What is premenstrual syndrome?
Half of the population, at some stage in their lives, will menstruate. Premenstrual syndrome (PMS) is the collection of physical, psychological and behavioural symptoms that may occur in the days or weeks preceding menstruation, including abdominal pain, breast pain, headaches, spotty skin, tiredness, mood swings, feeling upset or irritable, and changes in appetite and sex drive (NHS, 2021). This condition is thought to be caused by the fluctuations in hormone levels (primarily oestrogen and progesterone) that characterise a woman’s menstrual cycle.
Research suggests that 75% of menstruating women experience some degree of PMS (Casper et al., 2021), and it is thought that around 30% of women in the UK suffer from moderate to severe PMS (National Association for Premenstrual Syndromes, 2021). This can have a serious impact on women’s lives, affecting their work and leisure activities.
There is no cure for PMS. The NHS recommends managing symptoms by using pain medication as well as lifestyle interventions including regular exercise, eating a healthy diet, reducing stress, and avoiding smoking and excessive alcohol consumption. Some women may also be offered cognitive behavioural therapy or antidepressants to manage their psychological symptoms, or the contraceptive pill, which prevents ovulation and thus can reduce many PMS symptoms (NHS, 2021) (this was my experience, after struggling for years with severe PMS pain that was negatively affecting my quality of life). Given the efficacy of exercise for controlling so many other health conditions, I wanted to examine the evidence for exercise as a way to manage PMS, and consider the mechanisms behind why it might be so effective.
What does the research say about the effect of exercise on PMS?
A recent review of fifteen randomised controlled trials comprising 717 women suffering from PMS explored the effect of exercise on this condition (Pearce et al., 2020). All interventions lasted between eight and twelve weeks and the majority involved three exercise sessions per week. Most of the interventions focused on aerobic exercise, but some used other forms of exercise including yoga, Pilates, stretching and resistance training. All of the studies found that exercise significantly decreased PMS symptoms, and the authors concluded that exercise may be an effective treatment for PMS.
However, a criticism of much of this research is that it has almost exclusively been conducted in Iran, with 12 of the 15 studies in this review carried out in Iran, and none of them taking place in the UK. Whist the prevalence of PMS in is similar in Iran and the UK, there are cultural differences in women’s healthcare, as well as differences in women’s attitudes towards exercise, so these findings may not be entirely applicable to women in the UK.
There was also no indication of the severity of PMS that participants suffered from in these studies. We know that some women are more severely affected by this condition than others, and in my experience exercise was not sufficient to relieve my pain. However it may be that exercise is more helpful for women with mild to moderate PMS.
Additionally, the majority of the studies in this review and in this area have explored the impact of aerobic exercise (rhythmic movement that uses large muscle groups and works the cardiovascular system). The effect of resistance exercise (where your muscles contract against a force in order to get stronger) on PMS symptoms is not well-established, with just one of the studies in the review focusing on this. However, resistance training is an increasingly popular form of exercise for women worldwide, so it would be useful to see more research on this.
Finally, there were no long-term follow ups in any of the studies mentioned, so it is unclear whether the improvements in PMS symptoms were sustained after the study terminated. With these criticisms considered there is a need for UK-based longitudinal research exploring the effects of resistance training on PMS symptoms, particularly for women with severe PMS, with follow-up measures at 6/12/24 months post-intervention.
Why is exercise good for PMS?
There are several possible explanations as to why exercise may be so beneficial for PMS, and these can be broken down into biological, psychological and social reasons.
From a biological perspective, it’s been shown that exercise, particularly if it is aerobic, releases chemicals such as endorphins and endocannabinoids which numb pain and induce feelings of pleasure (Hoffman, 1997; Raichlen et al., 2013). This may explain why exercise appears to both reduce the painful physical symptoms of PMS such as headaches and abdominal pain, and improve the psychological symptoms such as low mood. Also, low-intensity exercise can reduce the production of stress hormones such as adrenaline and cortisol (Hill et al., 2008), and thus creates a more relaxed physical state.
When we look at the psychological mechanisms behind exercise, exercise can distract us from our daily routines, so may stop us from thinking about the discomfort or pain we are experiencing during PMS, and it may be this distraction rather than the exercise per se that helps us to feel better (Bahrke and Morgan, 1978). Exercise can also provide a sense of achievement, both in terms of improving at a skill and knowing that you’ve done something positive for your health, and this may help to reduce the negative psychological states associated with PMS (Greist et al., 1979).
Finally, most exercise involves some degree of social interaction, and social connection is key to mental wellbeing (Ransford, 1982), so this could also explain why exercise can be so helpful for improving many of the symptoms of PMS.
What if I don’t feel like exercising when I’ve got PMS?
You might be wondering how exercising when you have PMS is compatible with an intuitive approach to movement – after all, if our bodies are telling us to lie on the sofa and participate in a Netflix marathon rather than a gym class when we’re cramping and feeling rotten, then shouldn’t we honour that feeling?
To this I would argue that one of the goals of intuitive movement is moving because it makes your body feel good. So actually, given all the evidence discussed above, exercising whilst you’re experiencing PMS is absolutely compatible with intuitive movement, so long as you are doing it from a place of wanting to make yourself feel better, rather than from a place of punishment. If you can keep this in mind, along with the attitude that if when you start exercising you are allowed to stop at any point, this is a sensible way to approach it.
And that’s also not to say that you should always turn to exercise whenever you have PMS – at times you may choose to use other coping mechanisms, like pain medication, a hot water bottle or a tub of Ben and Jerry's – but just knowing that exercise is one tool in our self-care toolbox is a helpful way to think about it.
My final thoughts
The evidence certainly seems to suggest that exercise can help to alleviate the symptoms of PMS, and this may be due to a combination of biological, psychological and social factors at play when we exercise. However, like with most issues concerning women’s health, this is a massively under-funded and under-researched topic in the UK. It is inconceivable that although half of the population are at risk of experiencing some degree of PMS in their lives, no UK-based studies exist into the effect of exercise on PMS. The UK has its own unique healthcare system and female fitness trends, with resistance training being more popular amongst women than ever before, so it’s important that these factors are accounted for in women’s health research and public health advice.
References
Bahrke, M. S., & Morgan, W. P. (1978). Anxiety reduction following exercise and meditation. Cognitive Therapy and Research, 2(4), 323-333.
Casper, R. F. (2021). Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the Basics). UpToDate. Retrieved from: https://www.uptodate.com/contents/premenstrual-syndrome-pms-and-premenstrual-dysphoric-disorder-pmdd-beyond-the-basics
Greist, J. H., Ossip-Klein, M. H., Eischens, R. R., Faris, J. W., Gurman, A. S., & Morgan, W. P. (1979). Running as a treatment for depression. Comprehensive Psychiatry, 20, 41–54.
Hill, E.E., Zack, E., Battaglini, C., Viru, M., Viru, A., & Hackney, A.C. (2008). Exercise and circulating cortisol levels: the intensity threshold effect. Journal of Endocrinological Investigation, 31(7), 587-91. doi: 10.1007/BF03345606. PMID: 18787373.
Hoffmann, P. (1997). The endorphin hypothesis. In W. P. Morgan (Ed.), Series in health psychology and behavioral medicine. Physical activity and mental health (163–177). Taylor & Francis.
National Association for Premenstrual Syndromes (2021). About PMS. Retrieved from: https://www.pms.org.uk/about-pms/
NHS (2021). PMS (Premenstrual Syndrome). Retrieved from: https://www.nhs.uk/conditions/pre-menstrual-syndrome/
Pearce, E., Jolly, K., Jones, L.L., Matthewman, G., Zanganeh, M., & Daley, A. (2020). Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials. BJGP Open, 4(3), doi: 10.3399/bjgpopen20X101032. PMID: 32522750; PMCID: PMC7465566.
Ransford, C. P. (1982). A role for amines in the anti-depressant effect of exercise: A review. Medicine and Science in Sports and Exercise, 14(1), 1–10.