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Premenstrual Syndrome (PMS)


Dr Sheela Purkayastha - Female Gynaecologist


It is common to experience symptoms in the fortnight before your period is due, which is referred to as premenstrual syndrome, often shortened to PMS. While these symptoms are mild for most women, if you are among the 5% of women who experience more severe symptoms, these can interfere with your daily life. Thankfully, effective treatments are available to manage more severe PMS, but first it is important to get an accurate diagnosis to make sure that this is the right course of action. Consulting with a gynaecologist experienced in diagnosing and treating premenstrual tension is therefore essential.


Symptoms of Premenstrual Syndrome


Although the symptoms of PMS vary from one woman to another and can change slightly from one month to the next, you are likely to experience some of the most common physical and psychological symptoms. These include abdominal discomfort, bloating, headaches, breast pain, nausea, altered appetite, insomnia, mood swings, increased irritability, and anxiety, feeling tired or restless. Even though these signs of premenstrual syndrome can start up to 2 weeks before you period arrives, they should improve once it is here.


However, with more severe symptoms, particularly if they are more of a psychological nature, this can be a sign of premenstrual dysphoric disorder (PMDD). Typical symptoms of PMDD are feeling depressed, hopeless, angry, extremely anxious or low in self-esteem, along with a significant change in your sleep patterns. In the worst cases of PMDD, suicidal thoughts may arise. It is especially important that you seek advice about premenstrual symptoms if you think you may have PMDD.


Causes of Premenstrual Syndrome


The precise cause of PMS is not known, but changes in hormones and brain chemicals, as well as lifestyle factors may all play a role. Fluctuating levels of oestrogen and progesterone during your menstrual cycle is likely to have the biggest impact on how you feel. These hormone changes can also lower levels of the brain chemical serotonin, which usually enhances your mood, so lower levels may explain why a depressed mood is a feature of premenstrual syndrome. Research also suggests that you are more prone to PMS if your BMI is over 30, you take little exercise or you suffer from stress, though your diet can also influence the symptoms of premenstrual tension. For example, a high salt intake can worsen bloating, while alcohol and caffeine can affect your alertness and mood. A poor intake of certain micronutrients can also lead to more severe PMS.


Diagnosing and Treating Premenstrual Syndrome


The key to an accurate diagnosis of PMS is for a gynaecologist to take a detailed history of your symptoms and how they change. Keeping a record of your symptoms each month is a useful way to monitor your symptoms and aid your diagnosis, and questionnaires are available from the National Association of Premenstrual Syndrome to help you keep track of your premenstrual symptoms. With a firm diagnosis ofpremenstrual syndrome, your gynaecologist will discuss the various treatment options available with you. Dr Sheela Purkayastha will tailor your PMS treatment plan to your needs and preferences, though this may include lifestyle changes, complementary treatments, talking therapies and medical management using prescribed drugs.


Simple changes to your diet such as keeping well hydrated, eating little and often, including complex carbohydrates with meals, as well as plenty of fruit, vegetables and foods rich in calcium may help to ease your symptoms. At the same time you may want to consider cutting back your intake of salt, alcohol and caffeine. Dr Purkayastha may also recommend certain vitamin, mineral or herbal supplements to complement your dietary intake. However, it is unwise to take these without supervision, as the evidence for some of these is limited and they may interact with other medications you take. Dr Purkayastha can therefore guide you as to which are most suitable. Keeping physically active can additionally help to reduce low mood and boost your energy levels, while specific activities like yoga and Pilates can combat stress. Meanwhile, cognitive behavioural therapy can help with low mood and anxiety if these are a key feature of your premenstrual syndrome. For severe PMS or if you have PMDD a range of medications are available. Painkillers and antidepressants may be suitable depending on your symptoms, though a gynaecologist may also advise oral contraceptives, oestrogen-only therapy or other hormone treatments to favourably adjust your hormone levels.


To receive a diagnosis and advice on the most suitable treatment for PMS, make an appointment with Dr Purkayastha now.

A Specialist Women's Healthcare Clinic in London working closely with women of all ages.

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