Premenstrual Syndrome, Female Hormones and ME/CFS by Dr Charles Shepherd | 25 September 2018

September 25, 2018


Dr Charles Shepherd, Hon. Medical Adviser, ME Association.

Today we launch a new leaflet “Premenstrual Syndrome, Female Hormones and ME/CFS” and provide an extract below.

The leaflet is available to members of the ME Association in the next issue of ME Essential magazine, and also available in our online shop (see bottom of page for details).


The premenstrual syndrome (PMS) – also known as premenstrual tension and premenstrual disorder – is a collection of symptoms that appear every month around the time of menstruation.

Some of these symptoms also occur in ME/CFS.

So, it’s not surprising to find that a significant proportion of women with ME/CFS notice an exacerbation of their ME/CFS symptoms at this time.

In fact, the NICE guidance on PMS notes that ME/CFS should be considered when making a diagnosis of PMS.

This new ME Association information leaflet summarises what we currently know about PMS, how it can overlap with ME/CFS, and the various treatment options that are available. The information draws on guidance to doctors from NICE, the Royal College of Obstetricians and Gynaecologists (RCOG) and National Association for PMS (NAPS).

What is PMS?

PMS symptoms start at some point after ovulation – the release of an egg from the ovary each month. Ovulation occurs about two weeks before the start of a period.

  • Symptoms tend to appear in the five days before the period starts. However, some women have symptoms that occur over the full two weeks or so leading up to the period.
  • Symptoms tend to worsen as the period approaches and then start to decline/disappear three to four days after the start of the period.

PMS is very common, with NAPS reporting that between 3% and 30% of women have some degree of PMS. For most women, PMS symptoms are mild and not particularly troublesome and may then disappear. However, 5% to 8% have more persistent and severe symptoms. PMS can occur at any age from puberty through to the menopause.

What causes PMS?

The precise cause remains uncertain. The most likely explanation involves the cyclical changes in female hormone patterns that occur during the menstrual cycle – with the release of the egg each month being the main trigger factor.

It appears that women become more sensitive to a female hormone called progesterone, which passes into the blood from the ovaries after ovulation. Over-sensitivity to this hormone reduces the level of two important brain chemical transmitters called serotonin and gamma-aminobutyric acid (GABA).

As the chemical transmitter changes involve serotonin, this may be relevant to ME/CFS because there is research evidence to show that this transmitter is also involved in ME/CFS. And some people with ME/CFS are very sensitive to drugs called SSRIs (selective serotonin uptake inhibitors) that alter serotonin levels in the brain.

  • Research into possible female hormone abnormalities involving oestrogen and progestogen in ME/CFS is summarised in a further leaflet covering the menopause and hormone research.

What are the symptoms?

PMS can cause a range of physical and psychological symptoms.

Physical symptoms include:

  • Backache
  • Abdominal bloating
  • Breast tenderness and/or pain
  • Clumsiness
  • Cognitive dysfunction – problems with memory, concentration, etc
  • Fatigue
  • Headaches
  • Sleep disturbance
  • Swollen hands or feet
  • Weight gain
  • Worsening of pre-existing asthma, migraine-type headaches and cold sores

Psychological symptoms include:

  • Irritability, anger, aggression
  • Feeling more emotional than usual
  • Feeling tense or even ‘out of control’
  • Food cravings
  • Mood swings, anxiety and depression
  • Changes in appetite and sexual feelings


This new leaflet can be read in full in the November issue of ME Essential our exclusive magazine for members of the ME Association.

If you are not a member you can join from as little as £1.50 a month (£18 a year) and if you pay by annual standing order, you will qualify for £10 of free leaflets.

“Premenstrual Syndrome, Female Hormones and ME/CFS” is also now available from our online shop which offers the largest collection of information relating to ME/CFS anywhere on the internet.




3 thoughts on “Premenstrual Syndrome, Female Hormones and ME/CFS by Dr Charles Shepherd | 25 September 2018”

  1. My thoughts based on my knowledge.

    In most cases, the condition will be premenstrual distress, i.e. an exacerbation of existing symptoms. Only symptoms which are absent for at least seven days in a typical 28 day cycle can be diagnosed as PMS. (Specialised in menstrual cycle and wrote Masters degree thesis on PMS after research at St. Thomas’s hospital, Dept gynaecology. Co-edited textbook on this field with Dr Mike Brush while there).

    Cause: hormones out of sync. 40% have low levels of progesterone but you see shifts in other hormones. They are all there, perhaps too much FSH in second half, but they are not at the right level at the right time. Diet plays an important part in hormone regulation. Cutting down on sugar is the most obvious thing one can do. And increasing veg and fibre to make sure the oestrogen doesn’t stay around longer than normal. Women in certain countries, e.g. Japan, have little PMS because of diet. Stress can also play havoc with hormones.

    Good review a while ago in BMJ. there are now 7 recognised conditions relating to the menstrual cycle. Premenstrual distress or secondary PMS, is no. 2. I’ve forgotten numbers 3-7.

    For those who are smug because they don’t have PMS, watch out. There is always the menopause. And men, don’t trivialise this as you can’t expect sympathy when your prostate gland starts playing up! Karma.

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