Treating pre-menstrual syndrome (PMS): what is the proof?


In a weblog for non-medical readers, Lynda Ware, Cochrane UK’s Senior Fellow in Normal Observe, appears to be like on the proof behind remedies for pre-menstrual syndrome, or PMS. 

‘I threw a knife at my husband due to PMS’

‘PMS turned me right into a monster’

‘I listened to my mouth and thought “What are you saying?”‘

Acquainted? Nicely not the knife throwing, hopefully.

I’m interesting to feminine readers right here. Males will most likely recognise these descriptions if they’ve ever hung out with a premenstrual girl.


As much as 95% of ladies of childbearing age expertise PMS signs. Of those 5% may have extreme PMS

What’s PMS?

PMS is outlined by its signs and importantly by its timing. It’s a situation which happens within the second half of the menstrual cycle and resolves by the top of menstruation. Greater than 200 signs have been related to PMS and they are often bodily, behavioural and psychological.

For instance :

  • bodily : bloating, breast ache
  • behavioural : diminished cognitive means (mainly having the ability to assume straight and work issues out), aggression (see above!)
  • psychological :  depressed temper, temper swings, nervousness, irritability, lack of confidence

There is no such thing as a restrict to the kind or variety of signs skilled however they will considerably influence on a lady’s life and well-being, usually affecting house life, work and relationships.

And it’s frequent. As much as 95% of ladies of childbearing age expertise PMS signs. Of those 5% may have extreme PMS, categorized as Premenstrual Dysphoric Dysfunction (PMDD). Within the UK round a fifth of ladies with PMS search medical assist.

“It’s all of their heads”

PMS was thought-about to be a hypochondriacal situation till the mid 1900s. The primary formal acknowledgement was some 70 years in the past when Robert Frank introduced a paper titled ‘Hormonal Causes of Premenstrual Stress’ to the New York Medical Affiliation. The time period Premenstrual Syndrome appeared within the BMJ in 1953.

What causes PMS?

No-one actually is aware of for positive. There are two theories.

  • a ‘sensitivity’ to progesterone (one of many hormones that regulates the menstrual cycle). The degrees of progesterone rise within the second half of the menstrual cycle and drop when a interval begins.
  • the consequences of serotonin and GABA, two neurotransmittors within the mind, that are affected by allopregnanolone, which is fashioned from progesterone.

The mechanism(s) underlying PMS are more likely to be complicated.

What will help ladies combating PMS?

Step one is to determine the prognosis. A diary saved over two to 3 months is useful in linking signs to the menstrual cycle and displaying how severely they have an effect on the girl’s life.

It is very important exclude different circumstances equivalent to despair, anaemia and hypothyroidism.

Pointers issued by NICE in March 2014 and the Royal School of Obstetricians and Gynaecologists in February 2017 are helpful right here.

Three Cochrane systematic critiques, taking a look at the efficacy and safety of SSRIs (selective serotonin reuptake inhibitors, generally used as antidepressants), non-contraceptive oestrogen-containing preparations and drosperinone (a progestogen utilized in some oral contraceptive capsules), have contributed to the rules.


Figuring out PMS: a diary saved over two to 3 months is useful in linking signs to the menstrual cycle

Deal with in response to symptom severity

NICE Guidelines give recommendation on the right way to deal with in response to severity of signs.

For women with delicate PMS (that’s, ladies whose signs don’t intrude with their private, social life) easy way of life recommendation equivalent to common sleep, train and weight loss program, and discount of stress is often adequate.

There’s restricted proof to assist using some complementary therapies equivalent to vitamin B6, ginko biloba, oil of night primrose, calcium/vitamin D and St John’s wort.

For ladies with reasonable PMS (these are ladies whose signs intrude with their private, social life, and probably social functioning) the NICE pointers suggest way of life recommendation and consideration of a new-generation mixed oral contraceptive (COC) tablet, particularly if contraceptive cowl is required too. There’s proof supporting using COCs containing drospirenone (Yasmin in UK). If ache is a predominant characteristic then paracetamol or a non-steroidal anti-inflammatory drug are recommended. Referral for Cognitive Behavioural Remedy (CBT) could also be acceptable.

For ladies with extreme PMS (that’s, ladies whose signs trigger them to withdraw from social actions, and forestall regular functioning)and for whom the above suggestions haven’t proved succsessful, an SSRI could also be prescribed, though at current this use will not be listed as a part of the drug licence. It may be given constantly or simply within the second half of the menstrual cycle (from day 15 to menstruation). Generally referral for specialist care is required.

A bit bolder…

The PMS treatment algorithm issued by the Royal College of Obstetricians and Gynaecologists for decision-making is bolder in its suggestions. Remedy is split into first, second, third and fourth line interventions. The steerage covers remedies recommended by NICE but in addition contains oestrogen patches, GnRH analogues (medication which suppress the ovaries) and surgical elimination of the ovaries.

In conclusion (and a nasty joke….)

Most ladies are conscious of temper and bodily modifications across the time their interval is due. Usually it’s not more than a nuisance to them (and to those that reside with them) however it may be extra intrusive than this and really often a significant drawback. There are remedies that may assist.

Query: Why does it take three ladies with PMS to vary a lightbulb?

Reply: It simply does. OK?

Apologies to anybody who takes offence at this. Sums up my PMS, now gone…….

References could also be discovered here.    

Lynda Ware has nothing to reveal.

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