Menstrual Health

Aug 23, 2021

PMS 101: Causes, Symptoms & Treatments

PMS can be an annoying acquaintance or your worst enemy. Learn about symptoms, causes and lifestyle changes for optimal management.

Your period is about to make an appearance. You know this not just because of any tracker you may use, but because you start experiencing headaches, mood swings, constipation, breast tenderness, anxiety and even irritability. These collection of signs and symptoms constitute what is popularly known as PMS or Premenstrual Syndrome — someone's annoying acquaintance and someone's worst enemy. In this blog, we'll define PMS, identify important symptoms and discuss treatments. Let's get started!

So, what is PMS?

PMS or pre-menstrual syndrome refers to certain emotional, physical and psychological symptoms that arise a few days before the start of a period and disappear soon after. These collection of symptoms have varying impacts on different people and can include the following: [1]

  • Bloating
  • Tenderness
  • Cramps
  • Mood swings
  • Irritability
  • Headaches
  • Back pain
  • Changes in appetite and weight gain
  • Changes in sex drive
  • Nausea
  • Constipation
  • Anger
  • Fatigue

The origin of PMS is complex and yet to be fully understood with several theories being investigated around stress, insulin resistance, genetics, prolactin levels and the action of progesterone on neurotransmitters. Since PMS symptoms show up in sync with the hormone fluctuations of the period cycle, hormonal imbalance could be a likely explanation. Symptoms are also associated with serotonin to link as a key etiological factor. [2]

A study from Egypt has also demonstrated a positive association between PMS and excess intake of sweet food items. In fact, other variables such as the consumption of junk food and caffeine, were also linked to PMS symptoms. Thus, establishing that lifestyle plays a significant role when it comes to PMS and PMDD. Cheng et al. conducted a similar study among female university students and found that dietary choices including the intake of fast food and sugary drinks, along with other lifestyle factors such as a sedentary life and poor sleep are significantly linked to PMS. [2][3]

Does everyone go through PMS?

While, ~80% of women report experiencing at least one of the PMS symptoms prior to menstruation, not everyone is clinically diagnosed with PMS.

Per, the American College of Obstetricians and Gynaecologists, in order to be diagnosed with clinical PMS, your symptoms must:

  • Be present in the 5 days before your period for at least three menstrual cycles in a row
  • End within 4 days after your period starts
  • Interfere with some of your normal activities (i.e., your symptoms prevent you from functioning as normal)

Research on the prevalence of PMS is still not conclusive: while some studies suggest that  ~12% of women meet the clinical definition of PMS [4], other studies place this number as high as 36-48% of women worldwide. [5] Regardless of the number, PMS is a legitimate condition that should not be trivialised.

PMS to PMDD

Along with PMS, there also exists a condition called PMDD or Pre-menstrual Dysphoric Disorder. Pre-menstrual Dysphoric Disorder is a severe form of PMS, experienced by ~2-5% of women in which the mood swings are far more pronounced than usual. This can be a debilitating condition, and can often be diagnosed incorrectly.

Can your symptoms be something else?

When it comes to diagnosing PMS or PMDD, it is important to rule out other conditions ****such as depression and anxiety, or premenstrual exacerbation of another disorder which can often have similar symptoms. To do this, observe whether the symptoms such as mood swings subside after your periods start or whether they persist longer. In case of persistent symptoms, it is probably not PMS or PMDD. The line of treatment will differ dependent on the underlying condition.

How can you make PMS better?

There exists this notion that PMS is just something you have to live with. While this could be feasible for for those with mild symptoms, it may not be an acceptable premise for those who suffer from severe PMS or PMDD. As is the case for other menstrual problems, adopting lifestyle changes around diet, exercise, and  cognitive behavior therapy (CBT) is believed to be the first line treatment for managing PMS symptoms.

Diet: As established earlier, there have been multiple studies conducted all over the world  [6] [7] that have established clear links between increased PMS symptoms and the regular consumption of  highly processed foods with excess salt and sugar. On the other end of the spectrum, jumping on fad diets has also found to contribute towards PMS. We recognize that relationships with food can be nuanced: culture, socio-economic status, working hours, industrialisation  - are all variables that impact food choices and availability, but we urge you to make the changes you can.

Emphasis in studies is placed on switching from simple carbohydrates such as sugary drinks, candy to complex carbohydrates such as whole grains, leafy vegetables etc. High fiber intake is also linked to better menstrual health. Some dietary supplements to consider taking include calcium, magnesium (you can also meet your daily magnesium requirement from consuming half an avocado, ~30 grams of pumpkin seeds or a half cup of black beans) and vitamin E. Please consult your GP before making any meaningful changes.

Exercise: In many cases, regular aerobic exercise (cycling, swimming, running etc.) is shown to relieve PMS symptoms such as cramps and back pain. The key is to be consistent and to aim for at least 150-180 minutes of exercise every week. There also exists a whole body of research that supports the practice of yoga to relieve PMS cramps and shortening the duration of each cramp. Yoga can also be a great way to lower stress which can help reduce the intensity of pain. If you're someone who relates to having period cramps, don't forget to join the waitlist for Girlmantra's app. We are designing a whole library around mindfulness and movement for your unique menstrual challenges.

Cognitive Behavior Therapy:  Severe PMS can negatively impact Quality of Life by interfering with self esteem, relationships and mood. Multiple studies [6] indicate that CBT interventions can be effective at reframing anxiety, increasing awareness and shedding light on coping mechanisms.

When should I see a doctor?

If you've already given lifestyle changes a try or If you find your normal routine getting completely derailed due to PMS or PMDD symptoms, consult a doctor immediately for medical interventions. It may be time for hormonal therapy or anti-depressants.

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