Premenstrual Syndrome

What is premenstrual syndrome (PMS)?

Premenstrual syndrome, or PMS, describes physical and emotional symptoms that begin a week or two before your period. Most people who menstruate have at least one or more symptoms of PMS. These symptoms usually tip you off that your period is coming soon. Once you get your period, symptoms of PMS usually go away. These symptoms will often reoccur around the same time each menstrual cycle.

Almost 50% of people who menstruate say they have at least one PMS symptom. About 20% of those people have symptoms that are severe enough to disrupt their life.

What are symptoms of PMS?

PMS symptoms can be physical, emotional or a mix of both. They can also be mild, severe or somewhere in between. Not everyone experiences PMS. If you do, your symptoms may change throughout your life.

Physical symptoms

The most common physical signs of PMS are:

• Bloating or a gassy feeling
• Pelvic pain
• Fatigue
• Acne flare-ups
• Breast soreness
• Headaches
• Diarrhea or constipation

Emotional symptoms

The most common emotional signs of PMS are:

• Irritability or lashing out toward others
• Mood swings
• Changes in your sex drive
• Feeling anxious, sad or having crying spells
• Brain fog or trouble concentrating
• Food cravings or increased/decreased appetite
• Having trouble sleeping (insomnia)

What causes PMS?

The exact cause is unknown. But most healthcare providers believe PMS happens due to hormonal changes related to your menstrual cycle.

Symptoms usually show up around ovulation, when levels of estrogen and progesterone increase. Once your period begins, these hormone levels drop for a few days, and then, will start to rise again. These hormonal changes may be to blame for PMS. Some people are more sensitive to hormonal fluctuations, which may explain why PMS affects everyone differently.

How long does PMS last before you get your period?

Most people experience PMS symptoms about one to two weeks before their period. But the timing isn’t always exact. You can have PMS two weeks before your period or two days before your period.

Risk factors for PMS

You may be more likely to have PMS if you have:

• A history of postpartum depression
• A personal or family history of depression or anxiety disorders
• High stress levels

Healthcare providers most often diagnose PMS in people who are in their late 20s and early 30s.

How is premenstrual syndrome diagnosed?

Your healthcare provider diagnoses PMS based on your symptoms. They‘ll ask you about what symptoms you have, when you have them and how they impact your life. To receive a PMS diagnosis, your symptoms must:

• Occur the week before your period
• End within a few days of your period starting
• Recur for at least three menstrual cycles in a row

Questions your provider may ask include:

• How many days pass between one period and the next?
• How many days do you bleed?
• How many days are light, medium or heavy?
• What symptoms do you have?
• When do your PMS symptoms show up/go away?
• When are your symptoms milder/more intense?
• Can you tell when your symptoms are about to start?
• Do your symptoms interfere with your life?

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 biological family’s medical history, too, as many conditions run in families. Your provider will rule out causes like:

• Anxiety
• Depression
• Perimenopause
• Chronic fatigue syndrome
• Thyroid disorders
• Irritable bowel syndrome (IBS)

How can I manage symptoms of PMS?

There are many treatment options for PMS. Some people may need to try several different treatments until they find one that relieves their symptoms.

Medications for PMS

You can usually manage mild symptoms with over-the-counter (OTC) medications. More severe symptoms may require a prescription from a provider. Options include:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve breast pain and menstrual cramps if you take them around the time when your symptoms start. Options include ibuprofen (Advil®, Motrin IB®), naproxen sodium (Aleve®), acetaminophen (Tylenol®) and aspirin. You can purchase them at your local drugstore.
• Hormonal birth control. Medicines that prevent you from ovulating can relieve unpleasant physical symptoms, like breast tenderness and pain. It may take some experimentation at first to figure out what kind of birth control helps you most. Options include birth control pills, the patch and the ring.
• Antidepressants and anti-anxiety medications. Selective serotonin reuptake inhibitors (SSRIs) are the most common types of antidepressants to treat the mood-related issues associated with PMS. Options include fluoxetine (Prozac®, Sarafem®), paroxetine (Paxil®, Pexeva®) and sertraline (Zoloft®).
• Diuretics. Diuretics can relieve symptoms like bloating and breast tenderness.

Lifestyle changes

You can modify your lifestyle to help relieve pain and combat the mood-related symptoms of PMS. Examples include:

• Getting regular exercise. Moderate exercise (running, walking, swimming) for 30 minutes a day can relieve stress and boost your mood. Plus, exercise is good for your overall wellness.
• Eating a diet that’s healthy for you. Eating more of some foods and less of others can help combat PMS symptoms. Eat fewer salty, fatty and sugary foods, and drink fewer caffeinated drinks and beverages containing alcohol for two weeks before your period to help fend off PMS symptoms. Instead, reach for fruits, vegetables and whole grains.
• Getting plenty of sleep. Getting at least eight hours of sleep can help reduce feelings of irritability. Waking up and going to bed at the same time each day adds the extra benefit of syncing your internal clock so you’re less likely to feel moody throughout the day.
• Practicing relaxation exercises. Yoga, meditation and breathing exercises can help relieve stress and combat the irritability and sadness that often accompany PMS.
• Avoiding smoking. Smoking tobacco products may worsen PMS symptoms.

Vitamins, minerals and supplements

Vitamins, minerals and herbal supplements aren’t regulated by the U.S. Food and Drug Administration (FDA) the way 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:

• Curcumin. Curcumin is especially effective in easing mood swings and cramps.
• Chasteberry. Chasteberry can help reduce bloating, cramping and food cravings.
• St. John’s Wort. St. John’s Wort is used for mood disorders and to help with anxiety and depression, which can be common during PMS.
• Evening primrose oil. This is an essential fatty acid that may help reduce depression, as well as relieve breast tenderness, swelling and bloating.
• Ginkgo biloba. Ginkgo biloba has been shown to reduce the severity of PMS symptoms.

When will PMS go away?

PMS doesn’t go away for good until you experience menopause and no longer have periods. Until then, there’s plenty you can do to help manage your symptoms so 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.

Can you prevent PMS?

You can’t prevent premenstrual syndrome, but you can manage symptoms with lifestyle changes, medications or a combination of both.

What can I expect if I have premenstrual syndrome?

PMS is common enough that many people accept it as an annoyance during “that time of the month.” Just because PMS is normal, it doesn’t mean you have to let it 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.

When should I see my healthcare provider?

Contact a healthcare 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.

Be prepared to share:

• Your symptoms (including how severe they are) and when they occur
• When your last two periods began and ended

You can use a pen and paper, a calendar or an app on your phone to track this information. This helps you and your provider recommend the best path forward.

What questions should I ask my provider?

If you have PMS, you may want to ask your provider:

• Are my symptoms only related to PMS or could they be a sign of something else?
• What lifestyle changes would you recommend to help PMS?
• Do I need medication to help my symptoms?
• Would you recommend herbal supplements to ease PMS symptoms?

What is the difference between PMS and PMDD?

Premenstrual dysphoric disorder (PMDD) is a severe and potentially debilitating form of PMS. It’s much less common than PMS, affecting about 3% of people who menstruate. 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.

At what age does PMS get worse?

There isn’t any solid evidence that PMS worsens at a particular age. Researchers believe PMS symptoms appear at similar rates across all age groups. Some people believe that their PMS symptoms tend to be more severe as they enter their 40s. But this is usually due to symptoms associated with perimenopause (like hot flashes or vaginal dryness).