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Dear Doctor: Are there treatments or complementary remedies for the symptoms of pre-menstrual syndrome?

Why do I get irritable and anxious and feel bloated prior to my period?

Three out of four women experience pre-menstrual syndrome (PMS). It can occur around the time of ovulation and may continue to the first few days of menstruation. Women note symptoms including mood swings, tender breasts, food cravings, fatigue, irritability, fluid retention, abdominal bloating, acne, insomnia and poor concentration.

For some women, these symptoms are severe enough to affect their daily routines and can be treated. For most, the symptoms disappear as soon as their period begins. There are a number of factors that contribute to PMS. Insufficient serotonin is linked to mood swings, fatigue, food cravings and sleep problems. Some women may have undiagnosed depression. Poor eating habits and low vitamin/mineral levels are other possible factors.

Are there any tests to diagnose PMS?

There are no specific lab tests or physical findings to positively diagnose PMS. To help establish a pre-menstrual pattern, record your symptoms for at least two menstrual cycles, noting the day your symptoms appear and disappear, and the day your period starts and ends.

What treatments are available for PMS?

Conventional treatment includes the use of antidepressants, mainly SSRIs, which can help with fatigue, food cravings, and sleep problems. Other medications that can help include NSAIDs (eg ibuprofen), which can ease cramping and breast tenderness. The combined contraceptive pill can stop ovulation and help stabilise hormonal swings. Yaz contains the progestin drospirenone, which is suited to reducing PMS symptoms.

Would taking vitamins or supplements help relieve my symptoms?

Complementary remedies include calcium — up to 1,200mg of calcium daily. Magnesium (400mg daily) can help reduce fluid retention, breast tenderness and bloating. Vitamin B6 (50-100mg) daily may also help. Vitamin E (400 IU) daily can reduce the production of prostaglandin, which can cause cramps and breast tenderness.

Some women report relief of PMS symptoms with herbs such as black cohosh, ginger, raspberry leaf, dandelion and evening primrose oil.

Does stress make PMS worse?

A recent study showed that women who feel stressed early in their menstrual cycle are more likely to experience symptoms, such as sadness, crying spells, anger or anxiety and irritability, associated with menstruation. Stress-reduction techniques can help prevent or reduce the severity of PMS.

This advice is to help you make informed decisions about your health. Not all the advice may be suitable if you are pregnant or breastfeeding. Always consult your doctor. Our health advisers won’t enter into personal correspondence.