Stress May Raise Risk of Premenstrual Syndrome

Study Shows PMS Symptoms Could Be More Severe if Women Are Stressed Before Menstruation

By Denise Mann
WebMD Health News

Reviewed By Laura J. Martin, MD

Aug. 24, 2010 -- Feeling stressed out in the weeks preceding your menstrual cycle may raise your risk for experiencing more severe premenstrual syndrome (PMS) symptoms, a study shows.

Women who reported high levels of stress in the two weeks before they got their period were two to three times more likely to experience depression, sadness, and crying spells as well as physical PMS symptoms such as body aches, bloating, low back pain, cramps, and headache, compared to women who did not feel stressed early on in their cycles.

The study appears in the Journal of Women's Health.

"Stress early in the cycle is a risk factor for PMS, and combating stress with yoga, exercise, biofeedback, or meditation may help prevent PMS symptoms or make them much more manageable," says study researcher Audra L. Gollenberg, PhD. She was a postdoctoral fellow at the National Institute of Child Health and Human Development in Bethesda, Md., when she conducted the study.

"The symptoms may not go away completely, but stress-reduction techniques could make symptoms more manageable to the point that some women may not need medication," Gollenberg tells WebMD.

"More than 50% of women report some degree of PMS symptoms and this is responsible for missed days at work, and if we can find things to prevent or mediate PMS without medications, that is a good thing," says Gollenberg, who is now an assistant professor of public health at Shenandoah University in Winchester, Va.

The new study included 259 women ages 18 to 44 who filled out questionnaires about their stress levels and their physical and psychological PMS symptoms throughout their four-week cycle. Women also tracked their ovulation using an at-home fertility monitor. All but nine women reported this information for two menstrual cycles.

Among women who tracked their stress levels and symptoms for two cycles, those who were stressed in the weeks before the beginning of one cycle, but not the other, usually had more severe premenstrual symptoms after the weeks where they reported more stress.

Women who had high stress before both cycles were 25 times more likely to experience physical and psychological PMS symptoms than those who reported low stress before both cycles.

"Developing a stress-reduction intervention and testing to see if it reduces PMS would be an interesting next step," says Gollenberg.

Window of Opportunity to Treat PMS

The new study "sheds an interesting light on PMS because it shows us that things are going on at other points in the cycle," says Shari Brasner, MD, an assistant professor of obstetrics and gynecology at Mount Sinai School of Medicine in New York City.

Many PMS treatments target the few bad days on or around that time of the month. But "this opens my eyes and hopefully many others' eyes that we may have a bigger window of opportunity to intervene, treat, and make a real difference for women with PMS," she says.

"Starting much earlier may make more sense as would incorporating non-pharmacological strategies like stress reduction," Brasner tells WebMD.

"Relaxation and counseling may help if a woman's stress levels are high," agrees Theodoros Vlachos, MD, vice chief of gynecology at Beaumont Hospital in Royal Oak, Mich. He is not sure if the stress causes the PMS or the anxiety about upcoming PMS causes the stress. "It may be the chicken or the egg," he says.

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SOURCES: Gollenberg, A.L. Journal of Women's Health, May 2010; vol 19: pp 959-967.

Audra L. Gollenberg, PhD, assistant professor, public health, Shenandoah University, Winchester, Va.

Theodoros Vlachos, MD, vice chief, gynecology, Beaumont Hospital, Royal Oak, Mich.

Shari Brasner, MD, assistant professor, obstetrics and gynecology, Mount Sinai School of Medicine, New York City.

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