The days before the days…

  09. July 2022

80% of women know it – changes with e.g. breast tenderness, mood swings, or water retention in the second half of the cycle.

The so-called premenstrual syndrome – PMS for short – refers to recurring, cyclical, physical as well as psychological complaints. Typical symptoms include depressed mood, irritability, hypersensitivity, anxiety, unilateral or bilateral breast pain or tenderness, bloating, water retention, headache, or fatigue. It is important to note that these complaints only occur in the second half of the cycle, i.e. after ovulation. Classically, they begin 5-7 days before menstruation and disappear with the bleeding or a few days after the onset of bleeding. For most women, the symptoms tend to be mild and not bothersome. 3-8% of women have clinically relevant changes and 2% of women suffer so much from these complaints that their professional and everyday social life is seriously affected. This extreme form of PMS is called premenstrual dysphoric disorder (PMDD).

The female hormone balance changes in the course of the cycle. In the first half of the cycle, various hormones cause the follicle to mature until ovulation occurs in the middle of the cycle. If fertilization does not occur, the mucous membrane in the uterus changes – again under the influence of hormones – and menstruation occurs. These cyclical hormonal changes affect the various tissues of our body as well as certain neurotransmitters in the brain. Although every woman is exposed to hormonal changes, it appears that those with PMS or PMDD are more responsive to the fluctuations.

There are no exams or tests to diagnose PMS. The anamnesis is important here, with the complaints occurring exclusively in the second half of the cycle. A cycle diary for at least three months can be helpful for this. By comparison, depression, for example, may also worsen during the cyclical changes, but the symptoms do not completely disappear during the first half of the cycle. After menopause, premenstrual syndrome no longer occurs.

In mild PMS, regular endurance sports, relaxation exercises, and sleep hygiene can already contribute to a significant improvement. Smoking, alcohol, and psychological stress increase the symptoms and should be avoided. Hormonal anticonceptives such as the “birth control pill” (e.g. Yaz®) can also alleviate the symptoms. On a herbal basis, there is chaste berry tea which can also alleviate the symptoms. In severe cases, psychotherapy or antidepressant therapy may also be useful.