In the days before menstruation begins, many women navigate body aches, cramps, mood swings, even constipation and diarrhea. A subset of women have premenstrual symptoms so severe that they interfere with daily life.
"True premenstrual syndrome, or PMS, describes emotional and physical changes in the days leading up to a woman's period that interfere with her ability to perform daily activities," says Page Animadu, M.D., an obstetrician/gynecologist at Henry Ford Health. "So while many women have premenstrual symptoms, only about 3 to 8% experience symptoms that are so severe that they can't perform daily activities."
Premenstrual Syndrome Explained
The menstrual cycle is typically described as a 28-day cycle with four phases. Each phase requires a woman's body to produce different hormones, each of which comes with its own set of physical and emotional changes.
Here's how the phases break down:
- Menstrual phase: Days 1–5
- Follicular phase: Days 6–13
- Ovulation: Days 14–16
- Luteal phase: Days 16–28
PMS is a syndrome caused by changing hormone levels during the luteal phase. After ovulation, women may feel tired, cranky and off-kilter. Those symptoms progress as you get closer to menstruation.
"Sometimes women are so fatigued they aren't able to work or even concentrate," Dr. Animadu says.
Symptoms include:
- Swollen or tender breasts
- Constipation or diarrhea
- Bloating
- Cramping
- Headaches
- Mood swings
- Fatigue
- Difficulty concentrating
How To Manage PMS
Whether you're trying to conceive or not, your body goes through the same cycle each month to prepare itself to support a pregnancy. Producing the best egg, releasing it and providing an environment suitable for a baby requires a surge of hormones like estrogen and progesterone followed by a sudden drop. That drop can cause a decrease in the body's production of feel-good hormones, such as serotonin.
"Women need to be assured that nothing is wrong with them; they're just experiencing a physiological response to the drop in hormones that cause joy and happiness," Dr. Animadu says.
There are several things you can do to help compensate for changing hormone levels.
- Eat a balanced diet. Cleaning up your diet can significantly reduce PMS symptoms. Eat a diet that's high in fruits, vegetables (especially leafy greens), legumes and whole grains, as well as healthy fats like omega-3s and omega-6s. Limit processed foods and saturated fats. "Processed foods can make you feel bloated," Dr. Animadu says. Not sure you're getting the nutrients you need? Talk to a registered dietitian to help fill the gaps.
- Exercise regularly. While it may seem counterintuitive, exercise can help keep PMS at bay. Not only is exercise a proven mood booster, it can also help you feel more energized. Plus, exercise helps reduce stress and stave off chronic disease.
- Get sufficient sleep. It's important to get more sleep in the days before your period begins. "If you usually need seven hours of sleep each night, try to get eight," suggests Dr. Animadu. "When you're tired, it's more difficult to concentrate and you can become more easily agitated."
- Try supplements. A variety of different vitamins and minerals can help ease PMS symptoms. A few of the most popular include vitamin B6 (for energy), vitamin D (for mood lifting) and magnesium (for PMS-induced headaches). "Unfortunately, there's not a one-size-fits-all nutrient mix to help alleviate PMS," Dr. Animadu says. "But there are a plethora of nutrients that can make a difference." Consult with a healthcare professional before introducing supplements. If you get too much of one nutrient, it can undermine your body's ability to absorb others.
- Relax. When you're premenstrual, practicing relaxation techniques can help you feel better, both emotionally and physically. If you're suffering from cramps, you can help tense muscles relax with a heating pad, warm bath or even certain essential oils. The key is to find what works for you and stick with it.
PMS Treatment Options
If you're still suffering from severe PMS symptoms after adopting the above strategies, see your healthcare provider. While lifestyle changes are the first-line recommendation for PMS, there are plenty of prescription and over-the-counter treatments available to help.
"Combined oral contraception (birth control), including estrogen and progestin, can help alleviate PMS symptoms," Dr. Animadu says. "If you don't notice an improvement within three cycles, your doctor may recommend antidepressants — either continuous or only during the luteal phase."
It's important to note that some women have a more severe form of PMS called premenstrual dysphoric disorder, or PMDD. PMDD can cause severe changes in mood in the days before your period begins. Treatment for both PMS and PMDD is largely the same.
To find a doctor or certified nurse midwife at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).
Dr. Page Animadu is an obstetrician and gynecologist who sees patients at Henry Ford Medical Center - Detroit Northwest.
