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Premenstrual syndrome (PMS) refers to the monthly symptoms women may experience before the start of a menstrual period.
The hormone changes associated with menstruation produce a variety of emotional, behavioural and physical effects.
These vary in duration and intensity from a few hours to 14 days and from mild to severe.
Most women experience fairly mild symptoms but for moderate to severe sufferers, PMS can have a significantly negative impact on their quality of life.


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Once a month, typically for a period of 7-10 days, you may experience a combination of emotional, behavioural and physical symptoms. These symptoms are often followed by a painful period, common especially in teenagers. Signs of PMS tend to recur in a predictable pattern and may include all or some of the following:


  • Emotional Behavioural Physical
  • Mood swings Appetite changes Breast fullness
  • Irritability or anger Food cravings Headache
  • Depression Poor concentration Abdominal bloating
  • Tension or anxiety Insomnia Weight gain from fluid retention
  • Social withdrawal Acne flare-ups
  • Fatigue
  • Constipation or diarrhoea
  • Cramping in lower abdomen and / or back


When PMS symptoms occur, other comorbid conditions (additional diseases or disorders) may worsen. For example, if you have rheumatoid arthritis, your arthritic pain may increase during your menstrual period.


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While the cause of PMS is not clearly understood, it may be described as the result of multiple factors such as:
During your menstrual cycle hormones thought to be the biggest factor contributing to many of the PMS symptoms fluctuate.
Hormone fluctuations may affect certain chemicals in your brain. One such chemical is serotonin, which helps to regulate moods.
Lifestyle choices such as diet, stress, lack of exercise and weight gain may increase your risk of PMS.
Environment, relationships, self-esteem, stress and depression may also increase your risk. In fact, if you are already a PMS sufferer, increased age and stress may worsen your condition.


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You cannot prevent PMS but you can reduce the severity of your symptoms by introducing healthy lifestyle habits:

  • Eat healthy foods
  • Exercise regularly
  • Stop smoking
  • Drink plenty of water
  • Get 6 – 8 hours of sleep per night
  • Reduce / manage stress levels


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There is no definitive laboratory test or procedure to diagnose PMS. Diagnosis is usually based on medical history. Research shows that self-tracking or diarising your symptoms for a minimum of two months can help your healthcare practitioner to identify characteristic patterns of symptom appearance. Periodicity (when and how often) and severity of symptoms is important. When tracking your PMS symptoms you should include emotional, behavioural and physical symptoms.


Menstrual periods are a natural part of life. As such, there is no cure for associated PMS. However, symptomatic relief is possible and there are multiple pharmacological and non-pharmacological options available. That said, symptomatic treatment is not absolute and there is no single treatment that works for everyone. PMS manifests as a combination of symptoms and treatment should therefore be personalised to best suit your individual needs.


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  • Mild: Does not interfere with personal/social and professional life.
  • Moderate: Interferes with personal/social and professional life but still able to function and interact.
  • Severe: Unable to interact personally/socially or professionally – withdraws from social and professional activities.


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Severe PMS (USA Institutes)
Mild PMS is self-treatable but more severe PMS symptoms may require medications that block the secretion of certain hormones. In extreme cases of PMDD (premenstrual dysphoric disorder) justified medical or surgical elimination of the menstrual cycle (removal of the ovaries) may be required.
In the case of emotional symptoms, such as anxiety and depression, you may require counselling. A qualified practitioner can help you to find ways to manage some of your symptoms.


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Self-track symptoms / keep a diary
Introduce healthy lifestyle habits
Consult a healthcare practitioner


• Kumar, P. and Clark, M. (2009) Kumar and Clark’s Clinical Medicine. Ninth Edition. Edenburgh: Saunders Elsevier. • Martini, H. M. (2004) Fundamentals of Anatomy & Physiology. Illustrated Sixth Edition. Pearson Education, Inc., as Benjamin Cummings. • O’Brien, P.M.S. (1993) Education & Debate: Helping women with premenstrual syndrome. British Medical Journal: Volume 307: 1471-5 • Stedman, T. L. (2008) Stedman’s Medical Dictionary for the Health Professionals and Nursing. Illustrated Sixth Edition. Philadelphia: Wolters Kluwer Health Lippincott Williams & Wilkins. • Berger D. et al., (2000) Archives of Gynecology and Obstetrics. 264: 150-153. • Schellenberg, R. (2001) Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. British Medical Journal. 322: 134-7. • Schellenberg, R. et al., (2012) Dose-dependent efficacy of the Vitex agnus castus extract Ze 440 in patients suffering from premenstrual syndrome. Phytomedicine. 14:1325-1331.

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