Period problems

Looking after yourself

Most women find that self-care is the main option for managing PMS: being aware that they have it, understanding what causes it, learning to forecast their symptoms and planning ahead to reduce the pressure they are under at these times. Exercise, diet and relaxation skills may help too (see below).

Here are some simple tips that may ease your PMS:

• Learn to anticipate your PMS symptoms, so you can predict the difficult days in your monthly cycle. Use a diary or a chart to mark days when you are likely to get mood changes or physical symptoms. Note how soon before a period they begin, and when they fade away.
• Adjust to your PMS cycle. Once you can predict the pattern, knowing when the most difficult days are likely to fall, you can prepare for them. Even if you can’t keep the worst PMS days free, you can at least be aware that these are times when your mood and sensitivity might cause problems.
• Be open about your PMS. Your family and friends may have noticed your ups and downs already; your partner too. Tell them what’s going on. But choose a time to discuss it when you’re not having PMS!
• Get active. Some women say their PMS is less bothersome if they exercise regularly. You might need to do this three or four times a week for it to help. Those who exercise regularly say they have fewer problems with PMS. Try doing some regular exercise several times a week.
• Watch what you eat and drink. Some women get food cravings before their periods, often for sugary and fatty foods. But these foods can make PMS symptoms worse. Try eating fewer carbohydrates before your period.
• Cut down on caffeine and alcohol. Alcohol and caffeine (found in tea, coffee, cola and energy drinks) sometimes make PMS worse. See if reducing them works for you.

Summary
Primary period pain in the womb is similar to the pain in angina in the heart – caused by spasm of the blood vessels and loss of oxygen to the muscles. Hot water bottles, baths or showers probably help by increasing blood flow to the womb and relaxing your muscles. If your pain is short-lived, this may be enough to get you through the first few hours.

Evidence
Two studies have suggested that heat might help with painful periods. In one study, it seemed to work better than paracetamol.

Safety
There are unlikely to be any safety problems as long as you don’t use water bottles that are too hot directly on the skin. If you use a heat pack of any sort, make sure you wrap it in a towel to protect your skin from burning.

Cost
There are no extra costs.

Summary
When you feel tired it’s tempting to reach for stimulating drinks such as tea, coffee, colas or so-called ‘energy drinks’. They can give you a quick lift, but if you rely on them they will only keep you going until your energy stores run down further. Reducing caffeine might help during PMS.

Evidence
Cutting down on caffeine is likely to help reduce stress and anxiety, so may help with some symptoms of PMS.

Safety
Cutting down on caffeine is safe and often beneficial in other ways.

Cost
There are no costs. In fact you will save money.

Summary
We now know that our relatively lazy modern lifestyle is bad for our health. Being more active can keep you fit by making your heart and lungs work better, toning your muscles and strengthening your bones and joints. It also stimulates blood circulation to your brain and internal organs, boosts your immune system, and helps protect against osteoporosis. Importantly for people feeling low or depressed, it triggers brain chemicals that lift your mood and can generate a real sense of well-being. It can also be a very good way of meeting people, and it definitely makes a difference to all sorts of health problems. Regular exercise seems to change the way people experience pain, and it definitely lift mood. So in theory at least it ought to help primary period pain and PMS.

Exercise can include aerobics such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretching for flexibility. Other types of exercise are tai chi, qigong and yoga.

Evidence
There is some evidence to show that exercise can help painful periods. Just getting more active with even a half hour’s walk every day is likely to help.

Safety
Supervised exercise programmes are safe for most people. But at first you might feel more tired. If you’re not used to being active, start off slowly and build up gradually, doing a bit more every other day. If you feel worse, cut back, and increase your activity more slowly. If you think it isn’t helping or that you’re getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should first get advice about exercise from a doctor or physiotherapist.

Cost
You can exercise at home for nothing – walking and gardening is all exercise – although you should get advice on the best exercises to do from a trainer first. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme.

Summary
Relaxation training can make you more aware of how your body reacts to certain situations or pressures. It can help you control the stress response and improve your mood. Stress raises your blood pressure, speeds up your heart, makes your muscles tense and increases your sensitivity to pain. It also affects the way your stomach and intestines work. Relaxation methods include slow breathing and muscle relaxation, self-hypnosis and imagery techniques, or a combination of two or more.

Evidence
There is mixed evidence from the clinical trials so far conducted.

Safety
These techniques are generally safe unless you have a severe or enduring mental health problem (see our pages on Stress and Anxiety).

Cost
Progressive muscular relaxation can be learned from a book, CD, DVD or during exercise classes such as yoga classes. No costs are involved, although you may need to buy a CD, DVD or book.

Summary
Smoking seems to be linked to painful periods and both smoking and excessive alcohol are likely to make PMS symptoms worse.

Evidence
There is some research that cutting down on alcohol and smoking are likely to ease painful periods and PMS.

Safety
Cutting down on smoking and alcohol is safe, but if you are cutting down from heavy use, there can be side-effects, including loss of appetite and difficulty sleeping. There are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you’re cutting down.

Cost
There are no costs. In fact you will save money.

Note
Moderate drinking means men should not regularly drink more than 3-4 units a day and women should not regularly drink more than 2-3 units a day.

A unit is:
– half a pint of ordinary-strength beer, lager or cider
or
– a small pub measure (25 ml) of spirits
or
– a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume)

A small (125 ml) glass of basic wine is 1 and a half units.

See the information on NHS Choices on sensible drinking.

Giving up or cutting down on smoking? You can order a Quit Kit from the NHS.
You can also phone the NHS Free Smoking Helpline on 0800 022 4332

Summary
Some women say their PMS is worse if they eat the wrong foods. Food cravings can be part of PMS. If you crave certain foods like chocolate and sweets, and eat lots of them, this could be making your symptoms worse.

Evidence
There is no conclusive evidence. However low-carbohydrate diets (in which you exclude foods like bread, rice and potatoes, and sugars) are worth trying. But they don’t work for everyone.

Safety
It can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it may help to see a dietician or other professional advisor: someone who can help you make sure you are still eating a healthy diet and getting all the nutrients you need.

Cost
Eating a healthy diet and excluding some foods need not cost you anything. But if you consult a professional there will be a charge, unless there is a dietician service provided by your GP’s practice.