Premenstrual Syndrome: A Foe

Premenstrual Syndrome: A Foe

Stop PMSing! Easier said than done.

What is Premenstrual Syndrome and who gets it?

Premenstrual syndrome or PMS is a combination of physical and emotional changes that many women get after ovulation and before the start of the menstrual period. While some women get their monthly periods without any signs of PMS or with very mild symptoms, there are a substantial many who experience severe PMS symptoms that sometimes make it difficult to do everyday activities like going to school or work. This condition is also known as premenstrual dysphoric disorder (PMDD). [1] Up to 85 per cent of menstruating women report having one or more PMS symptoms, while 2 to 10 per cent report incapacitating symptoms or PMDD symptoms. [2] 

A woman’s menstrual cycle is regulated by the complex interaction of hormones including luteinizing hormone, follicle-stimulating hormone, oestrogen and progesterone. [3] The menstrual cycle has three phases: 

  • Follicular (before the release of the egg)
  • Ovulatory (egg release)
  • Luteal (after egg release)

Any woman of reproductive age can get premenstrual syndrome. However, it is more likely for women who:

  • are in their late 20s to early 40s
  • have had at least one pregnancy
  • have a history of depression or other mood disorders in the family
  • have postpartum depression

How is Premenstrual Syndrome diagnosed?

There are no unique tests to diagnose premenstrual syndrome. [4] [5] An obstetrician-gynaecologist (ob-gyn) will confirm an established pattern of your symptoms to diagnose PMS. You have to keep a track of your symptoms for a few months to help your ob-gyn understand your condition. Some parameters that you will need to look for are: 

  • Happens in the 5 days before a period or for at least three menstrual cycles in a row
  • Ends within 4 days after your period starts
  • Interferes with your daily activities


What are the symptoms of Premenstrual Syndrome?

PMS symptoms are different for every woman. Sometimes it pertains to only physical symptoms or emotional symptoms, while in some cases a woman may experience both. PMS symptoms date back to biblical times when women experiencing physical and emotional changes related to their menstruation were believed to be “possessed”. Dr Robert Frank was the first one to propose possible hormonal participation for the occurrence of these changes through his description of premenstrual tension syndrome in 1931.  In 1953, doctors Raymond Greene and Katherine Dalton published their article “Premenstrual Syndrome” in the British Medical Journal where they established the term premenstrual syndrome and how it was more than just emotional tension. [6] 

Physical symptoms  of PMS may include:

  • Bloating
  • Cramps
  • Headache 
  • Muscle aches
  • Joint pain
  • Constipation or diarrhoea
  • Swollen or tender breasts
  • Weight gain
  • Pimples

Emotional symptoms of PMS may include:

  • Irritability or hostile behaviour
  • Feeling overwhelmed
  • Feeling tired
  • Mood swings
  • Tension or anxiety
  • Depression
  • Trouble with concentration or memory
  • Sleeping issue
  • Appetite changes or food cravings

What causes Premenstrual Syndrome?

The exact reason for premenstrual syndrome is not clear. However, it is linked with the decline in hormone levels in the woman’s body. Premenstrual syndrome happens after ovulation in the luteal stage when the oestrogen and progesterone levels fall dramatically if you are not pregnant. This change in chemicals plays a major role in PMS, which goes away a few days after a woman’s periods start as the hormone levels begin rising back to normal again. [7] 

How does PMS affect other health problems?

In the cases of some women, their premenstrual syndrome overlaps with other health problems, which may worsen in the time before their menstruation. Some of these include:

  1. Depression and anxiety disorders: Depression and anxiety disorders are the most common health conditions that overlap with both PMS and PMDD. Menstruation is a time of intense hormonal fluctuation in a woman’s body and this can cause increased vulnerability to depression as well as anxiety disorders.  [8] 

  2. Bladder pain syndrome: Bladder pain syndrome or interstitial cystitis is a chronic bladder condition that causes discomfort in the bladder or pelvic region. Women who have this condition go through a disabling pain sensation or cramp during their menstruation. Besides, a regular period cycle can also flare up interstitial cystitis a week before the onset of the period, contributing to worse PMS symptoms, and diminish once the flow begins. [9] [10] 

  3. Irritable bowel syndrome: Irritable bowel syndrome is a gastrointestinal (GI) disorder whose symptoms worsen in women experiencing premenstrual syndrome. These women experience severe GI symptoms such as bloating, abdominal discomfort and diarrhoea. [11]

  4. Myalgic encephalomyelitis/ chronic fatigue syndrome: Myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) can sometimes be hormone-related and worsen at certain times in the menstrual cycle. Studies show that women with CFS were 12 times more likely to have pelvic pain. Further, they reported excessive bleeding during menstruation, more bleeding in between periods and missing periods. [12]

What can be done at home to relieve PMS symptoms?

Finding ways to reduce stress can help women relieve their PMS symptoms. While these tips will help you maintain a healthier lifestyle in general, they will also help you in relieving the PMS symptoms at home:

  1. Regular physical activity: Getting regular physical activity throughout the month can help with certain symptoms such as trouble with concentration, depression and fatigue - a state of experiencing a lack of energy.  A survey conducted on 20 women showed that 12-week of aerobic exercise created the balance of estrogen and progesterone levels in women, reducing the symptoms.

  2. Healthy diet: Limit the intake of salt and caffeine to help with bloating and disrupted sleep cycles. Incorporating leafy greens, and calcium-rich food can ward off a number of PMS symptoms too. Besides, drink an ample quantity of water to help with digestion. Try eating complex carbohydrates as they will cause a moderate rise in insulin levels that can help stabilize your mood. [13] 

  3. Proper sleep cycle: Lack of sleep or reduced quality of sleep can interfere with your general well-being with potential problems like depression and anxiety. Thus, it is recommended to get a proper 7-8 hours of sound sleep every day. Cut back on alcohol as it can disrupt your sleep cycle through oversleeping or having trouble sleeping.  [14] 

  4. Healthy coping method for stress: As we mentioned earlier, finding ways to reduce stress can help relieve PMS symptoms. This could be something as simple as writing in a journal, talking to someone or doing yoga and meditation. [15] 

  5. Avoid smoking: Smoking can potentially worsen PMS symptoms because nicotine has effects on neurocircuitry, which can increase being prone to environmental stressors. Therefore, it is highly recommended that one must avoid smoking to help ease their PMS symptoms. 


Can medicines help relieve PMS symptoms? 

Apart from adopting a healthy lifestyle, PMS symptoms can be treated with the help of some over-the-counter and prescription medicines for instant relief. Some of these include:

  • NSAIDs: NSAIDs are nonsteroidal anti-inflammatory drugs that inhibit the production of prostaglandins and can thereby relieve period cramps. Prostaglandins are lipid compounds that choke the blood vessel in the uterus and make the muscle layer shrink causing painful cramps. Common NSAIDs include aspirin, ibuprofen, and naproxen. 

  • SSRIs: Antidepressants, particularly SSRIs, help with the treatment of PMS symptoms. SSRI refers to Selective Serotonin Reuptake Inhibitor. It can help to relieve moods swings and other emotional symptoms experienced during menstruation. [15]

  • Diuretics: Diuretics are water pills that help reduce fluid buildup and thus the symptoms of bloating and breast tenderness. However, one must avoid taking NSAIDs and diuretics together as they may cause kidney problems. [15] [16]

  • Hormonal birth control pills: Hormonal birth control pills are drugs that prevent ovulation and may find use in relieving physical symptoms of menstruating women. However, they might worsen other symptoms experienced. [15]

Note - Do remember to consult your doctor before taking any of the medicines mentioned above.

Which nutrients help with PMS symptoms? 

As you can see from the above facts, symptoms of premenstrual syndrome can be tackled to an extent with the help of lifestyle changes such as exercising. A healthy diet can also contribute, however. Certain essential nutrients that have been found to ease your PMS symptoms include:

  1. Calcium: Studies show that calcium has a positive effect on women with premenstrual syndrome as it reduces their symptoms to a great extent. In a study, 497 premenopausal women were given 1200 mg of calcium per day for 3 menstrual cycles, where half was in the form of calcium carbonate and the other half was in the form of a placebo. The calcium treated group showed a significant decline in core PMS symptoms. Similarly, another study conducted had women receiving 1000 mg calcium per day to reveal a decline in depression and anxiety by 27%. 

  2. Vitamin B6: A study conducted on 78 women showed that 60% of the vitamin B6 group became free of PMS symptoms after 3 menstrual cycles. Vitamin B6 helps in relieving PMS symptoms such as depression through a series of mechanisms that drive up the mood such as neurotransmitter synthesis which involves both dopamine and serotonin Besides, vitamin B6 reduces histamine, which plays a role in causing PMS trouble such as anxiety, other mood disorders and breast pain. [17] [18] [19]

  3. Magnesium: Studies indicate that magnesium controls symptoms of food cravings, water retention and anxiety caused due to premenstrual syndrome. It further showed that magnesium takes about 2 months to show therapeutic effects on PMS symptoms. A combination of magnesium and vitamin B6 has higher effectiveness in relieving PMS symptoms when compared with only magnesium. Carolyn Dean, MD, ND, magnesium expert and Medical Advisory Board member of the Nutritional Magnesium Association points out that “magnesium is known as the anti-stress mineral … and helps with constipation and painful cramps.”  [20]

  4. Polyunsaturated fatty acids (omega-3 and omega-6): Polyunsaturated fatty acids such as omega-3 and omega-6 can reduce the severity of PMS symptoms by increasing estrogen and progesterone levels. An imbalance in the hormones estrogen and progesterone can result in a decrease in serotonin synthesis which causes an effect on mood and behaviour. This is an emotional symptom of PMS that can affect appetite and eating behaviour.  [21] 

  5. Zinc: Zinc reduces the production of prostaglandins, which are a group of physiologically active lipids (fats synonym) that have a hormone-like effect. Prostaglandins temporarily reduce or completely stop the supply of blood to the uterus. This deprives the uterus of oxygen and causes cramps. Studies show that consuming 30 mg of zinc can relieve women of premenstrual syndrome symptoms, specifically menstrual cramping. Another study showed that zinc supplementation had favourable effects on both physical and emotional symptoms of PMS. [22]

  6. Vitamin B1: Vitamin B1 has also been effective in reducing symptoms of premenstrual syndrome. A study conducted with 80 students showed that vitamin B1 reduced mean mental and physical symptoms significantly by 35.08% and 21.2% respectively. Vitamin B1 also helps in reducing the symptoms of premenstrual syndrome by affecting the performance of coenzymes in the metabolism of carbohydrates, protein, lipids and the main branch of amino acids - all of which play an important role in the physical and emotional symptoms of PMS. Further, it helps with emotional symptoms of PMS by, increasing endorphin secretion and eventually causing relaxation and stimulating sleeping. [23]

              Final Words

              If you suffer from PMS then you are not alone. Lean on the science, learn from others and make changes in your life that you can control so that you can be a healthier, happier version of yourself every month.


              References:

              [1] https://www.nhs.uk/conditions/pre-menstrual-syndrome/ 

              [2] https://www.aafp.org/afp/2003/0415/p1743.html#afp20030415p1743-b5 

              [3] https://www.msdmanuals.com/en-in/home/women-s-health-issues/biology-of-the-female-reproductive-system/menstrual-cycle 

              [4] https://www.acog.org/womens-health/faqs/premenstrual-syndrome?utm_source=redirect&utm_medium=web&utm_campaign=otn 

              [5] https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787 

              [6] https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01374-6 

              [7] https://www.webmd.com/women/pms/ss/slideshow-premenstrual-syndrome-pms 

              [8] https://www.med.unc.edu/psych/wmd/resources/mood-disorders/menstrually-related/ 

              [9] https://pubmed.ncbi.nlm.nih.gov/16217302/ 

              [10] https://fwcenterforpelvicmedicine.com/interstitial-cystitis/ 

              [11] https://journals.lww.com/ajg/Fulltext/2008/09001/Premenstrual_Syndrome_Exacerbates_Irritable_Bowel.1187.aspx

              [12] https://www.menstrual-matters.com/tips-and-tricks/cfs/ 

              [13] https://health.clevelandclinic.org/11-diet-changes-that-help-you-fight-pms/ 

              [14] https://health.clevelandclinic.org/happens-body-dont-get-enough-sleep/#:~:text=Some%20of%20the%20most%20serious,function%20and%20lower%20sex%20drive.  

              [15] https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome 

              [16] https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/water-retention/art-20044983 

              [17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930825/ 

              [18] https://www.larabriden.com/the-end-of-pms-vitamin-b6-and-other-serious-cures/ 

              [19] https://www.larabriden.com/histamine-intolerance-pms-pmdd/ 

              [20] https://www.prnewswire.com/news-releases/magnesium-supplements-may-be-solution-to-pms-300000612.html 

              [21] https://www.sciencedirect.com/science/article/pii/S0213911121003101 

              [22] https://pubmed.ncbi.nlm.nih.gov/28188965/ 

              [23] http://eprints.skums.ac.ir/736/1/11.pdf
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