If you dread the week (or weeks) leading up to your period, you're not alone. Most women experience unpleasant physical and emotional symptoms just before their periods, but for some the problem is worse than for others and can significantly affect their quality of life. By tietitian Kate Marsh.
What is PMS?
You know what we're talking about. You're cranky, moody, sad (sometimes all at once). Your breasts are tender and you have cramps. Premenstrual syndrome, or PMS, describes these and a range of other symptoms that many women experience in the lead-up to their period each month. And while most women suffer from one of these symptoms, they are usually mild and manageable. However, a recent review in the medical journal The Lancet estimates that between 5-8% of women suffer symptoms that are severe enough to substantially affect daily activities. Another study found that between 11-32% of women reported severe or extreme premenstrual changes for each of the 10 symptoms researchers asked about.
These vary from one woman to the next, but most women experience the same set of symptoms each cycle. Apart from those we've mentioned, you can also be tense and have fluid retention or bloating. Usually whatever you suffer from will start to set in about six days before your period starts and peak about two days before. And, rather than growing out of them, PMS may actually get worse as you enter your thirties and continue until menopause.
If your symptoms occur in the two weeks before your period starts, resolve with menstruation, and you experience at least seven days without symptoms after your period, then it is likely you have PMS. But if your symptoms continue after your period, there may be another cause – depression, thyroid problems or approaching menopause, for example – so see your doctor.
What causes PMS?
No-one knows the exact cause, or why some women are affected more than others, but the most common explanation is changing hormone levels. One thing we do know is that symptoms are related to ovulation – you don't get them when ovulation doesn't occur. Some studies suggest being overweight, stress and traumatic events can increase the risk of PMS.
Can food affect PMS?
Some studies have linked food and PMS symptoms. For example, diets high in fat may increase the risk of PMS, while a higher intake of calcium and vitamin D may reduce risk. Including flaxseeds in your diet and reducing caffeine intake have been shown to reduce breast tenderness, and eating more soy products may reduce some symptoms. One study found that a low-fat vegetarian diet reduced the duration of PMS.
While more research into diet is needed, an Australian study found that 85% of women had tried some sort of treatment for PMS (eg diet, exercise, medication and supplements) and these women rated diet and exercise among the most effective of these treatments.
The effects of PMS
Anxiety and nervous tension
Reduced coping ability
Lower libido or, rarely, increased libido
Wanting to be alone
Reduced interest in life
On your body
Fluid retention (swollen fingers or ankles)
Tiredness and fatigue
Aches and pains
Skin problems such as acne
Do supplements work?
Research supporting supplements is sparse. Calcium and Vitex agnus-castus (Chaste tree) do have good evidence behind them. Research into vitamin B6 isn't convincing and it's important to remember that in excess it can lead to nerve damage within only one year. There's insufficient evidence for vitamin E, evening primrose oil, black cohosh and red raspberry leaf, too. Before you take supplements, chat to your doctor, particularly if you are on any other medication.
How to relieve your PMS symptoms with food
Ease pain and cramps
A low-fat vegetarian diet significantly reduced the intensity and duration of menstrual pain and cramps according to one study.
Taking a calcium supplement has also been shown to help.
Improve mood changes and depression
Drink less. Alcohol was positively associated with premenstrual anxiety and mood changes in a recent study.
Eat more omega-3. Some research also suggests that the omega-3 fats in fish can help fight symptoms of anxiety and depression.
Reduce breast pain
Try linseed. Women who ate a muffin containing 25g of linseed (flaxseed) each day for six months experienced a significant reduction in breast pain in one US study.
Reducing fat and avoiding caffeine may also help.
Relieve fluid retention
Drink more water. Perhaps surprisingly, you should drink plenty of water to avoid bloating.
Reduce salt in your diet. Replace salt in cooking with herbs and spices, avoid salty snack foods and choose low salt or no added salt products when shopping.
Try mini meals. Eat small regular meals containing low-GI carbs to maintain blood glucose levels and prevent hunger and overeating.
Keep regular with fibre from fruits, vegetables, wholegrains, legumes, nuts and seeds, and increase your fluid intake.
Regular exercise can also help.
Avoid skin problems
Eating a low-GI diet can help reduce acne according to recent research.
Foods to eat
Low-fat milk and yoghurt: Calcium can reduce cramps.
Wholegrain breads and cereals: Combat cravings, skin problems and constipation with high fibre and low GI.
Linseeds: Reduce breast tenderness by adding crushed linseeds to cereal, yoghurt or smoothies. Or choose bread or cereal with linseed.
Soy products: May help alleviate PMS symptoms, probably due to the isoflavones (plant oestrogens) they contain.
Fruit and vegetables: Can reduce the intensity and duration of cramps.
Foods to avoid
Other ways to manage PMS
There are a number of lifestyle changes you can make to help reduce and manage symptoms of PMS.
Regular exercise is linked with a reduced risk of PMS and can help to manage stress and improve your mood.
Smoking has been linked to a higher risk of PMS, along with many other diseases – another motivation to quit.
Ensure that you get adequate sleep and rest.
Manage stress levels – learn relaxation techniques and try to plan your schedule to avoid stressful activities in the lead-up to your period. Some find yoga or meditation helpful.