Premenstrual syndrome

‘I am so clumsy before my period; I drop everything.

I feel tetchy and cry all the time.’

‘My breasts feel so sore that

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nothing feels comfortable to wear.’

hat is premenstrual syndrome?

Premenstrual syndrome (PMS) is a group of symptoms, both physical and mental,
that occur any time up to fourteen days before the start of a woman’s period, and
cease within the first few days of menstrual bleeding. PMS used to be known as
premenstrual tension (PMT), as tension is often reported during the time leading up
to a period. However, women can also experience a variety of other symptoms
preceding menstruation, so the term ‘syndrome’ (meaning a group of symptoms)
was thought to be more appropriate.

There is some debate as to whether the syndrome exists. Some people argue that the
diagnosis of PMS can mask what are actually normal responses to the adverse events,
such as stress, poverty and feelings of powerlessness, that many women encounter.

Whatever its cause, many women feel that PMS is real. Studies vary, but statistics range
from 40 per cent of women of childbearing age being affected by PMS (with 5 to 10 per

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cent being severely affected), to 90 per cent of women experiencing some symptoms.

hat are the symptoms of PMS?

Over 150 symptoms have been recorded and attributed to PMS. Some of the most
common ones are listed here.

Physical
Swollen, tender breasts; bloating and water retention; headaches/migraine; stomach
cramps; skin rashes/allergies; acne; sleep disturbances; food cravings; increased thirst;
asthma; clumsiness; backache; dizziness; fatigue; increased/decreased sexual desire;
eye problems.

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Mental
Mood swings; tension; agitation; irritability; anxiety; depression; weepiness; anger,
aggression; panic attacks; loss of confidence; low self-esteem; impulsiveness; poor
concentration; indecisiveness; creativity; forgetfulness.

On rare occasions, women who have committed serious crimes have pleaded severe
PMS as their defence. The majority of women experience PMS symptoms to a much

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lesser degree.

ho can experience PMS?

Any woman between the years of puberty and the menopause can experience PMS.

It is thought that certain factors, including pregnancy, miscarriage, extreme weight

loss, the contraceptive pill, abdominal surgery, gynaecological disorders, poor diet,
and stress can make PMS more likely or make existing symptoms worse. The risk of

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being affected by PMS also increases with age.

ow do I know if I have PMS?

The key to determining whether you have PMS is not the actual symptoms
themselves, but rather the timing of them.

PMS can be diagnosed by keeping a diary or chart for at least three months.
The type, onset, regularity and severity of symptoms should be noted. Sometimes
underlying symptoms such as migraine or epilepsy can become worse just before
a period. Also the number of symptoms you experience can vary from month to
month. By keeping a diary it should be possible to determine whether a pattern of
symptoms is emerging between 1 and 14 days before the onset of your period. It
should also be possible to identify the most troublesome symptoms, and whether
they are all actually related to PMS.

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w hat causes PMS?
Hormonal imbalances
The majority of theories put forward to explain the existence of PMS are based on
hormonal imbalances.

Progesterone and oestrogen. Under the influence of the pituitary and hypothalamus
glands (situated in the brain), the hormones progesterone and oestrogen maintain
a woman’s menstrual cycle. Professionals such as Dr Katharina Dalton believe PMS
is caused by a deficiency of the hormone progesterone (in relation to oestrogen)
during the second half of the menstrual cycle; progesterone is thought to have
an effect on brain chemistry and on different cells within the body. Very high levels
of oestrogen (in relation to progesterone) are thought to cause mood swings,
depression and irritability.

Prolactin. Prolactin is a hormone produced by the pituitary gland. It regulates the

levels of oestrogen and progesterone. Too much prolactin can cause breasts to
become swollen and tender and cause hormonal imbalances.

Essential fatty acids. These substances cannot be manufactured by the body; they
need to be consumed as food. Essential fatty acids are similar to vitamins in that
the body cannot sustain life without them. Certain fatty acids can be converted
into compounds called prostaglandins; one type of prostaglandin regulates the
hormones prolactin, progesterone and oestrogen. Certain factors such as alcohol,
a diet rich in saturated fats, low vitamin B6 consumption and diabetes can interfere
with the process of creating prostaglandins. This can then result in a hormonal
imbalance and thereby cause PMS symptoms.

Hypothalamus and pituitary glands. These glands control the hormones involved in
the menstrual cycle. Stress and a poor diet can affect their functioning, which in turn
can result in hormonal imbalances and PMS.

Social/psychological causes
Other theories suggest social or psychological causes. Women are often taught in
childhood that it is wrong to feel or express anger. Some women feel that the only
time it is appropriate for them to admit to feelings of anger is premenstrually.
Anger at this ‘time of the month‘ is seen as being socially acceptable, although at
risk of not being taken seriously.

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Despite the growth of equal opportunities, women are often not as valued as men
in our society. Take the different implications of the words ‘chef’ and ‘cook’ for
example. Menstruation used to be put forward as a reason why women were
unable to carry out certain tasks or compete with men for jobs. This view is now
unacceptable, but has PMS replaced menstruation as grounds for perceiving
women as less able, reliable or competent as men at certain times, due to their

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biological make-up?

hat treatments are there for PMS?

The types of treatment available are based on the various theories explaining the
causes of PMS.

Progesterone therapy
This involves administering natural progesterone in the form of injections, pessaries or
suppositories during the second half of the menstrual cycle. Blood sugar levels must be
maintained in order for this treatment to be effective. This treatment can help some
women, but not others. Progesterone treatment can cause adverse side-effects.

Contraceptive pill
The pill can help with maintaining a regular level of reproductive hormones. Some
women find the pill can help alleviate their symptoms, others find it makes them
worse. This can occur either while they are on the pill or when they withdraw from
it. The pill can cause side-effects. If you want to use the pill as a remedy for PMS, it is
best to tell your GP, as they can then prescribe the most suitable type of pill for you.

Evening primrose oil

Evening primrose is a flower that produces seeds containing a certain fatty acid,
known as gamma linoleic acid (GLA). This fatty acid can easily be converted into
prostaglandins by the body; prostaglandins in turn help to maintain a balance of
female hormones. Evening primrose oil has been found to be particularly useful in
helping women with breast discomfort, irritability and anxiety. The amount of
evening primrose oil required to lessen symptoms of PMS can vary from woman to
woman and some people may find it necessary to increase the dosage. For more
information ask your pharmacist, or local health shop. Side-effects may include
lethargy, minor skin blemishes and feeling ‘spaced out’. The risk of side-effects
increases with higher dosages.

People with epilepsy should consult their GP before taking evening primrose oil, as it
can cause certain types of epileptic conditions to deteriorate.

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Vitamin B6 (pyridoxine)
This vitamin can be found in red meat, wholemeal bread, liver, milk, eggs, yeast and
rice polishing. Some women may require supplements. Some research suggests that
too much vitamin B6 can cause nerve damage, and there have been suggestions that
vitamin B6 should be made a prescription-only item. It may be useful to try 20mg a
day at first, increasing the dosage gradually if your symptoms are not alleviated.
Pharmacists now recommend that the dosage should not exceed 50mg a day, and
you should only take vitamin B6 during the premenstrual part of your cycle. You will
need to try a particular dosage for two menstrual cycles before you can establish
how effective it is.

Once you have found the correct dosage for you, you will need to maintain that
dosage for 6 months and then gradually reduce it. If you start to experience
symptoms again you can increase the dosage. You need to exercise care; if you
experience an increase in headaches, pins and needles, tingling, numbness, nausea
and/or disturbed sleep the dosage of vitamin B6 may be too high. Vitamin B6 can be
useful in alleviating breast tenderness, anxiety, headaches, irritability and mood
swings. It can also help the body use essential fatty acids more efficiently. If you are
worried about taking vitamin B6 or need help with dosage, ask your GP or local
pharmacist for advice.

Diet
It is important to eat a balanced diet and keep your blood sugar levels stable. If you
do not eat regularly, or if you consume a lot of food containing processed white
sugar (biscuits, sweets, soft drinks, convenience foods), your blood sugar levels can
actually drop. This then causes the hormone adrenalin to be activated, which can
cause anxiety symptoms. Insufficient sugar in the body’s cells can also stop
progesterone from working, which can make PMS symptoms worse.

It is important to eat when you wake up in the morning and eat regularly during
the day to keep your blood sugar levels constant. Experts recommend dividing your
daily food intake into small portions, and consuming food every 3 hours, even if
it is just a slice of crisp bread. Your diet should be balanced and include complex
carbohydrates such as potatoes, pasta, bread, crisp bread, chapattis. The sugars
found in these foods are released more slowly, allowing your body to maintain
blood sugar levels. Food rich in saturated fats can interfere with your body’s ability
to make use of essential fatty acids, which can lead to hormonal imbalances and
PMS symptoms.

Cutting down on salty foods and drinking lots of water can actually help your body
get rid of excess fluids and stop you feeling bloated. Some women find calcium
and magnesium supplements useful, especially if they suffer muscular problems or
cramps. Foods such as soya, tofu and yams can also help balance hormonal levels.

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Antidepressants
These can help with feelings of depression; however, they can carry adverse side-
effects. If you only experience feelings of depression just before a period it may be
worth trying something like vitamin B6 first. If your feelings of depression are
extreme and you feel suicidal, it can be helpful to talk to a friend, relative, the
Samaritans or your GP (see also Further reading p.10).

Minor tranquillizers
These can be prescribed for anxiety and feelings of loss of control. However, they
have side-effects and can be addictive. It may be useful to try remedies such as
relaxation techniques first.

Antiprostaglandins
Sometimes antiprostaglandins can be prescribed to counter the effects of certain
types of prostaglandins – chemicals in the body that, in excess, can cause cramps,
headaches and breast pain. These drugs include aspirin, Nurofen and Ponstan. These
drugs, like all medication, can have side-effects and can block the action of useful
prostaglandins, resulting in a hormonal imbalance.

Diuretics
These drugs cause the body to get rid of excess water as urine. They may be
prescribed to prevent bloating. They can cause palpitations, lethargy, weakness
and confusion. Maintaining blood sugar levels, drinking water and cutting down
on salty foods can stop you feeling bloated.

Talking therapies
It can be useful to talk to someone about how you feel. You may feel comfortable
talking to a friend or relative, or you may want to see a counsellor. There are
different types of counselling available, including psychotherapy, which can allow
you to look at your feelings in depth, and cognitive behavioural therapy, which
helps you to build up coping strategies and develop positive ways of thinking.

Relaxation and complementary therapies

Learning relaxation techniques can help you deal with anxiety symptoms. Yoga
and meditation can also help you to relax. Complementary therapies such as
aromatherapy, reflexology and acupuncture can aid relaxation and restore
equilibrium to your body’s hormonal system. There are herbal remedies which
manufacturers say can help to alleviate PMS symptoms, including water retention.

Exercise
Taking up a form of exercise that you enjoy can help you feel relaxed and less
depressed. It can also allow you to channel feelings of anger and aggression in a
positive way. In addition sleep may become easier.

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Dealing with anger
Assertion classes can help you to express yourself so feelings of anger and frustration
don’t build up. Other exercises such as writing things down and then tearing up the
paper afterwards can help to release anger.

Alleviating stress
Stress can make the symptoms of PMS worse. By lessening stress levels, PMS
symptoms can be helped. Problems such as housing, money worries, welfare
concerns and relationship issues can be very stressful. Organizations such as
your local Citizen’s Advice Bureau and the housing charity Shelter may be able
to offer you information and advice on dealing with some of these issues.
Relaxation, complementary therapies, exercise and talking therapies may help with

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alleviating the symptoms of stress.

elp for friends and family

PMS can affect relationships, especially if the sufferer is experiencing irritability
or anger. It will help to take the person’s anger or distress seriously and not
simply dismiss it due to their ‘time of the month’.

Listening to the person and acknowledging how they feel can help, as can giving a
hand with practical tasks such as housework, cooking, shopping and childcare. Try to
be encouraging and help the person to feel better about themselves. Where possible
postpone any important discussions to another time.

If you feel PMS is adversely affecting your relationship, try to talk about how you
feel without criticizing, and find out how the other person feels. If you both agree
that PMS is causing problems, examine how you can help that person successfully
deal with the symptoms. It can be useful after acknowledging someone’s distress to
remind them that these feelings will probably ease in a few days time, and they will
see things in a more positive way.

If you have a teenage daughter who is experiencing problems with PMS, you will
need to show patience, offer reassurance and show you are available if she wants
to talk. It can be very frightening to feel you are not in control of your body.
It may be useful to pass information leaflets on PMS to her.

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u seful organizations
British Association for Counselling
1 Regent Place, Rugby, Warks CV21 2PJ.
Will send you a list of trained counsellors in your area if you include an A5 s.a.e.

British Association for Behavioural and Cognitive Therapy

PO Box 9, Accrington, Lancs BB5 2GD.
Can send you a list of cognitive therapists in your area if you enclose an s.a.e.

You can also ask your GP to refer you to a counsellor.

The Stress Management Training Institute

Foxhills, 30 Victoria Avenue, Shanklin, Isle of Wight PO37 6LS, tel. 01983 868166.
Produces relaxation leaflets and cassettes and provide lists of relaxation classes.

The National Association for Pre-menstrual Syndrome (NAPS)

PO Box 72, Sevenoaks, Kent TN13 1XQ. Helpline 01732 741 709.
Provides help, information and support for PMS sufferers and their families.
Also produces leaflets, including Understanding PMS and its Treatments (£1)
A Young Person’s Guide to PMS (£2).

The Premenstrual Society (PREMSOC)

PO BOX 429, Addlestone, Surrey KT15 1DZ.
Provides information and support. Supplies leaflets and supports self-help groups
and research and education into PMS.

Women’s Nutritional Advisory Service

PO Box 268, Lewes, East Sussex BN7 2QN, tel. 01273 487 366. Provides information on
nutritional research to women suffering from PMS and menopause.

Institute for Complementary Medicine

PO Box 194, London. SE16 1QZ, tel. 0171 237 5165.
Provides information and can send out a list of practitioners if you enclose an s.a.e.

Samaritans
Provides 24-hour emotional support for people feeling suicidal, tel. 0345 909 090.

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qq
f
Qty
urther reading and order form

Coping Successfully with PMS Karen Evennett (Sheldon Press 1995) £4.99

qq The PMS Diet Book (Sheldon Press 1997) £5.99

No More PMS M. Stewart (Vermilion 1997) £8.99
Manage Your Mind: The Mental Health Fitness Guide G. Butler & A. Hope

qq (OUP 1995) £8.99

Overcoming Anxiety Helen Kennerley (Robinson 1997) £6.99

q Managing Stress Ursula Markham (Element 1996) £6.99

Stress Management: A Comprehensive Guide to Wellness

qq E. Charlesworth & R. Nathan (Souvenir 1997) £10.99

Understanding Depression (Mind 1998) £1

qq Understanding Anxiety (Mind 1998) £1

How to Assert Yourself (Mind 1995) £1
How to Cope with Panic Attacks (Mind 1997) £1

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Other publications in the 'Understanding' series are:

Anxiety
Attention Deficit Hyperactivity Disorder
Bereavement
Caring
Childhood Distress
Dementia
Eating Distress
Gender Dysphoria
Learning Disability
Manic Depression
Mental Illness
Personality Disorder
Phobias and Obsessions
Psychological Effects of Street Drugs
Post-Natal Depression
Post-Traumatic Stress Disorder
Schizophrenia
Seasonal Affective Disorder
Self-Harm
Talking Treatments

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ISBN 1 874690 75 8 © Mind 1998. No reproduction without permission

This booklet was written by Kaaren Cruse

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