Dossier: Sexuality

PMS: tough days before your period

Gloomy, tired, got a headache? It may be due to premenstrual syndrome (PMS). For many women, the days before their period are worse than the period itself. But the severity of the symptoms can vary.

Text: Michelle de Oliveira & Katharina Rilling; photo: iStock

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The days before a woman’s period are often tiring, stressful and uncomfortable. And symptoms may last one to two weeks a month – that’s a lot to put up with! Although menstruation is part and parcel of life, many women suffer every month, with three out of four women complaining that their symptoms have a significant impact on their quality of life. A quarter to a half of all women suffer from premenstrual syndrome (PMS). As the bleeding starts, the symptoms usually disappear, but sometimes they’re replaced by stomach pain or a migraine.

Take PMS seriously

Far too often today, those suffering from PMS are still ridiculed and not taken seriously when they talk about their premenstrual symptoms. This can lead to great uncertainty, especially among younger women. “The symptoms have to be taken seriously. PMS is an illness and can and should be classified as such,” says Alexandra Kohl Schwartz, Head of the Centre for Reproductive Medicine at the Cantonal Hospital Lucerne (LUKS). Women often don’t dare to seek help and instead suffer in silence. This must not be allowed to happen.

What is PMS? 150 symptoms? 

It’s hard to pinpoint what exactly PMS is, because the three letters PMS conceal countless symptoms. Since the American Robert Frank first described premenstrual syndrome in 1932, more than 150 individual symptoms have been recorded, according to ZEIT online. The one thing that they have in common is that they regularly occur in the days prior to menstruation.

“Women most frequently complain of exhaustion, mood swings, irritability and low moods,” explains Kohl Schwartz. “But symptoms can also include breast tenderness, headaches, nausea, sleep disruption, weight gain and blemished skin.” There are also reports of stomach cramps, constipation, water retention, anxiety, cravings and many more.

PMS can also exacerbate other illnesses such as depression, migraines or problems with vision. Those who suffer from the syndrome often react more sensitively to external stimuli such as criticism, touch, loud noises or bright light and feel stressed or overwhelmed more quickly. This not only affects their own well-being, but can also put a strain on relationships, family and working life.  

The causes: who suffers from PMS?

No one so far has been able to fully explain why women suffer from PMS. However, it is assumed that the fluctuations in sex hormones throughout the menstrual cycle have an influence on important messenger substances in the brain. And some women are more sensitive to these changes.

For example, progesterone and oestrogen levels rise in the second half of the cycle up until the period, only to drop sharply again at the start of menstruation. The neurotransmitter serotonin falls – with a sudden drop shortly before menstruation. Serotonin has a direct influence on our mood. When levels are high, we feel good and are less hungry. Low levels could be responsible for negative feelings during PMS. Many women who suffer from PMS produce less serotonin than women who don’t 

There’s another theory that PMS is a reaction to certain breakdown products of progesterone. “But progesterone can’t be the only explanation,” says Kohl Schwartz. “Women who have to take additional progesterone for other reasons don’t automatically suffer from more severe premenstrual symptoms.” 

The cause of PMS probably lies in a complex interplay of hormones and messenger substances, genetics and life circumstances. When mothers suffer from PMS, it often affects their daughters too. Premenstrual syndrome can also be made worse by stress or a lack of sleep or exercise. A high-sugar diet with lots of alcohol and caffeine is also thought to worsen the symptoms of PMS. The same applies to a lack of magnesium or calcium.

“As long as you have a menstrual cycle, you can suffer from PMS”
Dr Alexandra Kohl Schwartz, Head of the Centre for Reproductive Medicine at the Cantonal Hospital Lucerne (LUKS).

PMS – at what age do symptoms start?

Women of any age can be affected. “As long as you have a menstrual cycle, you can suffer from PMS”, says Kohl Schwartz. Women going through the menopause may even experience worse symptoms. However, it helps that they have many years of experience with PMS and know what is good for them during this time.

Treatment: how to ease PMS

You should certainly talk to your gynaecologist. Together you can decide whether simply adjusting your lifestyle is enough or whether you need a special hormonal analysis or therapy. However, there aren’t really any successful studies proving what really helps. 

Know your cycle

Women looking for support are often first asked to keep a diary of their cycle for at least two month where they record their symptoms. They can also document special events or eating habits.

This helps show whether the complaints are related solely to menstruation or whether other factors, such as a sugary diet or taking a break from sport, also play a role.

This will give you a better understanding of your cycle and help identify patterns and recurring symptoms, which can be classified more quickly by a medical professional. An app makes it particularly easy to track your cycle – simply search using the keyword “PMS” and try it out.

Watch what you eat

Not easy when you’re experiencing cravings, but a balanced diet with foods rich in calcium and magnesium can alleviate the symptoms. Salt promotes water retention, so you should stay away from very spicy foods. And it’s best to avoid alcohol, caffeine, nicotine and sugar as much as possible in the days before your period. 

Supplements

“Treatment often starts with highly concentrated doses of magnesium, calcium and vitamin B6,” says Kohl Schwartz. “This can be a big help for many women. Natural preparations such as monk’s pepper also often provide relief, as they can have a regulating effect on the female hormone balance”.

Diuretics help against severe water retention, but these should be dosed carefully. If too much water is lost, this can cause headaches. Generally speaking, you should always talk to your doctor before taking supplements as taking too much can do more harm than good. 

Keep moving

Doing gentle exercise as and when needed can help ease PMS symptoms, because the body releases dopamine while doing sport and serotonin afterwards. So if you can get yourself out there, it will help lift your mood.

Endurance sports like jogging, cycling or swimming in particular have a positive effect, because they also stimulate the circulation, thus helping to ease stomach cramps or back pain. And sport also flushes out stored water more quickly. It just helps you feel better.

Anti-stress measures and sleep

Relief can be provided by massages or relaxation techniques such as yoga, meditation, progressive muscle relaxation and autogenic training.

“However, it’s important that women don’t take on too much or have the feeling that these activities are solely responsible for solving their premenstrual syndrome,” explains Alexandra Kohl Schwartz. Longer to-do lists simply cause more stress and can do more harm than good.

It’s a good idea to take it easy and try to sleep at least seven hours a night.

pills, etc.

Hormonal contraceptives such as the pill (especially when taken without a monthly break) or a hormonal IUD also ease the symptoms of PMS or get rid of them completely.

This is because they suppress the body’s natural cycle. But you have to seek medical advice first. Hormonal contraceptives can sometimes have side effects.   

Painkillers

In the short term, painkillers can help ease headaches, stomach ache or back pain. Ibuprofen is recommended in this case instead of the blood-thinning aspirin.

Antidepressants and therapy

Therapy is one way of helping women who suffer from severe psychological complaints to conquer negative thoughts and fears. However, as the cause is biological, medication is often required.

Women who suffer from severe symptoms like depression can take antidepressants on a weekly basis. One of the most successful drugs is a selective serotonin reuptake inhibitor with Fluoxetine as an active ingredient.

Talk to friends

Talking to loved ones and marking difficult days in the calendar can be a big help. Partners and children often find it difficult to cope, so knowing what’s wrong and that there’s a biological cause ensures they are less likely to blame themselves. They can help by showing empathy, being patient, helping out with chores, cooking healthy food and encouraging you to take walks. 

PMDD: severe PMS

Some women suffer so badly from PMS that they can’t cope. For example, they experience depression-like states and fall into such a deep hole that they think they will never find their way out. They may even consider suicide. Other women experience outbursts of anger and become violent.

Some women find it hard to go to work, and friends and family, often their own children and partner, suffer as a result of their behaviour. “In such cases, we speak of premenstrual dysphoric disorder or PMDD,” says Kohl Schwartz. Around 3% to 8% of women suffer from the severe form of PMS.

Stronger medications, such as antidepressants or gonadotropin-releasing hormone (GnRH) agonists, are usually prescribed in these cases. These suppress ovulation and bring about a chemically induced menopause. As a last resort, a woman may opt for surgery to remove the ovaries This has the same effect as the menopause.

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