identify useful techniques to manage them moving forward.

Some of the best ways to manage or prevent PMS include:

1. Exercise regularly

Exercising might be the last thing you want to do when you’re experiencing bloating and cramps, but research has shown that performing 30 minutes of exercise three times a week can help alleviate symptoms.8

You’ll need to do this on a fairly regular basis to notice a difference. But this should happen pretty quickly; when assessing the impact of eight weeks of regular aerobic exercise in non-athletic girls, researchers in Iran discovered a significant reduction in PMS symptoms.9

Plus, other studies have shown that the endorphin rush you get when exercising regularly can not only boost your mood but also reduce feelings of fatigue and pain.10

2. Prioritise PMS-friendly food

Changes in oestrogen and progesterone levels can make you crave foods loaded with carbs, sugar or salt. This is perfectly normal – it’s simply your body’s way of dealing with both the increased appetite you get from the hormonal changes, while also trying to boost your mood.

Eating comfort food releases serotonin, nicknamed ‘the happy hormone’ for a reason – it boosts our mood and makes us feel better overall.

However, despite this serotonin boost, eating too many chocolate bars or crisps can make certain PMS symptoms worse, so it’s important to think carefully about which foods to prioritise when you’re PMSing.

Here are some of the best options to consider:11
  • fruits and leafy green vegetables
  • beans, whole grains, and foods rich in fibres and complex carbs
  • herbal teas like chamomile or peppermint tea
  • spices like turmericcinnamon and ginger
  • oily fish
  • milk and eggs
  • dark chocolate
It’s also important to drink plenty of water when experiencing PMS. This may help to stop you from feeling bloated or experiencing any headaches caused due to dehydration – a common symptom of PMS.

There are also some foods that you might want to avoid, as they can worsen your symptoms. Spicy food, alcohol, coffee, and foods high in salt or sugar can all leave you feeling much worse.11

If you’re struggling to get many vitamins and minerals in your diet, supplements can also help.

Food supplements like vitamin B6, vitamin D and calcium have all been shown through multiple studies to reduce PMS symptoms and are recommended as a first-line measure in PMS management guidelines set by the Royal College of Obstetricians & Gynaecologists.3

According to the NHS, you should take no more than 10mg of vitamin B6, 100mg of vitamin D, or 1500mg of calcium per day in supplement form, unless advised by your doctor.12,13,14

3. Practise self-care 

Prioritising self-care is important at the best of times but, when experiencing PMS symptoms, it’s even more essential.

If you’re feeling irritable, low or lethargic, don’t force yourself to power on. Give yourself a break – take some time to rest and regenerate.

Try to manage your stress levels by doing something you enjoy, or taking part in relaxing activities. Whether that’s having a massage, acupuncture, meditating, or doing yoga, prioritising both your physical and emotional health can help reduce the impact of your symptoms.

Depending on the type and severity of your symptoms, your doctor may also recommend cognitive behavioural therapy (CBT) – a form of talking therapy that’s been shown to help moderate-to-severe PMS and is also recommended by the Royal College of Gynaecologists.3,15

4. Get enough sleep

Sleep and PMS have a bit of a catch-22 relationship. Not only does having PMS make you twice as likely to experience sleeping problems like insomnia,16 but sleeping problems can also exacerbate several other symptoms of PMS, leaving you feeling tired and irritable during the day.

A healthy pre-bedtime routine with between seven and nine hours of sleep each night can help improve your sleep quality, reduce your overall symptoms and make PMS easier to cope with.17

Some of the steps you can take include:14
  • avoiding caffeine and too much screen time before bed
  • reducing noise and light in your bedroom
  • developing a relaxing bedtime routine
  • investing in a seasonal affective disorder (SAD) lamp

The final say

PMS is a very common condition that causes a wide range of symptoms and affects us all in different ways.

However, you can help minimise the impact these symptoms have on your day-to-day life by exercising regularly, maintaining a healthy diet, and taking the time to prioritise both your physical and mental wellbeing.

If you’re particularly concerned about any symptoms you’re currently experiencing, contact your doctor. They’ll be able to work with you to discuss your symptoms, make sure they’re not being brought on by another condition and, if needed, provide you with medical treatment.

PMS symptoms can be difficult to deal with but there’s no need to suffer in silence. Whether it be through medical intervention or small lifestyle changes, there are several things you can do to take control of your symptoms and get back to enjoying your life.

Sources

1. Gudipally, P., et al. ‘Premenstrual Syndrome’. StatPearls, StatPearls Publishing, 2023. https://www.ncbi.nlm.nih.gov/books/NBK560698/.
2. NHS. PMS (premenstrual syndrome) [Internet]. [cited 2024 Feb 1]. Available from: https://www.nhs.uk/conditions/pre-menstrual-syndrome/.
3. Green, L. et al. on behalf of the Royal College of Obstetricians and Gynaecologists. ‘Management of premenstrual syndrome’. BJOG 2017; 124: e73–e105. https://doi.org/10.1111/1471-0528.14260.
4. Dennerstein, L., et al. ‘Global study of women's experiences of premenstrual symptoms and their effects on daily life’. Menopause International. 2011;17:88–95. doi: 10.1258/mi.2011.011027.
5. Tschudin, S. et al. ‘Prevalence and predictors of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample’. Arch Womens Ment Health. 2010;13(6):485–494. doi: 10.1007/s00737-010-0165-3.
6. Bu, L., et al. ‘Negative Mood Is Associated with Diet and Dietary Antioxidants in University Students During the Menstrual Cycle: A Cross-Sectional Study from Guangzhou, China’. Antioxidants (Basel). 2020;9(1):23. doi: 10.3390/antiox9010023.
7. Gao, M., et al. ‘Trends in Research Related to Premenstrual Syndrome and Premenstrual Dysphoric Disorder From 1945 to 2018: A Bibliometric Analysis’. Front Public Health. 2021;21:9:596128. doi: 10.3389/fpubh.2021.596128.
8. Dehnavi, Z., et al. ‘The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study’. J Educ Health Promot. 2018;7:3. https://doi.org/10.4103%2Fjehp.jehp_79_17.
9. Samadi, Z., et al. ‘The effects of 8 weeks of regular aerobic exercise on the symptoms of premenstrual syndrome in non-athlete girls’. Iran J Nurs Midwifery Res. 2013;18(1):14–19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748549/.
10. Mahindru, A., et al. 'Role of Physical Activity on Mental Health and Well-Being: A Review'. Cureus. 2023;15(1):e33475. doi: 10.7759/cureus.33475.
11. BBC. What to eat on your period and when [Internet]. [cited 2024 Feb 1]. Available from: https://www.bbc.co.uk/food/articles/periods.
12. NHS. B vitamins and folic acid – vitamins and minerals [Internet]. [cited 2024 Mar 7]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/.
13. NHS. Calcium – vitamins and minerals [Internet]. [cited 2024 Mar 7]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/calcium/.
14. NHS. Vitamin D – vitamins and minerals [Internet]. [cited 2024 Mar 7]. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/.
15. Maddineshat, M., et al. 'Effectiveness of Group Cognitive-Behavioral Therapy on Symptoms of Premenstrual Syndrome (PMS)'. Iran J Psychaitry. 2016;11(1):30–36. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888138/pdf/IJPS-11-30.pdf.
16. Baker, F., et al. ‘Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome’. J Sleep Res, 2012; 21(5):535–45. doi: 10.1111/j.1365-2869.2012.01007.x.
17. Sleep Foundation. PMS and Insomnia [Internet]. [cited 2024 Feb 1]. Available from: https://www.sleepfoundation.org/insomnia/pms-and-insomnia.
 

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