How to manage premenstrual syndrome (PMS): lifestyle, medication and surgery

Written by: Mr Ajay Swaminathan
Edited by: Emma McLeod

Premenstrual syndrome (PMS) is the name given to both physical and emotional symptoms that can affect daily life in the two weeks before you have your period. It disappears or diminishes by the end of your period.

A women lying on a sofa due to PMS with her hands over her pelvic area.

PMS affects around 30 per cent of women

PMS can affect any woman during her childbearing years. Around 30 per cent of women can experience moderate to severe symptoms. Furthermore, there is PMDD (premenstrual dysphoric disorder), which is the American Psychiatric Association’s definition of a type of severe PMS.


The cause of PMS

We don’t know exactly why some women suffer from PMS. Some women are more sensitive to hormonal changes during their cycle, but it may also be due to chemical substances in the blood called neuro-transmitters.


Symptoms of PMS

Almost all women have some premenstrual symptoms. The common symptoms include:

  • Changes in mood
  • Feeling one or more of the following: depressed, irritable, bad-tempered, anxious, emotional
  • Tiredness
  • Headaches
  • Feeling bloated
  • Sometimes, there can be changes to the skin or hair


Diagnosing PMS

Diagnosis depends on the timing of the symptoms with the menstrual cycle. If you are suffering from PMS, write the symptoms you are having in a diary for at least 2 cycles. Your GP or gynaecologist can review your diary. If the diary is not enough for the correct diagnosis, a trial of treatment with GnRHa may help point us in the right direction. There are no blood tests that can help us in diagnosing PMS.


What women can do at home for PMS

Lifestyle adjustments such as exercise, a healthier diet, meditation and mindfulness are all positive steps in controlling your symptoms.


Medical treatments for PMS

Medical treatments for PMS are broadly divided into non-hormonal and hormonal treatments.


Non-hormonal treatment

Two specific groups of anti-depressants are known to help in PMS symptoms. These should only be started under guidance from a healthcare professional. The anti-depressants are either taken daily for two weeks before your period or all the way throughout the cycle. Some women suffer from the side effects of these meds which includes nausea, difficulty in sleeping and decreased libido (a lack of interest in sex). A specific water tablet may help some women with some of the physical symptoms of PMS.


Hormonal treatment

Hormonal treatment is usually with a newer type of continuous combined pill which contains a progesterone called drospirenone, which is best taken on a continuous approach without a break.


The oestrogen hormone taken as a patch or gel can improve the symptoms of PMS. These do not work as a contraceptive.


An injection called GnRH analogue may be recommended if other treatments have not worked or are not suitable. It can also be used if there is a question about the diagnosis. This injection causes a temporary and reversible menopause, meaning that when you are on these treatments, eggs are not released and usually there are no periods. HRT (hormone replacement therapy) is usually advised to reduce your menopausal symptoms and also to protect your bones.


Surgery for PMS

Surgical treatment for PMS is in the form of a hysterectomy and removal of both ovaries. It’s usually suggested if you have severe symptoms and if other treatments have not helped. HRT is advised after the operation.


The hysterectomy is usually done as a keyhole (minimal access) operation. If the uterus and ovaries have been removed, oestrogen-only HRT is used. If you still have the uterus, you will need both oestrogen and progesterone. Progesterone or progestogens can re-introduce the symptoms of PMS, but they are needed to protect the lining of the uterus if the uterus is not removed.


Two surgeries not recommended for PMS treatment are:

  1. Endometrial ablation (which involves removing or destroying the lining of the womb)
  2. Hysterectomy without the removal of ovaries


If you are thinking about having surgical treatment, GNRHa and HRT are usually tried for 6 months before. This gives you an idea about whether you will benefit from surgery and whether HRT suits you.


Discover what Mr Ajay Swaminathan can do for your gynaecological health – visit his profile.

By Mr Ajay Swaminathan
Obstetrics & gynaecology

Mr Ajay Swaminathan is a leading consultant obstetrician and gynaecologist in Cheshire. As a specialist in gynaecology, reproductive medicine and sexual and reproductive healthcare, he assists patients with a wide range of conditions.

His private practice is based at Spire Regency Hospital in Macclesfield along with an online and ‘virtual practice’. His NHS practice is based at Mid Cheshire (Leighton) Hospital and at the Hewitt Fertility Centre (Liverpool Women’s Hospital NHS Trust). Within the field of gynaecology, he specialises in subfertility and laparoscopic surgery.

During his training in the UK, he was in the Mersey rotation. He also attended the Kiel School of Gynaecological Endoscopy in Germany and is a British Fertility Society (BFS) accredited specialist in pelvic ultrasound, as well as a BFS accredited trainer in pelvic ultrasound.

Ajay has received extensive training in transport IVF and has vast experience in laparoscopic procedures (key-hole surgeries) as well as day case procedures including surgeries for ectopic pregnancy, endometriosis, adhesiolysis, ovarian cyst removal, tubal surgery and laparoscopic hysterectomy. He is also the deputy lead for gynaecology oncology at Leighton Hospital and a member of the South Manchester Cancer Network MDT.
In his clinics, in addition to patients with general gynaecological problems, he consults patients with heavy periods, pelvic masses and fibroids, subfertility, pelvic pain, endometriosis, polycystic ovarian syndrome, recurrent miscarriages and menopausal symptoms. At Leighton hospital, he implemented the enhanced recovery programme for gynaecological surgery.
Ajay was awarded the Diploma in Management in 2012 (University of London – London School of Economics and Political Sciences). He is involved in training candidates for the MRCOG examinations and was an RCOG moderator for the Enhanced Revision Programme. Ajay is the departmental lead for undergraduate medical education with the Manchester Medical School and is also a trained mentor for newly appointed consultants.

He was the principal investigator at Leighton Hospital for the GaPP2 trial which is a multi-centre randomised controlled trial looking at Gabapentin for pelvic pain. Ajay has presented research papers in various conferences including the European Society of Gynaecological Endoscopy Conference. He is a member of the Royal College of Obstetricians and Gynaecologists and specialist societies including the British Fertility Society and British Menopause Society.

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