Premenstrual syndrome is a combination of symptoms that arrive before your period. Your symptoms may primarily be physical (bloating, fatigue, etc.), emotional (irritability, sadness, etc.) or a combination of both. Either way, PMS symptoms disrupt your life. Lifestyle modifications and over-the-counter medications can often relieve PMS symptoms.
Premenstrual syndrome, or PMS, describes symptoms that show up before your period. Symptoms can be based on emotions such as irritability or depression, or you may have physical symptoms like breast pain or bloating. These symptoms usually arise one to two weeks before you start your period and return at the same time each month.
Premenstrual dysphoric disorder (PMDD) is a severe and potentially debilitating form of PMS. Around 2% of people who menstruate have PMDD. With PMDD, you experience PMS symptoms but with much more intensity, especially when it comes to emotional responses and your mood. You’re more likely to experience anger, severe depression and anxiety with PMDD than with PMS.
Although it’s common to have one or a few premenstrual symptoms, clinically significant PMS occurs in only 3% to 8% percent of people who menstruate.
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It’s common with PMS to experience a variety of symptoms that negatively impact your body and your emotional well-being. The symptoms associated with PMS aren’t always predictable. The symptoms you notice in your 20s may be different from the ones you experience in your 30s and 40s.
What is predictable is the timing. Aches and pains or feelings of irritability that regularly precede your period and then get better afterward are a telltale sign of PMS.
The most common physical signs of PMS are a feeling of fullness in your belly (bloating) and fatigue. Other symptoms include:
Feelings of irritability and mood swings are the most common emotional indicators of PMS. Other symptoms include:
The emotional toll that PMS takes can cause you to withdraw from friends and family. It can intensify negative feelings, making it easier to lash out toward others.
PMS shares symptoms with many other conditions. These shared symptoms often get worse (exacerbate) before around your period. These conditions include:
It’s important during diagnosis to rule out conditions that share symptoms with PMS. Your healthcare provider will help you identify whether your symptoms are signs of PMS only or if you have a condition that feels worse because you’re about to menstruate.
The causes of PMS are unknown. It’s possible that hormone changes related to your menstrual cycle cause some people to experience PMS symptoms. Symptoms usually show up after ovulation, when your ovaries release an egg. Your levels of the hormones estrogen and progesterone dip around this time. Symptoms often go away a few days after your period, when your hormone levels start to rise again. These hormone fluctuations may be to blame for PMS.
Your healthcare provider will ask you about what symptoms you have, when you have them and how they impact your life. It’s common to experience an unpleasant symptom or two on occasion before your period, but this isn’t the same as PMS.
For a PMS diagnosis, your provider will confirm that you have at least one symptom associated with PMS that occurs within five days of your menstrual cycle and then goes away within four days after your period ends. These symptoms must recur for at least three menstrual cycles for an official diagnosis.
Questions your provider may ask include:
Your provider may also ask about your medical history and medications you’re taking to rule out factors other than PMS that may be causing your symptoms. They may ask you about your family’s medical history, too, since many conditions (like mood disorders) run in families. Your provider will rule out causes like:
No. But your symptoms will eventually go away once you experience menopause and no longer have periods. Until then, there’s plenty you can do to manage your symptoms so that they don’t disrupt your life. Keep tabs on when you tend to notice symptoms, and take note of the treatments that relieve them. Put them to use each month when your symptoms usually begin.
You can usually manage mild symptoms with lifestyle changes and over-the-counter (OTC) medications. More severe symptoms may require a prescription from your provider.
You can modify your lifestyle to relieve pain and combat the mood-related symptoms of PMS.
Vitamins, minerals and herbal supplements aren’t regulated by the FDA the way that over-the-counter and prescription drugs are, so it’s a good idea to check with a healthcare provider before taking them. Still, there’s some evidence that they can help with PMS.
You can’t prevent PMS, but you can manage symptoms with lifestyle changes, medications or a combination of both.
PMS is common enough that many people accept it as an inconvenience during “that time of the month” that they have to live with. But you don’t have to endure symptoms that disrupt your life. Often, you can manage your symptoms with medications and lifestyle changes. If nothing you’re doing is making a big enough difference, see your provider to get treatments that can help.
See your provider if you’re unable to get relief from your PMS symptoms. To get the most out of your visit, come to your appointment prepared to discuss your symptoms and your period in detail. Track your period and symptom history on a calendar, planner or app. Be prepared to share information about your period start and stop dates and your symptoms (including how mild or severe) for at least two consecutive periods.
You can’t fix PMS, but you can manage it with lifestyle modifications and medication. The ultimate PMS “fix” is menopause, when you no longer get periods or the symptoms that accompany them.
The onset of PMS symptoms varies. For a PMS diagnosis, you should notice symptoms within five days before starting your period. But the timing isn’t always exact. You may start to notice symptoms two weeks before your period or two days before your period. Pay attention to your patterns.
PME is short for premenstrual exacerbation. If you have conditions that share symptoms with PMS, you may notice that they get worse around your period. Talk to your provider about how your symptoms change in response to your period.
A note from Cleveland Clinic
Just because premenstrual syndrome is common doesn’t mean that you have to tolerate the unpleasant symptoms it causes. Pay attention to any aches and pains or mood changes that happen around your period that may be signs of PMS. If they’re interfering with your well-being, try switching up your habits and taking over-the-counter medications that can ease symptoms. If that doesn’t work, see a healthcare provider to get the treatment you need.
Last reviewed by a Cleveland Clinic medical professional on 10/12/2022.
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