Premenstrual syndrome (PMS) – Symptoms, Causes and Treatment
What is PMS?
PMS is a combination of physical and emotional symptoms that many women get after ovulation and before the start of their menstrual period. Researchers think that PMS happens in the days after ovulation because estrogen and progesterone levels begin falling dramatically if you are not pregnant. PMS symptoms go away within a few days after a woman’s period starts as hormone levels begin rising again.
Some women get their periods without any signs of PMS or only very mild symptoms. For others, PMS symptoms may be so severe that it makes it hard to do everyday activities like go to work or school. Severe PMS symptoms may be a sign of premenstrual dysphoric disorder (PMDD). PMS goes away when you no longer get a period, such as after menopause. After pregnancy, PMS might come back, but you might have different PMS symptoms.
Who gets PMS?
As many as three in four women say they get PMS symptoms at some point in their lifetime.5 For most women, PMS symptoms are mild.
Less than 5% of women of childbearing age get a more severe form of PMS, called premenstrual dysphoric disorder (PMDD).6
PMS may happen more often in women who:
- Have high levels of stress7
- Have a family history of depression8
- Have a personal history of either postpartum depression or depression9,10
Does PMS change with age?
Yes. PMS symptoms may get worse as you reach your late 30s or 40s and approach menopause and are in the transition to menopause, called perimenopause.11
This is especially true for women whose moods are sensitive to changing hormone levels during the menstrual cycle. In the years leading up to menopause, your hormone levels also go up and down in an unpredictable way as your body slowly transitions to menopause. You may get the same mood changes, or they may get worse.
PMS stops after menopause when you no longer get a period.
What are the symptoms of PMS?
PMS symptoms are different for every woman. You may get physical symptoms, such as bloating or gassiness, or emotional symptoms, such as sadness, or both. Your symptoms may also change throughout your life.
Physical symptoms of PMS can include:12
- Swollen or tender breasts
- Constipation or diarrhea
- Bloating or a gassy feeling
- Headache or backache
- Lower tolerance for noise or light
Emotional or mental symptoms of PMS include:12
- Irritability or hostile behavior
- Feeling tired
- Sleep problems (sleeping too much or too little)
- Appetite changes or food cravings
- Trouble with concentration or memory
- Tension or anxiety
- Depression, feelings of sadness, or crying spells
- Mood swings
- Less interest in sex
Talk to your doctor or nurse if your symptoms bother you or affect your daily life.
What causes PMS?
Researchers do not know exactly what causes PMS. Changes in hormone levels during the menstrual cycle may play a role.13 These changing hormone levels may affect some women more than others.
How is PMS diagnosed?
There is no single test for PMS. Your doctor will talk with you about your symptoms, including when they happen and how much they affect your life.
You probably have PMS if you have symptoms that:12
- Happen in the five days before your period for at least three menstrual cycles in a row
- End within four days after your period starts
- Keep you from enjoying or doing some of your normal activities
Keep track of which PMS symptoms you have and how severe they are for a few months. Write down your symptoms each day on a calendar or with an app on your phone. Take this information with you when you see your doctor.
How does PMS affect other health problems?
About half of women who need relief from PMS also have another health problem, which may get worse in the time before their menstrual period.12 These health problems share many symptoms with PMS and include:
- Depression and anxiety disorders.These are the most common conditions that overlap with PMS. Depression and anxiety symptoms are similar to PMS and may get worse before or during your period.
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Some women report that their symptoms often get worse right before their period. Research shows that women with ME/CFS may also be more likely to have heavy menstrual bleeding and early or premature menopause.14
- Irritable bowel syndrome (IBS). IBS causes cramping, bloating, and gas. Your IBS symptoms may get worse right before your period.
- Bladder pain syndrome. Women with bladder pain syndrome are more likely to have painful cramps during PMS.
PMS may also worsen some health problems, such as asthma, allergies, and migraines.
What can I do at home to relieve PMS symptoms?
These tips will help you be healthier in general, and may relieve some of your PMS symptoms.
- Get regular aerobic physical activity throughout the month.15 Exercise can help with symptoms such as depression, difficulty concentrating, and fatigue.16
- Choose healthy foods most of the time.17 Avoiding foods and drinks with caffeine, salt, and sugar in the two weeks before your period may lessen many PMS symptoms. Learn more about healthy eating for women.
- Get enough sleep. Try to get about eight hours of sleep each night. Lack of sleep is linked to depression and anxiety and can make PMS symptoms such as moodiness worse.12
- Find healthy ways to cope with stress. Talk to your friends or write in a journal. Some women also find yoga,18 massage,19 or meditation20 helpful.
- Don’t smoke. In one large study, women who smoked reported more PMS symptoms and worse PMS symptoms than women who did not smoke.21
What medicines can treat PMS symptoms?
Over-the-counter and prescription medicines can help treat some PMS symptoms.
Over-the-counter pain relievers you can buy in most stores may help lessen physical symptoms, such as cramps, headaches, backaches, and breast tenderness. These include:
Some women find that taking an over-the-counter pain reliever right before their period starts lessens the amount of pain and bleeding they have during their period.
Prescription medicines may help if over-the-counter pain medicines don’t work:22
- Hormonal birth control may help with the physical symptoms of PMS,12 but it may make other symptoms worse. You may need to try several different types of birth control before you find one that helps your symptoms.
- Antidepressants can help relieve emotional symptoms of PMS for some women when other medicines don’t help. Selective serotonin reuptake inhibitors, or SSRIs, are the most common type of antidepressant used to treat PMS.23
- Diuretics (“water pills”) may reduce symptoms of bloating and breast tenderness.
- Anti-anxiety medicine may help reduce feelings of anxiousness.
All medicines have risks. Talk to your doctor or nurse about the benefits and risks.
Should I take vitamins or minerals to treat PMS symptoms?
Maybe. Studies show that certain vitamins and minerals may help relieve some PMS symptoms. The Food and Drug Administration (FDA) does not regulate vitamins or mineral and herbal supplements in the same way they regulate medicines. Talk to your doctor before taking any supplement.
Studies have found benefits for:
- Calcium. Studies show that calcium can help reduce some PMS symptoms, such as fatigue, cravings, and depression.24,25 Calcium is found in foods such as milk, cheese, and yogurt. Some foods, such as orange juice, cereal, and bread, have calcium added (fortified). You can also take a calcium supplement.
- Vitamin B6. Vitamin B6 may help with PMS symptoms, including moodiness, irritability, forgetfulness, bloating, and anxiety. Vitamin B6 can be found in foods such as fish, poultry, potatoes, fruit (except for citrus fruits), and fortified cereals. You can also take it as a dietary supplement.
Studies have found mixed results for:
- Magnesium.24 Magnesium may help relieve some PMS symptoms, including migraines. If you get menstrual migraines, talk to your doctor about whether you need more magnesium.26 Magnesium is found in green, leafy vegetables such as spinach, as well as in nuts, whole grains, and fortified cereals. You can also take a supplement.
- Polyunsaturated fatty acids (omega-3 and omega-6). Studies show that taking a supplement with 1 to 2 grams of polyunsaturated fatty acids may help reduce cramps and other PMS symptoms.27 Good sources of polyunsaturated fatty acids include flaxseed, nuts, fish, and green leafy vegetables.
What complementary or alternative medicines may help relieve PMS symptoms?
Some women report relief from their PMS symptoms with yoga or meditation. Others say herbal supplements help relieve symptoms. Talk with your doctor or nurse before taking any of these supplements. They may interact with other medicines you take, making your other medicine not work or cause dangerous side effects. The Food and Drug Administration (FDA) does not regulate herbal supplements at the same level that it regulates medicines.
Some research studies show relief from PMS symptoms with these herbal supplements, but other studies do not. Many herbal supplements should not be used with other medicines. Some herbal supplements women use to ease PMS symptoms include:
- Black cohosh.28 The underground stems and root of black cohosh are used fresh or dried to make tea, capsules, pills, or liquid extracts. Black cohosh is most often used to help treat menopausal symptoms,29and some women use it to help relieve PMS symptoms.
- Chasteberry .30 Dried ripe chasteberry is used to prepare liquid extracts or pills that some women take to relieve PMS symptoms. Women taking hormonal birth control or hormone therapy for menopause symptoms should not take chasteberry.
- Evening primrose oil. The oil is taken from the plant’s seeds and put into capsules. Some women report that the pill helps relieve PMS symptoms, but the research results are mixed.29
Researchers continue to search for new ways to treat PMS.
- Freeman, E., Halberstadt, M., Sammel, M. (2011). Core Symptoms That Discriminate Premenstrual Syndrome. Journal of Women’s Health; 20(1): 29–35.
- Dennerstein, L., Lehert, P., Bäckström, T.C., Heinemann, K. (2009). Premenstrual symptoms—severity, duration and typology: an international cross-sectional study. Menopause International; 15: 120–126.
- Winer, S. A., Rapkin, A. J. (2006). Premenstrual disorders: prevalence, etiology and impact. Journal of Reproductive Medicine; 51(4 Suppl):339-347.
- Dennerstein, L., Lehert, P., Heinemann, K. (2011). Global study of women’s experiences of premenstrual symptoms and their effects on daily life. Menopause International; 17: 88–95.
- Steiner, M. (2000). Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. Journal of Psychiatry and Neuroscience; 25(5): 459–468.
- Potter, J., Bouyer, J., Trussell, J., Moreau, C. (2009). Premenstrual Syndrome Prevalence and Fluctuation over Time: Results from a French Population Survey. Journal of Women’s Health; 18(1): 31–39.
- Gollenberg, A.L., Hediger, M.L., Mumford, S.L., Whitcomb, B.W., Hovey, K.M., Wactawski-Wende, J., et al. (2010). Perceived Stress and Severity of Perimenstrual Symptoms: The BioCycle Study. Journal of Women’s Health; 19(5): 959-967.
- Endicott, J., Amsterdam, J., Eriksson, E., Frank, E., Freeman, E., Hirschfeld, R. et al. (1999). Is premenstrual dysphoric disorder a distinct clinical entity? Journal of Women’s Health & Gender-Based Medicine; 8(5): 663-79.
- Richards, M., Rubinow, D.R., Daly, R.C., Schmidt, P.J. (2006). Premenstrual symptoms and perimenopausal depression. American Journal of Psychiatry; 163(1): 133-7.
- Bloch, M., Schmidt, P.J., Danaceau, M., Murphy, J., Nieman, L., Rubinow, D.R. (2000). Effects of gonadal steroids in women with a history of postpartum depression. American Journal of Psychiatry; 157(6): 924-30.
- Pinkerton, J.V., Guico-Pabia, C.J., Taylor, H.S. (2010). Menstrual cycle-related exacerbation of disease. American Journal of Obstetrics and Gynecology; 202(3): 221-231.
- American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS).
- Dickerson, L., Mazyck, P., Hunter, M. (2002). Premenstrual Syndrome. American Family Physician; 67(8): 1743–1752.
- Boneva, R. S., Lin, J. M., & Unger, E. R. (2015). Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women. Menopause, 22, 826–834.
- El-Lithy, A., El-Mazny, A., Sabbour, A., El-Deeb, A. (2014). Effect of aerobic exercise on premenstrual symptoms, haemotological and hormonal parameters in young women. Journal of Obstetrics and Gynaecology; 3: 1–4.
- Aganoff, J. A., Boyle, G. J. (1994). Aerobic exercise, mood states and menstrual cycle symptoms. Journal of Psychosomatic Research; 38: 183–92.
- Kaur, G., Gonsalves, L., Thacker, H. L. (2004). Premenstrual dysphoric disorder: a review for the treating practitioner. Cleveland Clinic Journal of Medicine; 71: 303–5, 312–3, 317–8.
- Tsai, S.Y. (2016). Effect of Yoga Exercise on Premenstrual Symptoms among Female Employees in Taiwan. Int J Environ Res Public Health; 13(7).
- Hernandez-Reif, M., Martinez, A., Field, T., Quintero, O., Hart, S., Burman, I. (2000). Premenstrual symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol; 21(1):9-15.
- Arias, A. J., Steinberg, K., Banga, A., Trestman, R. L. (2006). Systematic review of the efficacy of meditation techniques as treatments for medical illness. Journal of Alternative and Complementary Medicine; 12(8):817-32.
- Dennerstein, L., Lehert, P., Heinemann, K. (2011). Global epidemiological study of variation of premenstrual symptoms with age and sociodemographic factors. Menopause International; 17(3): 96–101.
- Rapkin A. (2003). A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder. Psychoneuroendocrinology; Suppl 3:39-53.
- The Medical Letter. (2003). Which SSRI?. Med Lett Drugs Ther; 45(1170):93-5.
- National Institute for Health Research, U.K. (2008). Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy.
- Ghanbari, Z., Haghollahi, F., Shariat, M., Foroshani, A.R., Ashrafi, M. (2009). Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwanese Journal of Obstetrics and Gynecology; 48(2): 124–129.
- Office of Dietary Supplements. (2016). Magnesium.
- Rocha Filho, F., Lima, J.C., Pinho Neto, J.S., Montarroyos, U. (2011). Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reproductive Health; 8: 2. doi: 10.1186/1742-4755-8-2.
- Johnson, T. L., Fahey, J. W. (2012). Black cohosh: coming full circle? Journal of Ethnopharmacolgy, 141(3): 775-9. doi: 10.1016/j.jep.2012.03.050.
- Dietz, B. M., Hajirahimkhan, A., Dunlap, T. L., Bolton, J. L. (2016). Botanicals and their bioactive phytochemicals for women’s health. Pharmacological Reviews, 68(4): 1026-1073. doi: https://doi.org/10.1124/pr.115.010843.
- Girman, A., Lee, R., Kligler, B. (2003). An integrative medicine approach to premenstrual syndrome. American Journal of Obstetrics and Gynecology, 188 (5), S56–S65.