PMS (Premenstrual Syndrome): Tanda Nak Period & Cara Atasi

PMS (premenstrual syndrome) is the name for the physical and emotional symptoms, such as mood swings, bloating, sore breasts and tiredness, that many women get in the days before their period. Symptoms usually get better once the period starts. Most women have PMS at some point, and lifestyle changes often help, but if your symptoms affect your daily life, a doctor can offer treatment. This guide explains the common tanda nak period (signs your period is coming), how to tell PMS from early pregnancy, when PMS may be something more serious such as PMDD, and what helps.

Apa itu PMS (maksud PMS)?

PMS stands for premenstrual syndrome. Australia's government health service, healthdirect, notes that it is the same as premenstrual tension (PMT). The American College of Obstetricians and Gynecologists (ACOG) explains that many women feel physical or mood changes in the days before their period, and when these symptoms happen month after month and affect a woman's normal life, they are known as PMS.

PMS is very common:

• the NHS says most women have PMS at some point;
• the US Office on Women's Health (OWH) says over 90% of women report some premenstrual symptoms, and as many as 3 in 4 women say they get PMS symptoms at some point in their lives. For most, symptoms are mild;
• the UK's Royal College of Obstetricians and Gynaecologists (RCOG) says between 2 and 4 in 100 women get PMS that is severe enough to stop them getting on with their daily lives.

OWH adds that, on average, women in their 30s are most likely to have PMS.

Tanda nak period: common PMS symptoms

Each woman's symptoms are different and can vary from month to month, although RCOG notes they tend to form a pattern over time. The NHS, ACOG and OWH list these common symptoms:

If your periods are also very heavy, or you pass large clots, see our guide to period berketul and haid banyak.

When does PMS start, and is it really PMS?

OWH says PMS symptoms usually start about 1 to 2 weeks before your period, in the days after ovulation (see our guide to ovulasi). Researchers think this is because the hormones oestrogen and progesterone start to fall if you are not pregnant. Symptoms go away within a few days after the period starts, as hormone levels rise again.

There is no single test for PMS. A doctor looks at the pattern of your symptoms. ACOG and OWH say you probably have PMS if your symptoms:

• are present in the 5 days before your period for at least 3 menstrual cycles in a row;
• end within 4 days after your period starts;
• stop you from doing some of your normal activities.

The NHS and RCOG recommend keeping a symptom diary for at least 2 cycles. ACOG suggests writing down and rating your symptoms every day for 2 to 3 months, along with the dates of your periods. OWH suggests using a calendar or a phone app, and bringing it to your appointment.

Tanda nak period atau hamil?

Many early pregnancy signs feel like PMS, which is why women often search for the difference between tanda nak period and tanda hamil. The NHS says early pregnancy symptoms usually start at about 4 to 6 weeks of pregnancy, and that breasts may become larger and tender, just as they might before your period.

Because the symptoms overlap, a pregnancy test gives a clearer answer than symptoms. The NHS says:

• most pregnancy tests can be used from the first day of a missed period; if you do not know when your period is due, test at least 21 days after unprotected sex;
• a positive result is almost certainly correct, but a negative result is less reliable, especially if you test too early;
• if you get a negative result but still think you are pregnant, wait a few days and test again, and see a doctor if a second test is negative and your period still has not come.

Hormonal contraception such as the pill does not stop a pregnancy test from working. For more, see our guides to tanda-tanda mengandung and period lambat (late periods).

Punca PMS: why some women get it

The exact cause of PMS is not known. RCOG, OWH and healthdirect explain that:

• it is probably linked to the changes in hormone levels during the menstrual cycle, and some women are more sensitive to these changes than others;
• it has also been linked to brain chemicals (neurotransmitters) such as serotonin and GABA;
• RCOG notes that women who use some forms of hormonal contraception are less affected by PMS.

OWH says PMS may happen more often in women who:

• have high levels of stress;
• have a family history of depression;
• have had depression or postnatal depression before (see our guide to kemurungan).

PMS and age: OWH says symptoms may get worse in your late 30s or 40s, as you approach menopause, because hormone levels go up and down unpredictably during this time (perimenopause). PMS stops after menopause, when you no longer have periods (see our guide to menopaus). After pregnancy, PMS may come back with different symptoms.

PMDD: when PMS is severe

A small number of women have a much more severe form of PMS called premenstrual dysphoric disorder (PMDD). The NHS says its symptoms are similar to PMS but much more intense, and can have a much greater effect on everyday life. ACOG describes PMDD as PMS that is severe enough to cause problems with work or relationships.

Symptoms of PMDD can include:

• feeling very anxious, angry or depressed;
• problems sleeping (insomnia) and overeating;
• headaches and joint and muscle pain;
• thoughts of self-harm or suicide.

Estimates of how common PMDD is vary: OWH says less than 5% of women of childbearing age, while healthdirect says about 8 in 100 women. The NHS says it is not clear what causes PMDD, but it has been linked to being very sensitive to changes in hormones, or to genes inherited from parents. ACOG notes that antidepressants called SSRIs can help some women with PMDD.

If you think you may have PMDD, see a doctor.

Conditions that can look like PMS

Some conditions can look like PMS or overlap with it. ACOG lists:

• depression and anxiety;
• perimenopause;
• chronic fatigue syndrome;
• irritable bowel syndrome (IBS);
• thyroid disease (see our guide to tiroid).

Depression and anxiety are the most common. ACOG says about half of women seeking treatment for PMS have one of these conditions. The key difference is timing: PMS symptoms come and go with your cycle, while women with depression often have symptoms all month long, which may get worse before or during a period. If your low mood or anxiety does not lift after your period, tell your doctor (see also our guide to panic attacks).

ACOG adds that the days before a period can also make other conditions worse, including migraines, asthma, allergies and seizure disorders such as epilepsy.

PMS in Malaysia

Malaysian studies show that premenstrual symptoms are common, but few girls seek help:

• A study of 1,092 secondary school girls in Kuala Lumpur, published in 2011, found that 80.7% had one or more emotional symptoms and 83.6% had one or more physical symptoms before their period. Irritability, mood swings and tension were the most common emotional symptoms, and tiredness and cramps the most common physical ones. The symptoms affected concentration in class and social activities, yet only 10.3% had seen a doctor about PMS, and about a third did nothing about it.
• In another study by the same researcher, using group discussions with 172 girls in Kuala Lumpur and rural Kelantan, girls from urban and rural areas and all ethnic groups saw PMS and period pain as completely normal, so they relied on self-care and did not want to seek professional treatment.

These studies looked at teenage girls, so the figures may not apply to adult women. But PMS does not have to be something you simply put up with: if your symptoms affect your life, talk to a doctor.

Cara atasi PMS at home

For mild to moderate PMS, ACOG says lifestyle and diet changes often help. The NHS recommends that you:

• exercise regularly. ACOG says regular aerobic exercise, such as brisk walking, running, cycling or swimming, lessens PMS symptoms for many women. Aim for at least 30 minutes on most days of the week, all month, not only when you have symptoms;
• eat a healthy, balanced diet. The NHS says you may find eating smaller meals every 2 to 3 hours better. ACOG suggests complex carbohydrates such as wholegrain bread, brown rice, beans and lentils, calcium-rich foods such as yoghurt and leafy green vegetables, and less fat, salt and sugar;
• cut down on caffeine and alcohol. ACOG advises avoiding caffeine and alcohol, and OWH suggests avoiding caffeine, salt and sugar in the 2 weeks before your period;
• get plenty of sleep. OWH suggests about 8 hours a night, and ACOG says going to sleep and waking up at the same times every day, including weekends, may help with moodiness and tiredness;
• reduce stress, for example with yoga or meditation. OWH also suggests talking to friends or writing in a journal;
• take painkillers such as ibuprofen or paracetamol to ease the pain;
• do not smoke. OWH reports that in one large study, women who smoked had more and worse PMS symptoms;
• keep a symptom diary for at least 2 cycles.

A note on supplements: the NHS says complementary therapies and supplements, such as vitamin B6, calcium, vitamin D and magnesium, may help with PMS, but there is not much evidence that they work. ACOG warns that most products advertised for PMS have not been tested or proven to work, and that taking too much, or taking them with some medicines, may be harmful. Check with a doctor or pharmacist before taking any supplement, especially if you take other medicines.

Rawatan PMS (treatment)

If lifestyle changes are not enough, a doctor may suggest treatment. RCOG advises continuing your symptom diary for another 2 to 3 months on any treatment, to see whether it is working.

If simple treatments such as the combined pill or SSRIs have not worked, RCOG says your doctor should refer you to a specialist. The NHS says this could be a gynaecologist, psychiatrist or counsellor.

When to see a doctor or get urgent help

The NHS advises seeing a doctor if you have PMS symptoms and:

• lifestyle changes have not helped;
• your symptoms are affecting your daily life.

Also see a doctor if your symptoms do not go away after your period starts, or if your low mood or anxiety continues all month, as this may be a sign of another condition such as depression (ACOG). In Malaysia, you can start at a klinik kesihatan or a GP.

Get urgent help if you have PMDD symptoms and feel suicidal. The NHS advises calling for emergency help straight away. In Malaysia, call 999 or go to the nearest emergency department. You can also call Talian HEAL 15555 or Befrienders KL at +603-7627 2929.

Frequently asked questions (FAQ)

Apa maksud PMS (what does PMS mean)?

PMS stands for premenstrual syndrome, also called premenstrual tension (PMT). It is the name for the physical and emotional symptoms, such as mood swings, bloating, sore breasts and tiredness, that many women get in the days before their period. Symptoms usually get better once the period starts. The NHS says most women have PMS at some point.

Apa tanda nak period (what are the signs your period is coming)?

Common signs in the days before a period include mood swings, feeling irritable, anxious or low, tiredness or trouble sleeping, bloating or cramping, sore or tender breasts, headaches, spotty skin, greasy hair and food cravings. Each woman's symptoms are different and can change from month to month.

Berapa hari sebelum period PMS bermula (how many days before a period does PMS start)?

PMS symptoms usually start in the 1 to 2 weeks before a period, after ovulation, and go away within a few days after the period starts. To diagnose PMS, ACOG says symptoms should be present in the 5 days before a period for at least 3 cycles in a row and end within 4 days after the period starts.

Tanda nak period atau hamil (is it PMS or pregnancy)?

Early pregnancy and PMS can both cause sore breasts, tiredness, mood changes and food cravings, so symptoms alone cannot tell you. A missed period is the clearest sign of pregnancy. The NHS says most pregnancy tests can be used from the first day of a missed period, or at least 21 days after unprotected sex if you do not know when your period is due.

Apa beza PMS dan PMDD (what is the difference between PMS and PMDD)?

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Its symptoms are similar but much more intense, especially mood symptoms such as severe anxiety, anger or depression, and it can seriously affect work and relationships. Estimates vary, but it affects a small minority of women. If you have PMDD symptoms and feel suicidal, get help straight away by calling 999.

Bagaimana cara atasi PMS (how can I relieve PMS)?

Regular exercise, a healthy balanced diet with smaller, more frequent meals, enough sleep, managing stress with activities such as yoga or meditation, and painkillers such as ibuprofen or paracetamol can help. Not smoking and not drinking too much alcohol also help. If these do not work, a doctor may suggest the combined pill, cognitive behavioural therapy (CBT) or antidepressants.

When should I see a doctor about PMS?

See a doctor if lifestyle changes have not helped or if your symptoms are affecting your daily life, work or relationships. Keep a diary of your symptoms for at least 2 cycles to bring to your appointment. Also see a doctor if your low mood or anxiety continues all month, because conditions such as depression and anxiety can look like PMS.

Disclaimer

This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. If you are in crisis, call 999 or Talian HEAL 15555. Health supplements are not intended to diagnose, treat, cure or prevent any disease.

References

• PMS (premenstrual syndrome) — NHS
• Premenstrual syndrome (PMS) — American College of Obstetricians and Gynecologists (ACOG)
• Premenstrual syndrome (PMS) — Office on Women's Health, US Department of Health and Human Services
• Managing premenstrual syndrome (PMS) — Royal College of Obstetricians and Gynaecologists (RCOG)
• Premenstrual syndrome (PMS) — healthdirect (Australian Government)
• Signs and symptoms that might mean you're pregnant — NHS
• Doing a pregnancy test — NHS
• Wong LP, Khoo EM. Menstrual-related attitudes and symptoms among multi-racial Asian adolescent females. Int J Behav Med. 2011;18(3):246-53.
• Wong LP. Premenstrual syndrome and dysmenorrhea: urban-rural and multiethnic differences in perception, impacts, and treatment seeking. J Pediatr Adolesc Gynecol. 2011;24(5):272-7.
• Talian HEAL 15555 tawar sokongan mental mula beroperasi — Sinar Harian
• Befrienders Kuala Lumpur