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What Is PMS?
Premenstrual syndrome (PMS) is a combination of physical and mood-related symptoms that occur before your menstrual period each month. Symptoms usually begin about one to two weeks before your period starts and go away in the first few days of your period. But this can vary greatly from cycle to cycle and may worsen during times of increased stress.
It's common to have tender breasts, bloating, and muscle aches a few days before your period. But when these normal premenstrual symptoms interfere with your daily life, it's called premenstrual syndrome.
Most people first get PMS in their mid-20s. But it can start with your first period and can continue until menopause (when you stop getting a period). After menopause, PMS goes away because hormones are low and don't rise and fall each month.
How common is PMS?
The National Institutes of Health (NIH) estimates that 70% to 90% of menstruating people experience some physical and/or emotional symptoms of PMS.
About 20% of menstruating people experience symptoms of PMS that are severe enough to interfere with their daily lives.
What Is PMDD?
Premenstrual dysphoric disorder (PMDD) is a severe and sometimes disabling condition with a wide range of physical and emotional symptoms. PMDD is an extreme form of PMS and is considered a psychiatric disorder.
In addition to both physical and emotional symptoms, PMDD causes significant distress and functional impairment that can significantly disrupt your everyday life. A person having a PMDD episode may have severe mood swings and be angry, anxious, depressed, fatigued, or exhibit a combination of emotions. Physical symptoms may include cramping and headaches.
PMDD also may negatively affect your social life and relationships.
For most people with PMDD, intense symptoms begin about six days before their period and are most severe two days before their period.
How common is PMDD?
PMDD affects between 3% to 8% of menstruating people. A person with PMDD will have an estimated 6.8 days of severe PMDD-related symptoms per cycle. That amounts to eight years of debilitating symptoms throughout their lifetime.
What causes PMS and PMDD?
PMS is tied to hormone changes that happen during the menstrual cycle. For instance, fluctuations in estrogen levels are often responsible for PMS-related mood changes. Doctors aren't sure why premenstrual symptoms are worse in some people than others, although PMS can run in your family.
The cause of PMDD is unknown. Studies have shown a relationship between PMDD and low levels of serotonin, a chemical in your brain associated with mood, attention, sleep, and pain. Monthly hormonal changes may cause a decrease in serotonin, which can worsen PMDD symptoms.
People with PMDD also may experience an abnormal reaction to the hormonal changes associated with menstruation. This reaction may cause symptoms of underlying depression and anxiety to worsen.
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PMS and PMDD risk factors and complications
PMS and PMDD risk factors
You may be more at risk of developing PMS or PMDD if you:
- Drink alcohol.
- Smoke and/or began smoking during adolescence.
- Have a body mass index (BMI) of 27.5 or higher.
- Have a family history of PMS or PMDD.
- Have a high stress level.
- Have a personal or family history of mood disorders, especially depression or postpartum depression.
- Have experienced past traumatic events.
Complications of PMS and PMDD
Nearly half of people who experience symptoms of PMS also have another health problem that PMS may worsen.
These health problems include:
- Asthma and allergies.
- Bladder pain syndrome.
- Depression and anxiety disorders.
- Irritable bowel syndrome (IBS).
- Migraines.
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
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What Are the Symptoms of PMS and PMDD?
Symptoms of PMDD are similar to those of PMS but more intensely felt.
Common physical symptoms of PMS and PMDD include:
- Aching muscles and joints.
- Breast swelling and tenderness.
- Clumsiness.
- Constipation.
- Cramps.
- Diarrhea.
- Fatigue or lack of energy.
- Feeling bloated or gassy.
- Food cravings, especially for sweet or salty foods.
- Headaches.
- Low sex drive.
- Nausea.
- Pain in your lower back.
- Restlessness.
- Sensitivity to noise or light.
- Sleeping too much or too little.
- Weight gain.
It's also common to experience changes in your mood and behavior in the days leading up to your period.
These symptoms may include:
- A sad or depressed mood.
- Appetite changes.
- Anger, irritability, or aggression.
- Anxiety.
- Crying spells.
- Decreased alertness.
- Difficulty concentrating.
- Feeling hopeless.
- Feeling out of control.
- Feeling tense.
- Forgetfulness.
- Hostility.
- Less interest in usual activities or sex.
- Mood swings.
- Withdrawal from family and friends.
Symptoms of PMS may worsen in your late 30s and 40s as you approach menopause and during perimenopause, the process of change that leads up to menopause. During perimenopause, your hormone levels fluctuate, which may cause your PMS or PMDD to intensify.
When should I see a doctor about my PMS or PMDD symptoms?
PMDD can dramatically impact every aspect of your life, including your work, school, social life, and relationships. If you suspect that you may have PMDD, you should talk to your doctor immediately.
You should call your doctor if:
- Home treatments for symptoms don't help.
- PMS symptoms regularly disrupt your life.
- Severe PMS symptoms (such as depression, anxiety, irritability, crying, or mood swings) don't end a couple of days after your menstrual period starts.
- You're having panic attacks.
- You're having thoughts of suicide.
- You feel out of control.
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How Do You Diagnose PMS and PMDD?
It's important to know that for either a PMS or PMDD diagnosis, it may take more than one visit for your doctor to diagnose your symptoms properly. There's no single test to diagnose PMS or PMDD.
Your doctor will ask you about your symptoms and do a physical exam.
They may want you to keep a written record of your symptoms for two to three months. This "menstrual diary" can help you track when your symptoms start, how bad they are, and how long they last. Your doctor can use it to help diagnose PMS.
Your doctor will also want to make sure that another condition isn't causing your symptoms. For example, thyroid problems can have symptoms similar to those of PMS. Your doctor may run a thyroid-stimulating hormone (TSH) blood test to see that your thyroid gland is working as it should.
A diagnosis of PMDD requires extreme experiences with five of 11 specific symptoms, including at least one mood-related symptom.
The 11 symptoms are:
- Anxiety, tension, and feeling on edge.
- Changes in appetite, overeating, or intense cravings.
- Depressed mood or feelings of hopelessness.
- Difficulty concentrating.
- Feeling overwhelmed and out of control.
- Less interest in usual activities.
- Lethargy or fatigue.
- Persistent anger or irritability.
- Physical symptoms, including breast tenderness or swelling, headaches, joint or muscle pain, bloating, or weight gain.
- Sleeping too much or not enough.
- Unpredictable, rapid mood swings.
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How Do You Treat PMS and PMDD?
Lifestyle changes
Lifestyle changes, such as healthy eating, regular exercise, and cutting back on alcohol and caffeine, can often help with PMS and PMDD.
Medicine to treat PMS and PMDD
If lifestyle changes don't help relieve your symptoms after a few menstrual cycles, your doctor can prescribe or recommend medicine for problems like bloating or more severe PMS symptoms.
These medications may include:
- Birth control — May help relieve physical and emotional symptoms of PMS or PMDD.
- Diuretics — May reduce bloating and breast tenderness if taken during the weeks leading up to your period.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) — Over-the-counter (OTC) drugs like ibuprofen and naproxen relieve premenstrual pain and cramps and also reduce menstrual bleeding. They work best when taken before and during the premenstrual pain period.
- Selective serotonin reuptake inhibitors (SSRIs) or antidepressants — Antidepressants can help reduce mood disorder symptoms, and SSRIs like citalopram, fluoxetine, and paroxetine may help relieve the physical and emotional symptoms of PMS. You can take them during your premenstrual weeks only, or on a regular basis.
Counseling and therapy for PMS and PMDD
For some people, the emotional symptoms of PMS and PMDD can be disruptive enough to affect their quality of life. Counseling and group therapy can help manage feelings of hopelessness, depression, anxiety, irritability, and significant mood imbalances.
Complementary therapies for PMS and PMDD
Most complementary therapies aren't considered standard treatment for PMS, but you may find that one or more may relieve some of your symptoms. Before you try any of these therapies, you should talk with your doctor first.
Some complementary therapies that may help with PMS symptoms include:
- Acupuncture or acupressure.
- Black cohosh.
- Bright light therapy.
- Calcium supplements.
- Chasteberry.
- Evening primrose oil.
- Magnesium.
- Omega-3 and omega-6.
- Vitamin B6.
- Vitex agnus-castus, a fruit extract.
While studies have shown that certain vitamins and minerals can alleviate some PMS symptoms, it's important to remember that the Food and Drug Administration (FDA) doesn't regulate supplements. Their quality can vary depending on the ingredients and manufacturer.
You should also consult your doctor before taking any supplements for PMS relief to make sure that they won’t interact negatively with other medicines or supplements you take.
Self-care for PMS and PMDD
Self-care for PMS means practicing healthy habits, managing pain, and reducing stress.
Here are some ways to practice self-care during your menstrual cycle:
- Avoid caffeine and alcohol, which may make PMS symptoms worse.
- Create a support system. Join a support group of people who also are managing PMS. With your loved ones, plan ways to reduce the demands placed on you when you have PMS.
- Eat a variety of healthy foods high in complex carbohydrates, calcium, and polyunsaturated fats. This can include vegetables (especially green leafy vegetables), fruits, milk products, nuts, whole grains, flaxseed, fish, and protein.
- Eat smaller, more frequent meals to help reduce bloating and the uncomfortable feeling of fullness.
- Exercise at least 30 minutes almost every day. Regular exercise — such as brisk walking, cycling, swimming, or other aerobic activity — can help improve your overall health and address certain symptoms like fatigue and a depressed mood.
- Get at least eight hours of sleep per night. Not getting enough sleep can make PMS symptoms — such as moodiness, depression, and anxiety ‚ worse.
- Keep a menstrual diary of your symptoms, how severe they are, when you have your period, and when you ovulate. This can help you find patterns in your cycle and plan ahead to better cope with symptoms.
- Limit foods and drinks that are high in sugar, like junk food.
- Limit your salt intake to reduce bloating and fluid retention.
- Practice better time management to reduce your stress.
- Try relaxation techniques, such as breathing exercises, journaling, yoga, hot baths, or massage therapy. These can help to reduce headaches, anxiety, or insomnia (trouble sleeping).
- Quit smoking. People who smoke report more and worse PMS symptoms than those who don’t smoke.
- Wear a more supportive bra, such as a sports bra, when your breasts are tender.
It's best to try one or two of these home treatments for PMS at a time to help you figure out what's most helpful in the long term.
By UPMC Editorial Staff. Last reviewed on 2024-09-05.
