What is PMS and who gets it?
Most women of reproductive age will have first-hand experience of premenstrual syndrome (PMS). Who hasn’t been in floods of tears over a video of a baby goat, then realised they’re due the next week? Who doesn’t find their boobs change size or get a bit tender a few days before their period starts? And menstrual mood swings are, of course, well documented, not the least by men who complain about their exposure to these, a complaint which tragically fails to acknowledge their partners are the ones who actually have to live them.
In short, PMS refers to the physical and emotional symptoms that appear one to two weeks prior to your period starting, and these symptoms then go away around the time your start bleeding. The pattern of symptoms can change over time, and symptoms don’t occur prior to puberty, during pregnancy, or after menopause.
As well as mood swings or shape-shifting boobs, some people get a bit spotty, some may bloat or gain a few pounds of water weight, others may find they get tired, achy, or utterly ravenous. Anxiety can increase, or you may feel depressed, tearful, or get headaches. Generally, these symptoms are nothing more than a minor inconvenience, although for some women they can be debilitating, especially if you have premenstrual dysphoric disorder (PMDD), in which case they can drastically affect your life and you may find you need medical help.
PMS still, predictably, has some detractors, who claim that women are socialised into thinking it’s a thing, and that this therefore gives it unjustified medical legitimacy.
While we are lucky to live in an age where the mythicisation of female medical complaints (hysteria, anyone?) is in the process of being stamped out, PMS still, predictably, has some detractors, who claim that women are socialised into thinking it’s a thing, and that this therefore gives it unjustified medical legitimacy.
While some don’t appreciate just how bad PMS can be then, or prefer to deny its existence altogether, the general consensus nowadays is that we’re happy to talk about the symptoms, roll our eyes at them, joke about mood swings. But why do these symptoms actually occur? What is going on in the body to cause them? And why do some people seem to get PMS so much more badly than others?
Why do PMS symptoms occur?
Around 80% of women report experiencing some symptoms before menstruation, of which an impressive 200 have been reported. It is well known and fairly self evident, given the cyclical nature of PMS, that it is related in some way to hormone changes that occur at ovulation, but other than that a shamefully small amount about PMS is known.
“We know that PMS and PMDD are caused by fluctuation of ovarian hormones,” says Dr. Narendra Pisal, leading consultant gynaecologist at London Gynaecology. “After ovulation (which tends to occur mid cycle), oestrogen levels go down and progesterone levels start rising, and this imbalance then gives rise to PMS symptoms.”
“There are two main theories that appear to be connected,” adds Dr. Savita Brito-Mutunayagam, specialist registrar in sexual and reproductive health, and a member of the FSRH’s Clinical Standards Committee. “The first suggests that some women are more sensitive to normal levels of progesterone that are released after ovulation, which causes symptoms, since the serum concentrations of oestrogen or progesterone are the same in those without PMS.”
“We know that PMS and PMDD are caused by fluctuation of ovarian hormones. After ovulation (which tends to occur mid cycle), oestrogen levels go down and progesterone levels start rising, and this imbalance then gives rise to PMS symptoms.”
The second theory, she continues, is that symptoms are secondary to the interaction of progesterone with the neurotransmitters serotonin and c-aminobutyric acid (GABA). This is supported by the fact that some women do respond to treatment with antidepressants called selective serotonin reuptake inhibitors (SSRIs), and GABA levels are modulated by the metabolite of progesterone.
Also posited is that chemical changes in the brain, stress, and any mental problems can make PMS worse, and there is some evidence to show that alcohol, salt, and caffeine can exacerbate some symptoms of PMS. Interestingly, some preexisting conditions can get worse during the luteal phase of your menstrual cycle (from when you ovulate until your period starts), and these include depression, migraine, fatigue, asthma, and irritable bowel syndrome.
Who is at risk?
Some women are more at risk than others of getting PMS, but there is little you can do to tell if you are one of these women. “We don’t know why some people get more symptoms than others,” says Dr. Pisal. “It may be to do with sensitivity to some of the ovarian hormones, and also the level of fluctuation of hormone levels.”
Generally, symptoms seem to present around the age of 25, and there is a certain genetic factor involved. On top of this, symptoms disappear if you are pregnant, or menopausal, because at both these times hormones are no longer in a state of flux. Dr. Pisal also points out that not only is there an association between intensity of period symptoms (such as heaviness and pain) and PMS, women with endometriosis also tend to have more PMS related symptoms.
If you get PMS, although not badly enough to deem it worthy of a diagnosis with PMDD, what can you do to reduce your symptoms as much as possible? As mentioned above, caffeine and excess salt intake won’t help, and eight hours sleep a night will help reduce stress levels, if nothing else.
Is there anything you can do to relieve symptoms?
Most advice encourages people to avoid smoking, but if you are a seasoned smoker that is probably easier said than done. Nonetheless, evidence is thin on the ground for any other failsafe lifestyle changes, although Dr. Pisal mentions stress-reducing strategies such as yoga and exercise as well as surrounding yourself with supportive family members, friends and colleagues.
Some studies have found that vitamin B-6 seemed to effective in relieving both physical and mental symptoms of PMS.
There are some medical interventions that can help if your symptoms are affecting your day to day life. “Using the combined contraceptive pill is one of the most common ways of overriding ovarian hormone fluctuations and is often useful in reducing, and sometimes completely eliminating PMS symptoms,” says Dr. Pisal. As the combined oral contraceptive suppresses ovulation, it follows that this will reduce symptoms triggered by the release of progesterone into the bloodstream after ovulation.
Another means of suppressing ovulation, says Dr. Brito-Mutunayagam, is by using a medication called gonadotrophin-releasing hormone analogues, although these are only used in cases of severe PMS or PMDD, and are given along with hormone replacement therapy to protect your bones and prevent symptoms of menopause.
Dr. Pisal also mentions taking vitamin B-6 (pyrodixine) and herbal supplements such as evening primrose oil tablets, although studies to substantiate these have not been strong enough to provide definitive results on their efficacy. Nonetheless, some studies have found that vitamin B-6 seemed to effective in relieving both physical and mental symptoms. This is because pyridoxine is a co-enzyme for the biosynthesis of dopamine and serotonin, but no explanation for how it alleviates physical symptoms has been found.
Ultimately, you will know if you have PMS, and if you have symptoms, keeping a diary of them and noticing if there is a pattern can help you confirm this. Your symptoms might not cause you enough distress to warrant any further action, but if they do it is worth going to seek the advice of your doctor to see what your options are. There is no shame in admitting that you have it hard in the run-up to your period – up to 80% of women would agree with you.
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