Your Guide to Premenstrual Syndrome (PMS)
This article will review the symptoms and causes of PMS. It will also discuss the treatment options available.
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.
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.
Who gets it?
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
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 may include:
- anxiety or tension
- irritability and anger
- changes in appetite
- restlessness and sleep issues
- mood swings
- concentration or memory problems
- depression and sadness
- decrease in sex drive
Physical symptoms can include:
- weight gain
- headaches and abdominal pain
- back pain and low back pain
- swelling and tenderness of the breasts
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.
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.
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.
Experts do not fully understand the cause of PMS. However, the following factors may place a role.
This causes an imbalance in the levels of these hormones and subsequently triggers the symptoms of PMS.
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:
- a family history of PMS, bipolar disorder, or depression
A doctor may recommend some medications and lifestyle changes to treat PMS.
These may include:
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
Some lifestyle adjustments can make PMS easier to manage. They include:
- avoiding smoking
- avoiding alcohol
- eating healthy foods
- limiting caffeine, salt, and sugar
- getting enough sleep
- reducing stress by practicing yoga or meditation
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:
- depression and anxiety disorders
- irritable bowel syndrome (IBS)
- thyroid disorder
- chronic fatigue syndrome
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.
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
Sometimes people confuse PMS with PMDD, but the two conditions are different.
The table below explains the differences further.
|Incidence||most females will experience PMS at some point||only a few females will get PMDD|
|Symptoms||symptoms are relatively mild||symptoms are typically severe|
|Treatment||may respond to remedies that do not involve medications||usually requires medications|
If you are unsure whether you have PMS or PMDD, contact your doctor for a diagnosis.
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
PMS causes physical and psychological symptoms in the weeks before your menstrual period. It mostly affects females in their reproductive years.
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.