PMS and PMDD

When your periods are about to start, you usually get signs in the form of certain physical and emotional symptoms. For many women, it’s not a big deal. They get some tenderness in breasts or a craving for sweets. But for some of them, the days preceding their periods are difficult. 

If the symptoms before period disturb your routine life, you may be suffering from premenstrual syndrome (PMS). PMS symptoms start when you are about to have your periods each month. PMDD or premenstrual dysphoric disorder is a severe form of premenstrual syndrome in which the symptoms are so much debilitating that they interfere with your daily life including work, social interaction, school, and relationships.

PMS is a combination of physical, behavioral, and emotional symptoms that occur in a woman during the premenstrual phase of her menstrual cycle. According to doctors, about 75% of women in their reproductive years suffer from some signs of PMS. These can be in the form of food cravings, tender breasts, cramps, fatigue, or mood swings. 

Wish we knew the exact answer to "when does PMS start?" Unfortunately, it differs from individual to individual, with the earliest manifestations on day 14 of the menstrual cycle, and the latest happening even four days after the start of your period.

The menstrual cycle of a woman lasts approximately 28 days. Ovulation or the time when a mature egg gets released from one of the ovaries usually occurs on 14th day of the menstrual cycle. Periods occur on the 28th day of the menstrual cycle, marking the beginning of a new one. PMS symptoms may start around the 14th day of the cycle and last till four days after the start of your period.

Premenstrual syndrome symptoms usually range from mild to moderate. Almost 80 percent of females have one or more PMS symptoms, which doesn’t significantly affect their daily functioning. 20 to 30 percent of women have moderate to severe premenstrual symptoms affecting important aspects of their lives. Three to eight percent suffer from PMDD. 

The severity of premenstrual symptoms may vary from woman to woman. The severity may even fluctuate month to month in the same person. Premenstrual syndrome symptoms are more common if you fall in the age group of 20 to 40 years; have had a baby; have a family history of depression or have a personal history of postpartum depression, bipolar disorder or depression. The signs and symptoms of PMS are described below. Note, that not everyone has to get all of the PMS symptoms at once.

• anxiety or tension
• crying spells
• PMS mood swings and anger or irritability
• depressed mood
• food cravings and appetite changes
• insomnia or trouble in falling asleep
• changes in libido
• poor concentration
• social withdrawal (does not want to meet people)
• forgetfulness

• pain in muscles and joints
• headache
• abdominal bloating
• fatigue
• flare-ups of acne
• diarrhea or constipation
• sore and tender breasts
• weight gain due to fluid retention
• pain in abdomen
• cramps
• swelling in feet and hands

Is nausea a symptom of PMS? You may get nausea before your periods due to the hormonal changes your body undergoes during that time. The headaches and cramps may also make you nauseous and unwell.

You should see a doctor if PMS mood swings or other premenstrual symptoms start affecting your daily activities and health. You should also visit a doctor if you are not able to stop PMS symptoms with diet and lifestyle changes.

Although PMS is a common condition, its exact cause is not known. According to most evidence, PMS occurs due to alterations in the levels of brain chemicals (referred to as neurotransmitters) and sex hormones. A fluctuation in the level of serotonin, a neurotransmitter, is one of the triggers of PMS symptoms. Insufficient amount of serotonin may result in premenstrual symptoms of depression, fatigue, sleep problems, and food cravings.

Some factors aggravate PMS even though they don’t cause it. Premenstrual syndrome symptoms can get worse by the following factors:

• Smoking 
• Leading a sedentary life
• Not sleeping enough
• Excessive alcohol drinking
• Eating excessive amount of salt, sugar or red meat
• Getting depressed
• Living under a lot of stress

If you suffer from other health issues such as asthma, allergies and migraine headaches, you may notice that these problems get aggravated before your periods.

There are no special lab tests or physical findings for premenstrual syndrome diagnosis. Your physician may assign a particular sign or symptom to premenstrual syndrome if it belongs to your expected premenstrual pattern. Your physician may ask you to record your signs of PMS either in a diary or on a calendar for a minimum of two menstrual cycles. This will help in establishing your premenstrual pattern. You have to record the day you have your first PMS symptom and the day the symptoms stop. Also, make sure to record the days your periods start and end.

Certain other health problems such as mood disorders (anxiety and depression), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), and thyroid disorders may mimic premenstrual syndrome. Therefore, your physician may order certain tests such as a pregnancy test or mood screening tests or thyroid function tests to make a correct diagnosis.

The hallmark of premenstrual syndrome diagnosis is the interval that remains without any symptoms between the end of period and the ovulation of the next menstrual cycle. If you don’t have such a symptom-free interval and you have symptoms throughout the menstrual cycle, then premenstrual syndrome is not the correct diagnosis.

For some women, premenstrual symptoms are relieved by making lifestyle changes. However, based on your PMS symptom severity, the doctor may give you one or more medicines for PMS treatment.

The medicines that are commonly prescribed for PMS treatment include:

• Antidepressants. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) including paroxetine, fluoxetine, and sertraline are successful in decreasing symptoms of PMS mood swings. SSRIs remain the first choice for premenstrual syndrome treatment, especially for severe symptoms of PMS and PMDD. These medicines are prescribed by your doctor and you have to take them daily. However, in some women, the doctor may ask to take these medicines only during 15 days before the start of menses. 
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include over-the-counter painkillers such as naproxen sodium or ibuprofen. You should take these drugs either before or during menses to relieve premenstrual symptoms of breast discomfort and cramping. Make sure that you follow the dosage exactly as mentioned on the medicine label.
• Diuretics. Diuretics or water pills are also a part of PMS treatment to reduce premenstrual symptoms of weight gain, bloating, and swelling. They help in removing the excess fluid from your body through the kidneys.
• Hormonal contraceptives. Hormonal contraceptives also referred to as birth control pills stop ovulation that helps in relieving premenstrual syndrome symptoms.  

You can reduce or manage your bad PMS symptoms by making certain lifestyle changes. These changes include modifying your diet, exercising regularly, and taking steps to reduce stress in your daily life.

One of the best treatments for PMS is to make some dietary modifications. Although a perfect PMS diet doesn’t exist, you can incorporate certain dietary habits into your routine to ease your premenstrual symptoms. Try the following tips :
Eat smaller meals more frequently to reduce the sensation of bloating and fullness.

Limit your intake of salty foods and salt, especially before menses.

• Eat foods that are rich in complex carbohydrates including whole grains, vegetables and fruits.
• Opt for calcium-rich foods such as green leafy vegetables and dairy products. If you are lacking dietary calcium, ask your doctor for a calcium supplement. 
• Avoid alcohol and caffeine.
• You may also ask your doctor for recommendations on magnesium, vitamin E and vitamin B6 supplements as these help to reduce symptoms of PMS mood swings and cramps.

One of the ways for PMS symptoms treatment is to engage in regular exercise for a minimum of half an hour every day. Exercise helps in releasing endorphins, which are the feel-good hormones that affect the perception of pain and mood. You should opt for low impact exercises such as cycling, brisk walking, and swimming. Regular exercise helps in not only improving your overall fitness and health but also alleviating your premenstrual symptoms of depression, anxiety, fatigue, and fluid retention.

Maintain a record of your symptoms before period. This helps in identifying the triggers and timings of your premenstrual symptoms, which allows you to follow strategies to lessen them.

Reducing your stress levels also helps to relieve premenstrual symptoms. Stress is also one of the many causes of experiencing period symptoms without actually menstruating. Get adequate amount of sleep. Practice deep breathing or progressive muscle relaxation exercises to reduce symptoms of anxiety, insomnia or headaches. Try massage therapy or yoga to relieve stress and relax.

If you are suffering from PMS or PMDD and want to track your periods or symptoms related to PMS and know more about other period-related issues, install our mobile app.

PMS is a common condition that affects many women during their reproductive years. The symptoms of PMS may range from mild to moderate in most of the cases. But in some cases, it may be severe, then it is referred to as PMDD. The symptoms of PMDD interfere with daily life activities, social life, work, and relationships. 

The symptoms of PMS can be physical and emotional. Based on the severity of your symptoms, your doctor may prescribe various medicines to relieve your symptoms. You can also manage your PMS symptoms by adopting certain lifestyle changes including making modifications in your diet, doing regular exercise, and reducing your stress levels. You may also consult your doctor and get prescriptions for supplements to help relieve your symptoms. 

Reviewed by prof. Tahir Mahmoud, Chair of Standards of Care European Board and College of Obstetrics and Gynaecology.