Premenstrual Syndrome

What is premenstrual syndrome (PMS)?

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.

What is the difference between PMS and PMDD?

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.

How common is 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.

What are the signs and symptoms of premenstrual syndrome?

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.

Physical symptoms

The most common physical signs of PMS are a feeling of fullness in your belly (bloating) and fatigue. Other symptoms include:

• Cramps.
• Acne flare-ups.
• Breast tenderness.
• Headaches.

Emotional symptoms

Feelings of irritability and mood swings are the most common emotional indicators of PMS. Other symptoms include:

• Changes in your sex drive.
• Feeling anxious, sad or depressed.
• Brain fog, or having trouble concentrating.
• Food cravings or increased/decreased appetite.
• Taking frequent naps or having trouble sleeping (insomnia).
• Diminished interest in activities.

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.

What is the relationship between PMS and premenstrual exacerbation (PME)?

PMS shares symptoms with many other conditions. These shared symptoms often get worse (exacerbate) before around your period. These conditions include:

• Depression and anxiety: Mood swings, feelings of sadness, irritability and isolation may get more intense around your period.
• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Fatigue and joint and muscle pain may intensify in the days and weeks leading up to your period. With ME/CFS, you’re also more likely to experience heavy menstrual bleeding and go through menopause early.
• Irritable bowel syndrome (IBS): Symptoms like bloating, gas and cramps can worsen alongside PMS.

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.

What causes premenstrual syndrome?

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.

How is premenstrual syndrome diagnosed?

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:

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

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:

• Anxiety.
• Depression.
• Perimenopause (the transitional period before menopause).
• Chronic fatigue syndrome.
• Thyroid disorders (ex. hyperthyroidism).
• Medications you’re taking.

Is there a cure for premenstrual syndrome?

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.

How can I manage symptoms?

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.

Medications

• NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve breast pain and menstrual cramps if you take them during your period or around the time when your symptoms start. Options include Ibuprofen (Advil®, Motrin IB®), Naproxen sodium (Aleve®), Acetaminophen (Tylenol®) and Aspirin. You can purchase them over-the-counter, or your provider can prescribe a stronger dosage if your symptoms are severe.
• Hormonal birth control: Medicines that prevent you from ovulating can relieve unpleasant physical symptoms, like 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 (NuvaRing®).
• Antidepressants and anti-anxiety medications: Selective serotonin reuptake inhibitors (SSRIs) are the most common types of antidepressant prescribed to treat the mood-related issues associated with PMS. Options include fluoxetine (Prozac®, Sarafem®), paroxetine (Paxil®, Pexeva®) and sertraline (Zoloft®). Take them only as directed by your provider.
• Diuretics: Diuretics can relieve symptoms like bloating and breast tenderness.

Lifestyle changes

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

• Regular exercise: Moderate cardio exercise (running, brisk walking, cycling or swimming) for 30 minutes a day can relieve stress and boost your mood. The benefits last beyond the 30 minutes.
• Healthy diet: Eating more of some foods and less of others can combat PMS symptoms. Eat fewer salty, fatty, and sugary foods, and drink fewer caffeinated and alcoholic beverages two weeks before your period. During your period, eat six small meals a day instead of three big ones. Or, eat three small meals and three small snacks. Healthy eating is good for your mood and your gut. Spacing out your meals prevents bowel troubles, like constipation.
• Plenty of sleep: Getting at least eight hours of sleep can 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 that you’re less likely to feel moody throughout the day.
• Relaxation exercises: Yoga, meditation and breathing exercises relieve stress and combat the irritability and sadness that often accompany PMS.

Vitamins, minerals and supplements

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.

• Calcium: Research suggests that calcium can improve symptoms like fatigue, food cravings and even depression. You can get calcium from dairy products (milk, eggs, yogurt), foods with calcium added (some cereals and bread) and supplements.
• Magnesium: There’s competing evidence about whether magnesium helps with PMS symptoms, like headaches, stress and anxiety. You can get magnesium from leafy greens, nuts, whole grains and supplements.
• Vitamin B6: Some studies have shown that Vitamin B6 can improve symptoms related to mild and moderate PMS. You can get Vitamin B6 from fish, poultry, potatoes, non-citrus fruits and supplements.
• Omega-3 and Omega-6: Some studies have shown that Omega-3 and Omega -6 fatty acids can ease PMS symptoms. You can get Omega-3 and Omega-6 from fish, flaxseed, nuts, leafy greens and supplements.
• Herbal supplements: Several herbal remedies are used to relieve the symptoms of PMS, with varying degrees of evidence. These include black cohosh, dried chasteberry and evening primrose oil. Talk to your provider before starting herbal supplements to ensure it’s safe and that you’re taking the right amount.

How can I prevent premenstrual syndrome?

You can’t prevent PMS, 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 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.

When should I see my healthcare provider?

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.

What questions should I ask my provider?

• Are my symptoms only related to PMS or could they be a sign of something else?
• What lifestyle changes would you recommend to manage symptoms?
• How can I tell whether or not I need a prescription to ease my symptoms?
• Would you recommend herbal supplements to ease PMS symptoms?
• How can I proactively manage my PMS symptoms?

How do you fix premenstrual syndrome?

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.

How long does PMS last before you get your period?

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.

What is PME and how does it relate to my period?

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.