Premenstrual Syndrome (PMS)

In theory, a woman’s monthly menstrual cycle is quite simple: it lasts for 28 days and begins on the first day of menstrual bleeding. After menstruation, the uterus begins to build up its lining again while an egg cell approaches maturity. Ovulation occurs towards the middle of the cycle: around day 14. If the egg cell is not fertilised, the uterine lining is shed during menstruation, and the cycle begins anew.

In reality, however, few women have cycles that follow such a textbook description. Normal cycle length is between 25 and 35 days. Some women suffer from menstrual disorders, resulting in longer or shorter cycles. In some cases, the woman stops menstruating or experiences intermenstrual bleeding. Some women also notice changes in their cycle when they are under stress. All of this shows how complex the female cycle is and how it can differ between women. Numerous hormones and biochemical messengers also affect it.

The term premenstrual syndrome (PMS) refers to a range of symptoms, such as breast tenderness, abdominal pain or mood swings, and occurring 4 to 14 days before menstruation. These symptoms typically go away with the onset of menstruation or shortly thereafter. One in three women are affected by PMS.

Between 2 and 5 per cent of all women suffer from an especially acute form of PMS that seriously affects their day-to-day life. This is referred to as premenstrual dysphoric disorder (PMDD).

The exact causes of PMS are still not entirely understood. It appears that several factors often come into play. Experts believe that the underlying cause is a hormonal imbalance. During the second half of the cycle, the body produces more progesterone and prolactin. After rising during the first half of the cycle, oestrogen levels drop. These hormonal fluctuations can cause changes in the fluid and electrolyte balance, causing the breasts to swell and triggering a whole range of other symptoms.

These hormonal processes occur in all women. So why then does premenstrual syndrome only affect about a third of all women? Studies have shown that women who suffer from PMS may react differently to hormones. For example, they may be more sensitive to progesterone metabolites, which accumulate in the body before a woman’s period begins.

Interactions with other messengers in the body may also be involved. Serotonin, melatonin and the thyroid hormones work closely with the sex hormones. A woman’s individual levels and interactions between these different messengers may cause PMS symptoms.

It is also clear that several factors do not actually cause the symptoms, but they can make them worse. These include stress, an unhealthy diet, smoking, lack of exercise and certain medications (e.g. laxatives).

Premenstrual syndrome is associated with more than 150 different symptoms. What all of these have in common is that they do not occur before the middle of the cycle and they abate with the onset of menstruation.

The symptoms of premenstrual syndrome can be divided into three groups: physical, mental and behavioural symptoms.

Physical symptoms

• Tender breasts
• Headaches
• Weight gain
• Water retention
• Abdominal cramps
• Skin problems

Psychological symptoms

• Unstable moods
• Depressive episodes
• Oversensitivity
• Irritability
• Anxiety
• Nervous tension

Behavioural changes

• Lack of motivation
• Social withdrawal
• Trouble concentrating
• Increased appetite
• Changed interest in sex

If you look at the symptoms above, it quickly becomes obvious how they can also affect a person’s day-to-day life. During the premenstrual phase, many women feel less motivated, irritable or tired. In cases of acute PMS, symptoms can become so severe that a woman is unable to work or only to a limited extent. The same is true for household tasks, hobbies and other activities.

Many women find it so distressing that it can also affect the people closest to them. Rows with partners are more common when a woman has PMS. When in an irritable or oversensitive state, a woman might not respond appropriately in parenting situations. These women should know that PMS is not a fate over which they have no control. There definitely are things you can do about it. Often, all it takes are some lifestyle changes and herbal products to stay happy, relaxed and pain-free during your “period before the period”.

Any woman of childbearing age can suffer from premenstrual syndrome. The exact symptoms and their acuteness can change over time, however. Some women do not experience symptoms as intensely every month because external factors, such as exercise or stress and diet, play a role. Hormonal contraceptives can alleviate symptoms for some women, but the contraceptive pill can make them even worse for others.

Because PMS is related to the menstrual cycle, the symptoms go away when a woman stops menstruating (menopause). Women still experience hormonal ups and downs during menopause, however. Cycles become more irregular, ovulation ceases and the production of female hormones drops. In some cases, this makes PMS symptoms worse, or a woman may even experience them for the first time with the onset of menopause. During menopause, herbal remedies containing black cohosh (cimifemin® neo) often have a supportive, soothing effect.

Women who suffer from PMS symptoms and who feel it is negatively affecting their everyday life should address the problem. If symptoms are severe, they should see a doctor. There are several self-treatment options for minor discomfort, however.

To alleviate symptoms, the fruit of the monk’s pepper plant (Latin: Vitex agnus castus) is an effective herbal remedy. The effects of monk’s pepper include minimising the release of the hormone prolactin, which is responsible for breast tenderness and swelling before a woman has her period. It can help relieve physical and emotional PMS symptoms. This is why gynaecologists often prescribe preparations containing monk’s pepper. Monk’s pepper must be taken daily over an extended period in order to build up its concentration. Traditionally, monk’s pepper is also used to treat menstrual disorders (too frequent or too infrequent menstruation).

For acute premenstrual syndrome, a doctor may prescribe medications to alleviate symptoms. Analgesics or antispasmodics can be taken for headaches and abdominal cramps. Diuretics can help alleviate severe water retention. Treatment with antidepressants and hormones may sometimes be prescribed for certain symptoms.

Lifestyle changes can help relieve premenstrual syndrome for some (but not all) women. Because the following recommendations promote a healthy lifestyle in general, it is often worth trying out several of them. Taking monk’s pepper at the same time can be especially helpful.

Tips for preventing PMS symptoms:

• A healthy, balanced diet with plenty of fruits and vegetables as well as limiting intake of sugar and animal fats.
• Adequate intake of omega-3 fatty acids. A good source is linseed oil or fatty fish (salmon, herring).
• Make sure to get plenty of regular exercise.
• Consume plenty of B vitamins (legumes, meat, nuts, fish) and magnesium (whole grain products, rice, legumes).
• Reduce stress by specifically planning downtime or doing relaxation exercises (autogenic training, progressive muscle relaxation).
• Do not smoke.
• Avoid caffeine.
• Avoid excessive alcohol consumption.
• A PMS journal can help you to recognise any influencing factors as well as physical and emotional symptoms. This journal can also be a valuable resource when discussing treatment with your doctor.

As with monk’s pepper, the same applies: it can take some time to work. Lifestyle and dietary changes should ideally be maintained over the course of several months: often only then will they have any noticeable effect.