How to alleviate PMS symptoms

Premenstrual syndrome (PMS) is marked by physical and psychological symptoms and usually occurs a week before menstruation. A majority of women (90%) get PMS at some point in their lives. Although only 5% to 8% suffer severe PMS. Common symptoms include bloating, abdominal pain, mood swings, breast tenderness, poor concentration, and headaches. Unsurprisingly, these symptoms can be a great source of distress for many women and significantly interfere with their lives.  

But there are a few things you can do to reduce PMS symptoms.

Hormonal contraceptives

Hormonal contraceptives such as the combined pill can severely lessen PMS. The combined pill contains progesterone and estrogen which prevent ovulation and certain PMS symptoms may be completely eliminated as a consequence. But it’s not only the pill that can help you relieve PMS. Here are the top hormonal contraceptives known to relieve symptoms.

• Contraceptive pill. If you already take a combined or mini-pill but are still suffering from PMS, consult your doctor to switch to a pill that can be taken consecutively (i.e. without a 7-day break). Eliminating your period entirely is a proven way to relieve PMS symptoms. 
• The patch. Much like the birth control pill, the patch contains a combination of hormones that reduce PMS symptoms. The patch is like a plaster that is applied on top of the skin to release hormones into the bloodstream. You can also avoid your period by applying the patch consecutively – without a 7-day break.
• The ring. The birth control ring is similar to the patch and supplies a steady dose of hormones to ease PMS symptoms. The flexible ring is inserted into the vagina where it releases a small steady dose of estrogen and progestogen.
• The implant. The contraceptive implant (Nexplanon) is a small plastic rod that is inserted in the upper arm by a healthcare provider. It releases hormones which may result in some women not getting a period at all.
• Intrauterine device (IUD). The IUD is a small T-shaped device that is implanted into the womb by a doctor or nurse. There are two versions: one with and one without hormones. To treat cramps and PMS, you must choose the hormone-containing IUD.   

If you’re not sure which option is the best for you, speak to your doctor.

Lifestyle changes

A research study among 200 female students found that PMS was related to lifestyle choices. Women who ate a diet rich in fried foods, fast foods, and sugary drinks and those who exercised little were more likely to get PMS. That means there are few changes you can make to feel better and reduce symptoms.

• Eat healthily. A healthy diet includes plenty of vitamin-rich foods such as fresh vegetables and fruits. Whole grains and lean proteins are an excellent option to get enough B-vitamins. Avoid too much sugar, salt and alcohol because they can make you bloated and depress your energy levels.
• Exercise. Physical activity promotes the production of happy hormones. Regular exercise also reduces fluid retention and constipation. It’s a great way to combat stress which can contribute to negative mood before menstruation.
• Drink plenty of fluids. Drinking at least two liters of water a day helps with symptoms of bloating and constipation.
• Take supplements. You may prefer to get all your vitamins from the foods you eat, but a few extra vitamins and supplements can be helpful to address PMS symptoms. Calcium and vitamin D supplements have both been shown to help lower the frequency of PMS symptoms.
• Reduce stress. Research has found that women who suffer from PMS often have higher stress levels than those who do not. Practice meditation and get enough sleep to decrease the intensity of stress.  

Medications

If lifestyle modifications aren’t having the desired effect after three months, there are a few medical options you could try to reduce pain and other symptoms.

• Painkillers. Paracetamol and ibuprofen usually suffice to reduce abdominal pain or cramps experienced during PMS. There is no research, however, which suggests that painkillers treat PMS in the long run.
• Anti-depressants. If PMS symptoms are having a debilitating effect on your life and are accompanied by depression, anxiety and despair, you could consult your doctor about serotonin reuptake inhibitors. These prescription drugs increase a brain chemical called serotonin which helps to stabilise mood.
• Diuretics, If you experience swollen and sore breasts before your period, you could try diuretics which reduce the amount of water your body retains. This will ease the swelling.
• Gonadotropin-releasing hormone (GnRH). GnRH is a type of sexual hormone which is usually only prescribed in severe cases of PMS. Its action reduces the production of hormones in the ovaries. Typically, treatment with GnRH should not exceed six months.

No single proven treatments or medications for the management of PMS exist. The strategies that work best will differ by individual. It’s best to test out a few different approaches to find the one that works for you.

References

1. Winer, S. A., Rapkin, A. J. (2006). Premenstrual disorders: prevalence, etiology and impact. Journal of Reproductive Medicine; 51(4 Suppl):339-347.
2. Yonkers, K. A., O'Brien, P. M., & Eriksson, E. (2008). Premenstrual syndrome. Lancet (London, England), 371(9619), 1200–1210. https://doi.org/10.2147/OAJC.S9701310.1016/S0140-6736(08)60527-9
3. Lete, I., & Lapuente, O. (2016). Contraceptive options for women with premenstrual dysphoric disorder: current insights and a narrative review. Open access journal of contraception, 7, 117–125. https://doi.org/10.2147/OAJC.S97013
4. Rad, M., Sabzevary, M. T., & Dehnavi, Z. M. (2018). Factors associated with premenstrual syndrome in Female High School Students. Journal of education and health promotion, 7, 64. https://doi.org/10.4103/jehp.jehp_126_17
5. Abdi, F., Ozgoli, G., & Rahnemaie, F. S. (2019). A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstetrics & gynecology science, 62(2), 73–86. https://doi.org/10.5468/ogs.2019.62.2.73
6. Liu, Q., Wang, Y., van Heck, C. H., & Qiao, W. (2017). Stress reactivity and emotion in premenstrual syndrome. Neuropsychiatric disease and treatment, 13, 1597–1602. https://doi.org/10.2147/NDT.S132001