Sofie Wise

Courtney Bennett

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About Author — Courtney aims to simplify the complexities of modern medicine, enabling readers to make informed choices about their health. Her interests include reading, camping, hiking, painting, and photography.

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Symptoms Before Period: Learn Common Pre Period Symptoms

Every woman’s body is different, but there are common threads throughout all women. Menstruation, or having your period, is a process that all women will go through. For most women, with menstruation often comes pre period symptoms that can cause both physical and emotional discomfort – this is referred to as premenstrual syndrome (PMS). These symptoms range from headaches and backaches, to bloating and breast tenderness, to irritability and mood swings.

Whether you have recently gotten your first period, you have an irregular cycle, or you are dealing with recent changes to your cycle, learning more about the symptoms that precede your period can help you feel prepared. Find out more about what pre period symptoms to expect and how to treat them.

The Female Reproductive System

Let’s begin with a quick overview of the female reproductive system. From birth, girls have two ovaries, fallopian tubes, and a uterus. The ovaries are situated on either side of the uterus and are connected to it by the fallopian tubes. The ovaries contain thousands of eggs – interestingly enough, a girl is born with all of eggs that she will ever have. When a girl starts puberty, hormones are released by the pituitary gland and stimulate the ovaries to produce estrogen and progesterone, which triggers puberty and the beginning of the menstrual cycle.

The Menstrual Cycle

The menstrual cycle is measured from the beginning of one period to the beginning of the next one. The cycles can last anywhere from 21-45 days when they first begin, but will generally shorten to 21-34 days after a couple of years. The average cycle is 28 days.

Women often use birth control to alter their period. Find out more here.

The two weeks before a woman begins her period is known as the luteal phase, this occurs once an egg has been released from one of the ovaries. It is during this time that pre period symptoms begin. The ovaries release hormones and the uterus begins preparing for the potential of hosting a baby – including building up the uterine wall or lining with spongy tissue. If the egg is fertilized by a sperm cell and remains viable, it would ultimately attach to the padded uterine wall – this is known as implantation. However, when the body detects that no pregnancy has begun, menstruation will begin.

What is Menstruation?

Menstruation is the process of shedding the unneeded blood and tissue that had been built up within the uterus; this blood and tissue is discharged through the vagina. Menstruation is commonly referred to as a woman getting her period. Periods are a normal development of puberty, and are usually preceded by breast development. It is common for periods to start between the ages of 11 to 14. However, some girls may begin them earlier or later. After menarche, the first period or menstruation cycle, menstruation will continue until the woman reaches menopause around age 50.

Menstruation typically lasts anywhere from 2–10 days, with 5 days being the average. The menstrual flow, or the amount of blood being discharged, can also vary from cycle to cycle and woman to woman. The average amount of blood discharged during a menstrual cycle is 2 tablespoons. The first 2-3 days of the period is usually when the flow is the heaviest.

What is Premenstrual Syndrome (PMS)?

PMS refers to the constellation of physical and psychological symptoms that occur due to the hormonal changes in a woman’s body as she approaches menstruation. This is sometimes also known as "premenstrual tension" (PMT). It is normal to have PMS symptoms before period flow begins, and it affects up to 90% of women during the luteal phase of the menstrual cycle.

The exact cause of PMS is not fully understood by medical professionals, but several factors are thought to contribute to the symptoms. The top two contributors are thought to be hormonal changes throughout the body and subsequent chemical changes in the brain. Estrogen and progesterone levels rise and fall during the menstrual cycle, and they are thought to be the biggest contributor to PMS symptoms. The fact that PMS symptoms tend to improve after menopause and during pregnancy lend credit to this theory.

Related, it is also believed that these hormonal changes can affect certain chemicals found in the brain – namely serotonin. Serotonin works as a neurotransmitter and plays a large role in mood regulation. Studies show that low serotonin levels can predispose individuals to mood and impulse control disorders, including depression, anxiety, and obsessive compulsive disorder (OCD).

The intensity and duration of PMS symptoms can vary from period to period, and vary further as you get older and go through hormonal changes. As a woman begins perimenopause, generally in her 30s and 40s, it is common for PMS symptoms to become more intense. As the slow transition toward menopause begins, ovulation becomes sporadic and hormone levels tend to fluctuate unpredictably.

PMS Signs and Symptoms

PMS symptoms tend to peak 2-3 days before a woman’s period starts, and tend to resolve within 3-4 days of the period starting. This is due to the increase of progesterone, and decrease of estrogen, during the luteal phase. Symptoms begin to resolve as progesterone falls. If a woman has a regular cycle, she may be able to predict exactly when PMS and her actual period will begin. If a woman has an irregular cycle, she can often rely on the appearance of PMS symptoms as a signal that her period will soon arrive.

PMS Symptoms include:

  • Abdominal pain or cramping
  • Headaches
  • Back pain
  • Water retention (bloating)
  • Breast tenderness
  • Joint or muscle ache
  • Pimples / acne outbreaks
  • Digestive problems or altered bowel movements
  • Sleeping problems
  • Irritability or mood swings

Most women experience mild forms of PMS throughout their menstruating years. However, between 20–40% of women experience some severe symptoms, with about 3–8% of women being so severely affected that it causes a significant impact on their everyday lives.

A Note on Premenstrual Dysphoric Disorder (PMDD)

When PMS symptoms are debilitating and have a severe impact on mental health, causing depression or anxiety, they may be further classified as Premenstrual Dysphoric Disorder or PMDD (occasionally also known as Late Luteal Phase Dysphoric Disorder). Dysphoria refers to a profound state of unease, dissatisfaction, or discomfort with one’s body. PMDD causes extreme mood shifts that can range from melancholy to rage to despondency. These extreme mood shifts are generally accompanied by the physical PMS symptoms listed above; in fact, physical symptoms, such as a lack of energy, changes in appetite, and changes in sleep, are sometimes more severe in PMDD as well. It is estimated that PMDD affects 3–8% of women that are of reproductive age.

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Treating PMS Symptoms

For mild cramping, muscle aches, back pain, or headaches, most women find relief through over the counter pain relieving medications such as aspirin, ibuprofen, or naproxen. You can also use a heating pad or soak in a warm bath to help relieve aches. Some women find that gentle stretching or yoga helps alleviate cramps, as well.

Women that suffer from more severe PMS symptoms, or from PMDD, may benefit from a hormonal birth control that can help regulate hormone levels and avoid the large peaks and valleys that tend to cause symptoms. There are a variety of options that you can discuss with your healthcare provider – including the birth control pill, patch, and ring.

Additionally, in severe cases of PMDD, anti-depressants such as serotonin-reuptake inhibitors (SSRIs) may be prescribed to combat depressive symptoms. Less commonly, if you experience severe bloating, your primary care physician may recommend diuretics.

Lifestyle Changes that Help Combat PMS Symptoms

In addition to medicine interventions in the midst of PMS symptoms, there are several steps that you can take in your daily life that will lead to a decrease in symptoms before your period.

  • Exercise. While exercise may be the last thing you want to partake in once you have PMS symptoms, maintaining a regular aerobic exercise routine throughout your daily life can lessen or prevent those symptoms. You should aim for at least 30 minutes per day.
  • Maintain a healthy diet. Salt, sugar, and caffeine can make PMS symptoms more troublesome. In addition to maintaining a healthy diet overall, you should avoid foods that are high in any of those substances in the two weeks before your period.
  • Get adequate sleep. Since the hormonal changes that your body will undergo as you approach your period can cause fatigue and irritability, it is important to get enough rest so as not to further exacerbate the symptoms.
  • Don’t smoke. We all know how detrimental smoking is to your general health. However, in addition, a study showed that women who smoke tend to have a wider range of PMS symptoms as well as more severe symptoms.

Detecting Menstrual Irregularities

While a woman’s cycle will often become more regular as she gets older, and especially after the first three years, many women still experience slightly different cycle times each month. In addition, it is not uncommon to occasionally have a missed period, or an extra period, especially if she is under unusual amounts of stress. It is also common for the duration of the flow to vary between cycles.

However, irregularity may be a sign of underlying issues. Primary amenorrhea refers to the absence of any menstruation by the age of 16. Secondary amenorrhea is the absence of periods in a woman who had previously been menstruating. Over exercising, being under weight or having an eating disorder can cause a woman’s period to stop completely, this is a form of secondary amenorrhea known as hypothalamic amenorrhea.

Hypothalamic amenorrhea refers to the state when the hypothalamus has stopped releasing the hormone GnRH, which starts the menstrual cycle. If you have had unprotected sexual intercourse and your period does not come at its normal time, this could be a sign that you are pregnant. In any of these cases, it is a good idea to consult your primary care physician.

Hormone imbalances are often the culprit when there are menstrual irregularities. The thyroid, which plays a large role in metabolism and menstruation, can cause irregularities if it is overactive (hyperthyroidism) or underactive (hypothyroidism). If the body produces too much androgen, polycystic ovary syndrome (PCOS) will occur and the ovaries will develop fluid-filled sacs (cysts) that can interfere with ovulation.

Menorrhagia or abnormal uterine bleeding (AUB) refers to abnormal and excessive bleeding in relation to menstruation. It is abnormal for your period to occur more than every 21 days or to last longer than 7 days on a regular basis. Additionally, bleeding so heavily during your period that you soak through a pad on an hourly basis is also considered abnormal. All of these scenarios can cause anemia, among other issues, and are therefore cause to consult your doctor.

If you suffer from extremely painful periods with the following symptoms, you may be suffering from dysmenorrhea:

  • nausea and/or vomiting
  • diarrhea
  • severe cramps and/or backaches
  • severe headaches

Primary dysmenorrhea refers to the fairly common cramps that accompany menstruation and are not caused by any other disease. It is considered abnormal if the cramps are so severe and debilitating that they prevent you from functioning normally in your daily life. Secondary dysmenorrhea presents similarly, but is caused by another disorder or disease of the reproductive organs, such as:

  • Endometriosis. The endometrium or endometrial tissue typically lines the uterus. Endometriosis occurs when the tissue begins to grow outside of the uterus, such as in the ovaries or fallopian tubes. Sometimes the tissue will even attach to other organs, such as the intestines, or in the space between the uterus and rectum. It can occur in any woman who has gotten her period, but is most likely to occur between the ages of 25 and 40.
  • Adenomyosis. Adenomyosis occurs when the endometrium moves into the uterus’ outer muscles. This condition may result in an adenomyoma, or growth inside the uterus. It is very rare in women who haven’t carried a pregnancy to term.
  • Uterine polyps or fibroids. Uterine polyps are small growths in the endometrium that are benign (noncancerous). Uterine fibroids are tumors that attach to the wall of the uterus and they can vary in size from quite small to the size of a grapefruit. Uterine fibroids are also generally benign, but can cause pain and heavy bleeding, as well as put pressure on the bladder or rectum if they are large enough.

Other conditions that can cause menstrual irregularities include:

  • Pelvic inflammatory disease (PID). PID is a bacterial infection of the female reproductive organs. Bacteria can enter the vagina through various means (e.g. sexual intercourse, gynecological exam, or childbirth) and spread throughout the uterus, fallopian tubes, and ovaries.
  • Polycystic ovary syndrome (PCOS). PCOS occurs when the ovaries produce excessive amounts of androgens, which are hormones that regulate the development of male characteristics. Women with PCOS will typically develop ovarian cysts and have irregular menstrual cycles – sometimes menstruation will stop completely. PCOS is associated with infertility, excessive hair growth and acne, and obesity.
  • Von Willebrand disease. Von Willebrand disease is a genetic bleeding disorder that is caused by the dysfunction of the von Willebrand factor (VWF), a protein that is crucial to your body’s ability to create blood clots.

When to Contact Your Doctor

Most women adjust to the menstruation process fairly easily, and will experience varying mild to moderate PMS symptoms throughout their life (until reaching menopause). However, PMDD is a serious condition and you should consult your doctor if you believe that you are experiencing abnormally severe changes to your mental health. In addition, if the physical symptoms are severe enough to impact your daily life, you should consult with your primary care physician. Occasionally these symptoms may be an indication of a more serious health concern such as those mentioned above. Furthermore, if no other serious health conditions are found, there are treatment options available that can help counteract the more extreme physical symptoms.

PlushCare’s team of healthcare professionals can provide diagnosis, treatment, and prescriptions all with one phone call. That means taking care of your health from the comfort of your own home. If you need help with your pre-period symptoms, contact us to book an appointment today.

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