The monthly premenstrual syndrome (PMS) monster: causes, symptoms and what to do about it

Transforming into an irritable mess who’d much rather crawl back into bed with a heat pad; this scenario is awfully familiar for everyone who has to deal with the mental and physical pains related to the menstrual cycle. But for about 5 percent to a quarter of people who menstruate, the pain can be practically unbearable. To the point that it influences - and sometimes prevents them from properly living - their daily life. Welcome to the glamorous world of PMS.

What is it exactly?

You’ve probably heard of premenstrual syndrome (PMS) before. It’s used as an umbrella term for a plethora of symptoms, both physical and emotional, which women experience one or two weeks prior to their period. 

Mood swings, fatigue, headaches, stomach aches, back pains and sugar cravings. It’s all the usual premenstrual symptoms but way, way, way worse. For some it only lasts a few days, but others experience up to two weeks of this horridness. The symptoms disappear into thin air once your period hits, which gives you practically one week to truly recuperate before it starts all over again. 

Most women who struggle with PMS only realize they have this syndrome after their first pregnancy or around age 30. Younger women often experience a milder version which then worsens over the years. But not all is lost, because after menopause PMS will be in the past and during pregnancy women often struggle less as well.

How, what, where?

It’s a shame that not enough research has been done on PMS to truly tell, but the cause is definitely related to hormones. It’s not like women with PMS have more hormones than women who don’t struggle with PMS. It appears that women with PMS react more sensitively to progesterone, which is a hormone produced by the ovaries after ovulation. Progesterone is supposed to have a calming effect, but it might have a different effect on women with PMS. Research proves that for women with PMS, in the period of time after ovulation, serotonin levels drop, a hormone also known as the happiness hormone. There’s a high chance that this is genetically related and likely passed from parent to child as well.

PMS symptoms are chronically downplayed and PMS patients are generally viewed as if they’re overreacting. This is quite problematic because PMS is a serious condition. It could trigger epilepsy, diabetes, asthma, migraine and allergies, but maybe most importantly, it could severely affect someone’s mental health. 

Surprisingly, PMS symptoms are way more common in the west than anywhere else. There appears to be a connection with stress…having to juggle work, kids, social life and sometimes looks (thanks society). Let’s not forget the pressure of having to hide the fact that you’re on your period just to be taken seriously in social and work environments alike. All that stress combined with a western diet consisting of sugar, coffee and alcohol on top of a lack of exercise, makes for a perfect climate of the worst symptoms. 

How do you know if you have PMS?

The only way to diagnose PMS is to keep a detailed calendar of symptoms. You can do this by writing down all your symptoms over the course of two cycles. Write down what the symptoms are and how long you experience them. If they remain unchanged over the course of the whole month, meaning there’s no break of at least a week, there’s a large chance that you might be dealing with something different from PMS. Call your GP to find out the cause of your symptoms. 

There are more than a hundred different symptoms associated with PMS. Since a ‘syndrome’ stands for a group of symptoms, people who experience it can have wildly different symptoms while still falling under the umbrella term of PMS. It also means that no woman experiences all symptoms (which, again, more than a hundred), and the symptoms can differ between cycles and change over time too. The most commonly experienced symptoms are: 

• Depression

• Fatigue

• Mood swings

• Temper tantrums

• Crying spells

• Nervousness

• Irritability

• Distress

• Bloating

• Painful, firm breasts

• Stomach ache or cramps

• Lower back pain

• Headaches

• Joint pain

• Water retention (often in hands and feet)

• Weight gain

• Digestive issues (nausea, cramps, diarrhea)

• Sleeping problems

• Concentration problems

• Loss of libido

• Sugar cravings 

• Acne

• Perspiration

• General malaise

How to relieve symptoms?

Treating PMS is not easy. Lots of women feel extremely lonely and misunderstood in regards to their PMS. That’s pretty understandable considering PMS is not taken as seriously as it should. It’s important to at least take yourself seriously and to be kind to yourself. 

Healthy lifestyle

Exercising regularly and eating healthy food. Look, we know it’s a bit obvious but there’s a good reason behind that: it clearly works. Exercise helps your body release endorphins, which makes you feel better in general. You’re probably not exactly looking forward to moving your body at all when you’re PMSing, let alone doing a full workout, but taking a short walk for some fresh air makes a world of difference.

A healthy diet often relieves PMS symptoms. There are a few guidelines that will help, though they do leave your meals looking and tasting terribly boring…

• Eat small meals every three or four hours. This makes it easier to avoid bingeing. 

• Eat as little sugar as you can, this makes it easier to avoid fluctuations in your blood sugar levels. 

• Pay attention to hidden sugars in sauce, soup and meat. 

• Drink as little alcohol and caffeine as possible.

• Avoid spicy foods.

• Avoid using too much salt (especially if you struggle with water retention).

• Eat foods rich in calcium

Contraceptive pill

Some women swear on using the pill to soothe PMS symptoms, as the pill reduces hormonal imbalances. You could even decide to take the pill without a break, so you won’t get your period at all. Pills in which the levels of hormones are the same in all pills (monophasic pills) work better against PMS symptoms than ones that have differing levels of hormones (multiphasic pills). Pills containing the hormone drospirenone, a hormone similar to progesterone, help against water retention. If you struggle with water retention, bloating or painful breasts, the pill might be the solution for you. But taking the pill is not a foolproof solution to PMS symptoms, it doesn’t work for everyone. 

LHRH agonists

This medicine suppresses the ovarian cycle, which then suppresses the production of oestrogen and progesterone. You won’t have a period nor will you get any PMS symptoms. However, this will result in an early perimenopause with all its unpleasantness. Hot flashes, nausea, night sweats and headaches for example. Besides, it’s not recommended to use this medicine for more than 6 months, because it heightens the risk of cardiovascular diseases and osteoporosis.

Antidepressants 

Antidepressants influence the serotonin levels in the brain, making you less susceptible to hormonal imbalances. The most commonly used medicines are fluoxetine (Prozac), paroxetine (Seroxat) and sertraline (Zoloft). In the case of PMS it’s fine to take the medicine only during the second half of your cycle, when the symptoms are the worst. Antidepressants come with their own side effects though. From dizziness and difficulty reaching orgasms, to insomnia. It’s important to decide which is worse: the cure or the disease. 

IUD 

A hormonal IUD releases small amounts of progestin every day, which soothes the symptoms experienced during periods and often stops the period from happening entirely. Sometimes, this helps against PMS symptoms as well, but this isn’t always the case.

Surgery

For women who don’t want any (more) children, the ovaries can be removed entirely. This will stop your cycle and PMS. The negative side is that this surgery could have serious complications. You would also hit your menopause immediately which is unhealthy for younger women, as premature menopause causes all kinds of troubles related to ageing. Therefore this surgery isn’t performed often.

Vitamins and supplements

Some women can’t or choose not to take hormones, meaning the pill is not an option. They usually look for a solution in supplements. Examples are vitamin B6, homeopathy and natural remedies. But we’ve also heard of people using vitamin E (tocopherol), fish oil (for menstrual pains), krill oil (for breast tenderness), evening primrose oil (for mental balance) and chasteberry. According to research these supplements are nothing more than a placebo, but that doesn’t mean it can’t soothe the symptoms. Our advice is to always seek advice from an expert first, before looking into alternative methods.

Talk about it 

Talk about it with your friends, family, partner, anyone in your close circle who will listen. It will help them understand how you’re feeling and how to help you get through the struggle. If you’re struggling anyway, you might as well do it together. Maybe it’s an idea to do this after your period though. This way you have a clear head and don’t say anything you might regret later. If you feel like you can’t do it alone, there’s no shame in talking to a professional about it. Together you can try to find the best strategies on how to deal with the symptoms.

Do you feel like you’re experiencing these symptoms but more severe, with feelings of depression and anxiety? It might be helpful to read this article on PMDD.