PMS (premenstrual syndrome): symptoms, causes, therapy
PMS (Premenstrual Syndrome) refers to physical symptoms such as lower abdominal pain and/or psychological impairments up to depressive moods that occur before the start of menstrual bleeding. The reasons for this are not yet fully understood. However, female hormones seem to play a central role. Here you can read everything you need to know about PMS: symptoms, causes and risk factors, treatment and prognosis.
- What is PMS? PMS is the abbreviation for premenstrual syndrome. It occurs about two weeks to a few days before menstruation starts and is associated with physical and/or psychological symptoms. With the onset of menstruation the complaints disappear again. About 80 percent of women of childbearing age are affected by PMS.
- Symptoms: physical complaints such as lower abdominal pain, nausea, headaches. Psychological symptoms like sadness, mood swings, depressive moods. The symptoms vary from woman to woman and from cycle to cycle.
- Causes: Not fully clarified. Probably cycle-related fluctuations in the blood levels of female hormones (estrogen, progesterone) play a central role.
- Risk factors: stress, partnership problems, unbalanced diet, family history
- Treatment: sufficient sleep and exercise, balanced diet, relaxation and meditation exercises, hot water bottles and hot teas. In severe cases, medication (painkillers, possibly antidepressants, draining agents). Medicinal plants and homeopathics often have a supportive effect.
- Prognosis: PMS is not a disease in the classical sense and therefore cannot be “cured” by medical treatment. After the menopause, the symptoms usually disappear.
PMS affects about 80 percent of all women of childbearing age. You will have various physical and/or psychological complaints two weeks to three days before the start of your period, which will disappear again when your period begins. The nature and extent of the symptoms vary from woman to woman. They may also vary from month to month.
Physical PMS symptoms
Possible physical PMS symptoms include
- Abdominal pain
- Feeling of pressure in the lower abdomen
- Diarrhoea or constipation
- Circulatory problems, dizziness
- Hot flushes, sweating
- Back pain
- impure skin, pimples
In addition, appetite can be altered by PMS: Some women suffer from ravenous appetite attacks, while others complain of loss of appetite and a feeling of fullness. Nausea before the period and an inflated stomach are also possible. Some women also report weight gain before their period. This is not so much due to an increased food intake as to a storage of water in the tissue.
Breast tenderness and chest pain before menstruation are also possible signs of PMS. Doctors refer to this as mastodynia. Puncturing or pulling pain is characteristic. Often the breast is also enlarged because the hormonal imbalance before the period causes water to be stored in the breast tissue. With the beginning of menstrual bleeding, these water accumulations (edemas) recede again.
Mastalgia is to be distinguished from mastodynia. This is chest pain independent of menstruation (i.e. independent of the menstrual cycle). They can be caused by cysts, breast inflammation or breast cancer.
Headaches before the period are also not uncommon in PMS. Many women suffer from pressure pains in the middle of the head before menstruation. In some patients, the headache develops into a migraine. In general, women can react much more sensitively to stimuli such as bright light, noise, smells or touch before menstruation, which are then often perceived as extremely unpleasant. In addition, PMS sufferers are less able to cope with time pressure or stress during this time.
Mental PMS symptoms
PMS is usually accompanied not only by physical but also psychological symptoms. For example, affected women are often irritable in the period before menstruation. They also get tired faster, need more breaks and more sleep than usual. Other psychological PMS symptoms that are frequently observed are
- sudden fits of rage
- depressive moods
- greater anxiety
- Lack of interest
- Loss of drive
- inner anxiety
- Concentration disorders
Many women also feel overstrained more quickly in the period before their period. They worry more and feel a loss of control. Many are also sad or depressed. Often this also affects the self-esteem. This reinforces the overall negative sensation, which in turn can increase other PMS symptoms such as anxiety, concentration and sleep disturbances. Thus the affected women often get into a cycle of negative emotions.
The sadness or depressive mood before the period often has no objective reason. It can also disappear again suddenly. These inexplicable mood swings often lead to problems with the partner, family or friends.
If you suffer from mental PMS symptoms, it does not mean that you are mentally ill. The psychological changes – just like the physical ones – are caused, among other things, by the changed hormone level. Just like the physical symptoms of PMS, the psychological symptoms disappear one or two days before menstruation.
Many women suffer from premenstrual syndrome, but the symptoms can vary from woman to woman.
PMS or pregnancy?
Some PMS symptoms, such as mood swings, abdominal pain, nausea and ravenous appetite attacks, may also indicate pregnancy. However, especially at the beginning of a pregnancy, there are other complaints that can be clearly distinguished from PMS. These include morning sickness, a permanently slightly elevated temperature and extreme exhaustion. And at the latest when the next menstrual bleeding fails to occur, the question is clarified: PMS or pregnant?
Premenstrual Dysphoric Disorder (PMDS)
In about five percent of PMS sufferers, the burden of premenstrual syndrome is so great that the normal daily routine, work and family life are affected. These particularly severe cases are known as premenstrual dysphoric disorder (PMDS). In contrast to PMS, it is considered a disease.
PMS (Premenstrual Syndrome) is the term used to describe complaints such as mood swings, breast tenderness or a feeling of fullness (bloated abdomen), which occur exclusively before the onset of menstruation and disappear again when bleeding begins. They are therefore clearly associated with menstruation.
The consumption of chocolate increases the sugar and insulin levels. This indirectly leads to a “better feeling”, but does not change the actual PMS. As a preventive measure, you can try to eat a balanced diet, get enough sleep and exercise. Sometimes monk’s pepper (Agnus castus) also relieves the occurrence of the symptoms.
If the symptoms persist in spite of the above tips, a hormonal disorder could also be the reason. A thyroid dysfunction or an increase in the hormone prolactin sometimes leads – as does the beginning of the menopause – to a weakness of the corpus luteum, which triggers PMS. If you suspect that this could be the case with you, have your hormone levels checked.
PMS: causes and risk factors
The causes of PMS have not yet been clearly clarified. Doctors suspect that several factors trigger the symptoms. This is called a multifactorial origin or multifactorial genesis.
The role of hormones
Hormones appear to be the main cause of PMS. These are endogenous messenger substances that transmit messages between different organs and/or the brain. The female sex hormones estrogen and progesterone are particularly relevant for menstruation. Together with other female hormones, they ensure in each cycle that an egg matures, ovulation (release of the egg from the ovary) occurs and the uterine lining is prepared for the implantation of a fertilised egg. If fertilisation does not occur, the egg, including the prepared uterine lining, is rejected during menstruation.
During ovulation the estrogen concentration in the blood is highest. Many women feel the ovulation by a painful pulling in the lower abdomen. In addition, more prolactin is produced during this time. This hormone makes the mammary glands swell, which sometimes leads to tension pains in the breasts.
The hormonal changes during the cycle can also cause electrolyte and fluid shifts in the body. This could be responsible for at least some PMS symptoms. The substances that are produced when the hormone progesterone is broken down are also suspected of triggering PMS symptoms. In addition, PMS sufferers may be more sensitive to the interaction between progesterone and certain messenger substances in the brain such as serotonin.
Other possible causes of PMS
Other factors that could contribute to the development of premenstrual syndrome are
- low melatonin level
- Hypothyroidism (hypothyroidism)
- Vegetative nervous system disorders
- Problems in the partnership
- unbalanced diet
- Nicotine consumption
- little movement
- some hormonal contraceptives
In addition, a family history of mental illness (for example depression) is considered a risk factor for premenstrual dysphoric syndrome (PMDS).
PMS: examinations and diagnosis
If you suspect you have PMS, you should discuss this with your gynaecologist (gynaecologist). The doctor will first ask you about your medical history (anamnesis). Describe your complaints as precisely as possible so that the doctor can form an exact picture. You should prepare yourself for these questions:
- How long before menstruation do the symptoms first appear?
- Are you in pain and if so, where exactly?
- Do the symptoms always occur before the start of your period?
- Do you only have physical complaints or do you also feel mentally impaired?
A PMS diary can help you prepare for this, in which you note down over several cycles when which symptoms occur. This will allow you to give your doctor accurate information. This helps him to rule out other causes for your complaints.
The medical history is followed by a physical examination. With a gynaecological palpation and an ultrasound examination of the uterus and neighbouring organs, the doctor can exclude organic diseases such as a tumour as the cause of the complaints. In addition, the physician (possibly together with other specialists) will examine whether the symptoms are possibly caused by hypothyroidism, endometriosis or depression. The onset of menopause must also be excluded, as PMS-like symptoms can also occur during this period.
A blood test can provide additional information. The expert can tell from various blood values whether your symptoms are due to hormonal causes. In general, women with PMS symptoms show increased levels of inflammation during the symptoms.
PMS treatment depends on how intense the symptoms are. In mild cases it usually helps if you get enough sleep and exercise regularly. A balanced diet is also recommended: make sure you eat a diet rich in carbohydrates, low in salt and easily digestible. Avoid coffee, alcohol and nicotine because they can increase PMS symptoms. You can relieve lower abdominal pain with a hot water bottle or hot tea. Many women also benefit from specific relaxation exercises or meditation.
In severe cases, however, when the complaints affect everyday life, such symptomatic therapy is not sufficient. Then the PMS should be treated with medication. Painkillers such as ibuprofen, hormone preparations such as the pill and mood-lifting drugs (antidepressants) are available for this purpose. Massive water retention (edema) can be treated with diuretic drugs. Psychiatric treatment can be useful for severe psychological symptoms.
Sometimes dietary supplements, for example with magnesium or iron, can also alleviate the symptoms. Discuss the use of such preparations with your doctor.
PMS: homeopathy and medicinal plants
Many women rely on complementary cures for PMS. Even though their effectiveness is often not scientifically proven, many sufferers nevertheless report an improvement in their symptoms.
Homeopathy knows several remedies that can be used for PMS. Depending on the type of complaints, these include, for example, Calcium carbonicum (water retention, especially with swollen breasts), Pulsatilla (sadness with frequent crying), Natrium muriaticum (irritability, sensitivity, crying) and Cyclamen (painful swollen breasts, migraine-like headaches, etc.). Women can seek advice from an experienced therapist on the selection of suitable homeopathic remedies.
Herbal medicine can also help with PMS symptoms. For example, the effectiveness of herbal preparations containing monk’s pepper has been scientifically well researched. Such preparations are used, for example, when an increased prolactin level causes pain and tension in the breasts. Preparations with St. John’s wort are helpful for mild depressive moods. Valerian and lemon balm are recommended against sleeping problems and nervous restlessness. A doctor or pharmacist can recommend suitable medicinal plants to women for their PMS symptoms and give advice on how to use them.
PMS: Course and prognosis
An exact prognosis for PMS is not possible. This is because it is not an acute disease that can be completely cured with therapy. But at the latest with the menopause, the PMS symptoms generally disappear completely. Until then, the symptoms of PMS can usually be controlled with relaxation, sufficient sleep and exercise, and a balanced diet.