Premenstrual Syndrome (PMS)
Physical and emotional symptoms in the days before a period
Quick Facts
- Type: Menstrual cycle condition
- Timing: 1 to 2 weeks before a period
- Common symptoms: Mood changes, bloating, cramps
- Relief: Lifestyle changes and medication
Overview
Premenstrual syndrome (PMS) is a common condition in which physical and emotional symptoms appear in the week or two before a menstrual period and then fade soon after bleeding begins. The symptoms follow a predictable, cyclical pattern tied to the menstrual cycle.
Most people who menstruate notice at least some premenstrual changes, and for many they are mild. For others, symptoms are strong enough to interfere with daily life, work, or relationships. A more severe form with prominent mood symptoms is called premenstrual dysphoric disorder (PMDD). PMS is manageable, and a range of lifestyle measures and treatments can ease symptoms.
Symptoms
PMS includes both physical and emotional symptoms, which vary from person to person and cycle to cycle. Common emotional symptoms include:
- Mood swings, irritability, or tearfulness
- Anxiety or feeling tense
- Low mood or trouble concentrating
- Changes in appetite or food cravings
- Tiredness and changes in sleep
Common physical symptoms include:
- Bloating and fluid retention
- Breast tenderness
- Headaches
- Cramping and lower abdominal discomfort
- Acne flare-ups
A defining feature is that symptoms come before the period and ease once it starts.
Causes
The exact cause of PMS is not fully understood, but it is closely linked to the natural hormone changes of the menstrual cycle. After ovulation, levels of estrogen and progesterone rise and then fall, and this shift appears to trigger symptoms in sensitive individuals.
Contributing factors are thought to include:
- Hormone fluctuations: The cyclical rise and fall of reproductive hormones.
- Brain chemical changes: Shifts in serotonin, which affects mood, sleep, and appetite.
- Individual sensitivity: Some people are more sensitive to normal hormone changes than others.
Risk Factors
- A personal or family history of PMS or PMDD
- A history of depression or anxiety
- High stress
- Being in the reproductive years, with symptoms common in the 20s to 40s
Diagnosis
There is no specific blood test for PMS. It is diagnosed from the pattern and timing of symptoms:
- Symptom diary: Tracking symptoms over at least two cycles to confirm they appear before the period and ease afterward.
- Medical history and examination: To rule out other conditions that can mimic PMS.
- Additional tests: Sometimes used to exclude thyroid problems or other causes of mood or physical symptoms.
Treatment
Treatment is tailored to symptom severity and may combine self-care with medication.
- Lifestyle measures: Regular exercise, a balanced diet, limiting salt, caffeine, and alcohol, and good sleep can ease symptoms.
- Stress management: Relaxation techniques, mindfulness, and adequate rest.
- Pain relief: Over-the-counter pain relievers for cramps, headaches, and breast tenderness.
- Hormonal options: Some forms of hormonal birth control can smooth out cyclical symptoms.
- Other medicines: For severe mood symptoms or PMDD, certain antidepressants can be very effective.
Many people find a combination of approaches works best, and it can take some trial to find the right plan.
Prevention
- Exercise regularly throughout the month
- Eat balanced meals and limit salt, sugar, caffeine, and alcohol, especially before your period
- Aim for consistent, adequate sleep
- Practice stress-reduction techniques
- Track your cycle so you can anticipate and prepare for symptoms
When to See a Doctor
See a doctor if PMS symptoms interfere with your daily life, work, or relationships, or if self-care measures are not enough. Also seek care if you have:
- Severe mood changes, hopelessness, or thoughts of self-harm, which may indicate PMDD or depression
- Symptoms that do not clearly follow your cycle
- Very heavy or painful periods
If you ever have thoughts of harming yourself, seek help right away by contacting a crisis line or emergency services. Effective treatments are available.
Frequently Asked Questions
How is PMS different from PMDD?
PMS and premenstrual dysphoric disorder (PMDD) both occur before a period, but PMDD is more severe, with intense mood symptoms such as depression, irritability, or anxiety that significantly disrupt daily life. PMDD often needs specific treatment, including certain antidepressants.
When do PMS symptoms usually occur?
PMS symptoms typically begin one to two weeks before a period, during the second half of the menstrual cycle, and ease within a few days of the period starting. This predictable timing is a key feature that distinguishes PMS from other conditions.
What lifestyle changes help with PMS?
Regular exercise, a balanced diet with less salt, caffeine, and alcohol, good sleep, and stress-reduction techniques can all ease PMS. Tracking your cycle helps you anticipate symptoms and prepare for them.
Can birth control help with PMS?
Yes, for some people. Certain hormonal birth control methods can smooth out the cyclical hormone changes that drive symptoms. A healthcare provider can help decide whether this approach is right for you.
When should I see a doctor about PMS?
See a doctor if symptoms disrupt your daily life or do not improve with self-care, or if you have severe mood changes. If you ever have thoughts of harming yourself, seek help immediately through a crisis line or emergency services.
References
- Office on Women's Health, U.S. Department of Health and Human Services. Premenstrual syndrome (PMS).
- Mayo Clinic. Premenstrual syndrome (PMS).
- American College of Obstetricians and Gynecologists (ACOG). Premenstrual Syndrome (PMS).
- MedlinePlus, U.S. National Library of Medicine. Premenstrual syndrome.