Symptoms of PMS include:

• irritability
• mood swings
• bloating
• breast tenderness
• loss of interest in sex

Normally symptoms improve once your period starts and disappear a few days later.

However, one in 20 women develop symptoms that are so severe it impacts on their day-to-day life.

This can be due to a more intense type of PMS called Premenstrual Dysphoric Disorder (PMDD).

It is recommended that you talk to your doctor if you are finding the symptoms of PMS debilitating or if they are having a significant impact on your life. Your doctor will ask you to describe your symptoms and can recommend some possible treatments to help you manage them.

Keep a Symptoms Tracker for a few months so you can start to see patterns in your physical and emotional well being.

Lifestyle is believed to play a part in aggravating or lessening the symptoms of PMS. If you have a poor diet, lack exercise and are overweight or experience high levels of stress, you are more likely to suffer from PMS. Your doctor will talk about some of the steps you can take to help yourself in the first instance.

In severe cases of PMS, you may be offered hormone-based treatment, alongside other forms of medication to help you to manage the symptoms. Among the hormone-based treatments that are available are:

• A combined oral contraceptive pill – this can help to relieve symptoms of PMS by preventing ovulation.
• Oestrogen-only patches – these also help to prevent ovulation. However, unless you have had a hysterectomy you will also need to take low doses of the hormone Progestogen.
• Selective Seratonin Reuptake Inhibitors (SSRIs) – these are a form of antidepressant that can be effective in managing severe PMS or PMDD. However, they can cause a range of side effects (including nausea, tiredness and loss of libido) so you will need to talk it through with your GP before starting to take them.
• Gondatrophin-releasing hormone (GnRH) – these are synthetic hormones that produce a temporary menopause and stop you having periods. They are only recommended in severe cases of PMS or PMDD as they can produce symptoms associated with menopause (including hot flushes, vaginal dryness and loss of libido).

Diet
It is important to eat a healthy, balanced diet to manage the symptoms of PMS.

Gynaecologists recommend:

• Drinking plenty of water to avoid dehydration, which can give you a headache and make tiredness worse
• Eating smaller meals at regular intervals to reduce bloating
• Avoiding salty foods to reduce fluid retention
• Aiming to eat at least five portions of fruit and vegetables every day
• Getting plenty of calcium. If you can’t eat dairy products try calcium-fortified soya alternatives
• Eat lots of complex carbohydrates which are found in wholegrains, as well as fruit and vegetables
• Avoid caffeine and alcohol which can affect your mood

Exercise
Exercise improves your health generally and can help to combat depression and tiredness.

Try yoga or pilates to manage stress levels and help you to sleep better.

Also aim to do around two and a half hours of moderate aerobic activity every week, for example, swimming, running, cycling, dancing or an exercise class.

Supplements
Some women notice their symptoms improve if they take certain supplements, for example:

• Vitamin D
• Magnesium
• Calcium
• Agnus Castus

However, these are not scientifically proven. If you do decide to take supplements, it is advisable to take them one at a time so you can see what works for you and what doesn’t. And always talk to your GP as some supplements interfere with conventional medication or can be harmful in high doses.

CBT
Cognitive Behavioural Therapy is a type of talking therapy that has been shown to be effective in helping with anxiety and depression. If PMS is impacting your mood significantly or causing you to feel depressed or anxious, your doctor may be able to refer you for CBT.

HRT Hysterectomy

A HRT Hysterectomy, with removal of ovaries, is also an option in a selected group of women.