Premenstrual tension (PMT) | Premenstrual syndrome (PMS)
Glengarry Private Hospital

Premenstrual syndrome (PMS) or premenstrual tension (PMT refers to physical and emotional symptoms occurring 1 to 2 weeks before the period starts. PMS | PMT can be very severe. The probable cause is a drop in hormones or a change in hormone ratios before the period starts. A lot is still unknown about the condition.

Symptoms

Symptoms of PMS | PMT include: acne, anxiety, back pain, bloating, change in appetite, clumsiness, constipation, depression, diarrhoea, dizziness, headache, irritability, joint pain, lethargy, low libido, mood swings, nervousness, sleep problems, swelling, tender breasts,  and tiredness.

Assessment

It’s very important to rule out other causes of premenstrual symptoms. For instance, endometriosis can cause discomfort, bloating and other symptoms before menstruation. Thyroid disorders can mimic the other symptoms, as can depression. Your GP can consider these diagnoses. Endometriosis can be ruled out by performing a laparoscopy.

Treatment of PMS | PMT

There are several strategies taken when planning treatment.

Lifestyle change

• Exercise: Regular exercise, yoga or tai chi can all be helpful with PMT
• Diet: Reduce sugar, salt, caffeine, fat. Increase fibre

Supplements

• Calcium – helpful -1200-1600mg/day helps PMS
• Vitamin B6 – helpful in PMT – 50-100 mg/day – no more
• Magnesium: may be helpful – 500mg/day

Herbal therapies

• Chaste tree (agnus casta) – helpful in PMT
• St John’s wort – helpful but lots of interactions

Medical therapies

Hormonal medications

• Progesterone pessaries for 10 days before the period – very helpful in PMT
• Crinone progesterone gel on alternate days for 10 days before the period – very helpful but expensive
• COCP good if contraception needed. Best to tricycle it ie take 3 packs without a period.

Non hormonal medications

• Venlafaxine – very helpful in PMT – best non-hormonal choice
• SSRI – very helpful