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Premenstrual Syndrome and Menopause

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Premenstrual Syndrome and Menopause Premenstrual syndrome and menopause 1 This booklet has been written by Dr Louise Newson, GP, menopause specialist and founder of the Newson Health and Wellbeing Centre in Stratford-upon-Avon, England. For more information on Dr Newson visit www.menopausedoctor.co.uk Contents Types of PMS . 4 Diagnosing PMS . 5 Impact, causes and symptoms of PMS . 5 Treatments for mild to moderate PMS . 7-9 Treatments for moderate to severe PMS . 9-10 PMS, perimenopause and menopause . 11 2 What is Premenstrual syndrome/PMS? Premenstrual syndrome (also known as PMS) is when women who have periods experience distressing symptoms in the days or even weeks leading up to starting their period. PMS encompasses a vast array of psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings. There are also physical symptoms, such as bloatedness and breast tenderness. PMS is identified when symptoms occur - and have a negative impact - during the luteal phase of your menstrual cycle. The luteal phase occurs between ovulation (normally mid- cycle, around day 14) and starting your period (usually around day 28). Although the average length of the menstrual cycle is 28 days, it can vary greatly between women and you may find the length of your cycle varies from month to month. 3 Types of PMS Many women notice their premenstrual luteal phase and improve when you start symptoms, but they are not really affected your period. You should then have a by them in any significant way. This would symptom-free week after your period. not be considered as a premenstrual disorder as such, merely a typical Variant PMDs physiological process. Unfortunately, for There are also PMDs that do not meet many other women the symptoms that the criteria for core PMDs. These are occur in the premenstrual part of their called ‘variant’ PMDs and examples of cycles do have a negative effect on their these include when you experience PMS lives and relationships. symptoms but do not have periods (for various medical reasons), when you have There are several types of premenstrual PMS symptoms that are triggered by disorders (PMD) and they are classified progestogen treatments or when you into two groups: ‘core’ premenstrual have an existing medical condition that is disorders and ‘variant’ premenstrual exacerbated in the premenstrual phase. disorders. The most commonly encountered and widely recognised types Premenstrual dysphoric disorder of PMS are the core premenstrual (PMDD) disorders. This term is becoming increasingly used and is an extreme version of a core Core PMDs premenstrual disorder; there are strict Women with premenstrual disorders criteria for diagnosing PMDD. Certain have symptoms that are severe enough to symptoms must be present, and this affect daily functioning, interfere with always includes mood. The symptoms work, school performance or must occur in the luteal phase and must interpersonal relationships. The symptoms be severe enough to disrupt daily occur and recur in ovulatory cycles. functioning. Symptoms must be present during the 4 Diagnosing PMS It is the timing of symptoms and the degree change over the course of a cycle (such as of impact on daily activity that supports a balance-app.com) diagnosis of PMS, rather than merely the types of symptoms themselves. Identifying Using such tools will accurately reflect what the timing of the symptoms is crucial as days symptoms occur, which days they are there are no blood tests to confirm PMS; absent, the days of menstruation and the keeping a symptom diary is the most duration of the menstrual cycle. It provides reliable method of diagnosis. You should your GP with an evidence base from which keep the diary over the length of two cycles to both diagnose and treat the PMS. This as a minimum and write in it as it happens information should be established and rather than relying on your memory a week shared with your GP before any treatment or two later. is commenced. There are charts or questionnaires If a symptom diary is inconclusive, there is developed for this purpose. The DRSP an alternative way of diagnosing PMS and tool (Daily Record of Severity of that is to ‘shut off’ the ovaries by using Problems) is a questionnaire that is medication. GnRH (gonadotropin releasing widely used by doctors; The National hormone) analogues are a group of drugs Association for Premenstrual Syndrome that are modified versions of a naturally (NAPS) has a chart that can be occurring hormone in the body, which help downloaded (www.pms.org.uk) and the to control the menstrual cycle. Shutting IAPMD also has a symptom tracker down the body’s production of estrogen (https://iapmd.org/symptom-tracker) to and progestogen for three months, by using record your symptoms over the month. a GnRH analogue, will stop the menstrual Alternatively, some women find using a cycle occurring and should in theory stop period tracking app useful for logging PMS symptoms. If symptoms do not stop symptoms and monitoring how they then other medical or psychiatric causes should be investigated. 5 Impact of PMS PMS can occur in any woman during her PMS can affect not only the individual child-bearing years. It is estimated that as woman but her whole network of many as 30% of women experience relationships – partners, children, relatives, moderate to severe PMS and 5-8% of friends and work colleagues. The these women suffer with very severe PMS fluctuating nature of symptoms can be or PMDD. This means that for 5 million unsettling for all involved. women in the UK, PMS is having a significant and detrimental effect on their quality of life, if left untreated. Causes of PMS Although the precise causes of PMS are by their hormones, postmenopause, and yet to be identified – there may be a time is often needed to find the right HRT genetic susceptibility for some women - regimen for these women). there is compelling evidence that symptoms are directly related to the PMS appears to begin, or increase in fluctuation of hormone levels in the severity, at times of marked hormonal monthly cycle. PMS is not seen in young change such as in puberty (even before girls who are yet to start their periods, in the first period happens), starting or pregnancy, or after the menopause in stopping the oral contraceptive pill, most women. (Women with a history of after pregnancy, and during the severe PMS/PMDD may still be affected perimenopause and menopause. Symptoms of PMS PMS is characterised by a number of Most women will experience only a few symptoms (over 150 have been identified) of these symptoms – one or two may be and they are usually grouped into dominant - and each symptom can vary psychological and behavioural, and physical in severity during a cycle, and from one symptoms. cycle to another. New symptoms may present at any time during a woman’s Common psychological and behavioural experience of PMS. symptoms are mood swings, depression, tiredness, fatigue or lethargy, anxiety, PMS symptoms may be experienced feeling out of control, irritability, aggression, continuously from ovulation to anger, disordered sleep, and food cravings. menstruation, for just the 7 days before menstruation, at ovulation for 3 or 4 days, Common physical symptoms are and/or just prior to menstruation. Some breast tenderness (mastalgia), bloating, women do not experience relief from clumsiness, and headaches. symptoms until the day of the period’s heaviest flow. 6 Treatments for PMS Treatments for mild to moderate PMS There are different levels of management weight gain. Changing to carbohydrates for PMS, depending on the severity of that releases glucose more slowly (low symptoms and how a woman has glycaemic index/GI carbohydrates) such as responded to previous treatments. The wholegrain bread, brown or basmati rice, first line approach most GPs will adopt is pulses, beans or sweet potatoes and having to try one or more of the following: plenty of low GI vegetables such as salad lifestyle changes and exercise, vitamin or greens, can be beneficial. Avoiding meat B6 supplements, the combined oral in the 7 - 10 days before your menstrual contraceptive pill, Cognitive Behavioural cycle may help to reduce the pain Therapy (CBT), and a low-dose SSRI associated with PMS. (antidepressant). The essential fats in oily fish, such as Lifestyle changes salmon, mackerel and sardines, or in Making healthy changes to your lifestyle can plant-based foods such as chia seeds, be beneficial if you experience milder PMS edamame, or kidney beans, may improve symptoms. This includes reducing stress, PMS symptoms. It is recommended that limiting alcohol and caffeine, and cutting you eat foods high in Omega 3 oils down or stopping smoking. Alcohol may two times a week or in the form of a contribute to anxiety symptoms and quality fish oil supplement or algae-based hormone imbalance - it is best consumed EPA/DHA. Green vegetables are rich in in moderation. High caffeine consumption fibre, magnesium and folic acid and are has been associated with an increased important for hormone balance, foods rich incidence of PMS, and it may make breast in B vitamins, particularly B1 and B2, such tenderness worse for some women. as cereals, legumes and nuts, and leafy Studies have shown that smokers are more vegetables can help with PMS symptoms. likely to develop PMS and the more severe Studies have also shown that women form, PMDD. whose diet is rich in calcium and vitamin D are less likely to suffer from PMS. In Important lifestyle changes also involve addition to dairy products, calcium can be improving your diet and getting the right found in green vegetables like cabbage, amount and type of exercise: kale and broccoli, as well as nuts and seeds, and vitamin D is made by the skin in Diet response to sunlight.
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