Your Guide to Premenstrual Syndrome (PMS)

Medically Reviewed By Valinda Riggins Nwadike, MD, MPH
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PMS causes physical and psychological symptoms in the weeks before your menstrual period. Symptoms may include back pain, anxiety, and mood swings. Other symptoms can include changes in appetite, abdominal pain, and restlessness. It affects nearly 5 in 10 females in the reproductive age range. Symptoms can be mild for some people and severe for others. Sometimes symptoms can be severe enough to disrupt your daily routine.

This article will review the symptoms and causes of PMS. It will also discuss the treatment options available.

What is premenstrual syndrome? 

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PMS is a set of physical and psychological symptoms that occur before your menstrual period. It commonly affects women of childbearing age.

Sex and gender exist on spectrums. This article will use the terms “female” and “women” when discussing people assigned female at birth to reflect language that appears in source materials.

Learn more about the difference between sex and gender here.

Most people experience only mild symptoms and can go about their usual routine. Others will experience significant physical and emotional distress.

Symptoms typically go away within a few days of the onset of menstruation.

Read about the menstrual cycle.

Who gets it?

Experts say around 8–9 in 10 women experience at least one symptom of PMS.

Those who are pregnant will cease to have symptoms until after pregnancy, and those who pass menopause will no longer have symptoms.

Visit our hub to read more about menopause.

What is severe PMS?

Studies indicate that 2.5–3% of women who get PMS will go on to develop premenstrual dysphoric disorder (PMDD).

PMDD is the most serious form of PMS. It may severely affect physical and emotional well-being.

Symptoms of PMDD may include:

  • extreme irritability
  • thinking and concentration problems
  • binge eating
  • severe cramping
  • sudden mood swings
  • severe anxiety and panic attacks
  • depression
  • insomnia
  • bloating

Read more about PMDD.

What are the symptoms of premenstrual syndrome? 

Symptoms of PMS can differ from one person to another. 

In some, symptoms appear consistently each month. In others, symptoms vary from month to month.

Here is an overview of common symptoms.

Emotional symptoms 

Emotional symptoms may include:

  • anxiety or tension
  • irritability and anger
  • changes in appetite
  • fatigue
  • restlessness and sleep issues 
  • mood swings
  • concentration or memory problems
  • depression and sadness
  • decrease in sex drive

Physical symptoms 

Physical symptoms can include:

  • weight gain
  • headaches and abdominal pain
  • back pain and low back pain
  • swelling and tenderness of the breasts
  • nausea
  • constipation
  • bloating 
  • cramping
  • clumsiness

Symptoms 1–2 weeks before your period 

Symptoms may get significantly more intense right before menstruation.

For example, irritability may turn into hostility, and depression may turn into suicidal thoughts.

Suicide Prevention

If someone you know is at immediate risk of harming themselves or others, or is experiencing thoughts of suicide: 

  • Ask the question, “Are you considering suicide?” even if it is tough.
  • Listen without judgment.
  • Call 911 or your local emergency number. 
  • Stay with the person until emergency services arrive.
  • Try to remove weapons, medications, or other potentially harmful items.

If you or someone you know is experiencing suicidal thoughts, contact the National Suicide Prevention Lifeline:

  • Call 800-273-8255 (or 988 after July 16, 2022).
  • Chat with the lifeline.

This service is available 24/7. 

How long do symptoms last? 

The menstrual cycle comprises four main phases, namely:

  • Ovulation: This is the ovaries releasing a mature egg. 
  • Follicular phase: This is the uterine lining thickening in response to a rise in estrogen levels.
  • Luteal phase: This is the matured egg traveling to the uterus. If fertilization does not occur, hormone levels will fluctuate. Symptoms of PMS typically occur in this phase. It typically has a duration of 14 days
  • Menstruation: This is the body shedding the lining of the uterus. Symptoms of PMS will typically dissipate a few days into menstruation.

When to contact a doctor

If your symptoms severely affect your daily routine or your physical or emotional well-being, seek advice from your doctor.

Treatments are available to help manage your symptoms.

What causes premenstrual syndrome? 

Experts do not fully understand the cause of PMS. However, the following factors may place a role.

Hormones 

When you reach the luteal phase of the menstrual cycle, estrogen and progesterone levels fluctuate naturally.

This causes an imbalance in the levels of these hormones and subsequently triggers the symptoms of PMS.

Chemical changes

The luteal phase also causes changes to some brain chemicals.

Specifically, the hypothalamus, which is a deep structure in your brain, releases a chemical messenger called norepinephrine. This reduces the levels of acetylcholine, dopamine, and serotonin, which are other chemical messengers. 

These changes can trigger insomnia, depression, and other symptoms of PMS.

Mental health conditions

Certain medical conditions can also contribute to PMS. They include:

How can you treat premenstrual syndrome? 

A doctor may recommend some medications and lifestyle changes to treat PMS.

These may include:

Medications 

Medications will aim at controlling hormonal fluctuations and easing symptoms. They include:

  • dietary supplements, such as vitamin B6, calcium and vitamin D, and magnesium, to reduce fatigue and anxiety 
  • over-the-counter (OTC) pain relievers, such as ibuprofen, to reduce pain and bleeding 
  • hormonal medication, such as the combined contraceptive pill, to limit hormonal activity
  • therapies, such as talk therapy to promote emotional well-being
  • anti-anxiety medicines, such as chlordiazepoxide (Librium) and diazepam (Valium), to help reduce anxiety
  • antidepressants, such as SSRIs and SNRIs, to reduce symptoms of depression
  • diuretics to reduce bloating and breast tenderness

Lifestyle changes 

Some lifestyle adjustments can make PMS easier to manage. They include:

  • exercising 
  • avoiding smoking 
  • avoiding alcohol
  • eating healthy foods 
  • limiting caffeine, salt, and sugar 
  • getting enough sleep
  • reducing stress by practicing yoga or meditation

How do you diagnose premenstrual syndrome? 

Your doctor will review your symptoms and family history to see if you have PMS.

They will also run some tests to rule out other conditions. 

Several conditions can cause symptoms roughly similar to those of PMS. They include: 

Always remember to record the onset and disappearance dates of your symptoms in a diary. 

Doing this can help your doctor make a quicker and more accurate diagnosis.

What are the risk factors for premenstrual syndrome?

Your risk of PMS and PMDD can increase with the following factors:

  • excess intake of sugar and coffee 
  • excess intake of fast foods and deep-fried foods
  • doing little or no exercise 
  • lack of sleep

Other risk factors include:

  • high levels of stress
  • a personal history of postpartum depression or depression
  • a family history of depression

PMS vs. PMDD 

Sometimes people confuse PMS with PMDD, but the two conditions are different.

The table below explains the differences further.

PMSPMDD
Incidencemost females will experience PMS at some pointonly a few females will get PMDD
Symptoms symptoms are relatively mildsymptoms are typically severe
Treatmentmay respond to remedies that do not involve medicationsusually requires medications

If you are unsure whether you have PMS or PMDD, contact your doctor for a diagnosis.

How can you manage premenstrual syndrome? 

You may find these practices helpful in easing your symptoms of PMS:

  • exercising daily
  • cutting back on caffeine
  • practicing yoga and meditation
  • using birth control pills 
  • using SSRIs or SNRIs
  • eating more calcium-rich foods, such as cheese and yogurt
  • eating more vitamin B6 foods, such as fish and fortified cereals
  • consuming herbal supplements, such as dried ripe chasteberry and black cohosh

Summary

PMS causes physical and psychological symptoms in the weeks before your menstrual period. It mostly affects females in their reproductive years.

Symptoms include weight gain, headaches, and abdominal pain. Other symptoms include anxiety and irritability.

Doctors often diagnose the condition by reviewing your symptoms and family history. They may also run some tests to rule out other conditions. 

Treatment methods include vitamin B6 and calcium supplements, birth control pills, and OTC pain relievers.

Report severe or persistent symptoms of PMS to your doctor.

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Medical Reviewer: Valinda Riggins Nwadike, MD, MPH
Last Review Date: 2022 Sep 12
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