What Is Premenstrual Syndrome (PMS)?
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Medically reviewed by Cordelia Nwankwo, MD
Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that generally occur one to two weeks before your menstrual period. Research suggests that as many as 75% of people who have periods experience PMS symptoms at least once in their life.
Symptoms of PMS can vary from person to person but common symptoms include irritability, depression, breast tenderness, and food cravings. While these symptoms can be painful and disruptive, there are various treatments that you can use to reduce symptoms and improve your quality of life.
Symptoms
Most people who have PMS tend to experience a combination of physical and emotional symptoms one to two weeks before their period. Symptoms usually go away a couple of days after your period starts. While PMS can cause pain and discomfort, symptoms should be mild. However, some people may have more severe pain that can disrupt their daily life and affect their ability to go to school, work, or social events.
If your symptoms are severe, you may be experiencing premenstrual dysphoric disorder (PMDD)—a severe form of PMS that can cause extreme pain and emotional symptoms such as anxiety, depressive moods, or suicidal thoughts. While PMS is common, PMDD affects about 3% to 8% of people who have periods.
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Physical Symptoms
PMS can cause a variety of physical symptoms including:
Emotional and Behavioral Symptoms
There are a number of emotional and behavioral symptoms that you might experience as a result of PMS. These include:
Irritability
Mood swings
Sadness or crying
Low sex drive
Loss of interest in daily activities
Feeling overwhelmed
Food cravings
Causes
Researchers don't exactly know what causes PMS, however, experts believe that a change in hormone levels during your menstrual cycle can influence the onset of symptoms.
Generally, symptoms of PMS begin after ovulation—a part of the menstrual cycle that occurs when your ovaries release an egg. When this happens, you experience a drop in your reproductive hormone levels. Research suggests that hormone fluctuations can affect the tissues in your body, including your brain chemistry and serotonin levels (a chemical that affects your mood).
Risk Factors
While anyone who has periods can experience PMS symptoms, some factors may increase your risk of developing symptoms. Risk factors include:
Being between the age of 20 and 40
Living under moderate to severe stress
Having a family history of depression
Smoking tobacco
Eating a diet high in sugar and salt
Diagnosis
If your symptoms are affecting your daily life, it's good practice to talk to your healthcare provider about your condition. There is no diagnostic test currently available to help healthcare providers give you a diagnosis for PMS. However, during your appointment, you can expect your provider to ask about your medical history, symptoms, and lifestyle habits.
You may have PMS if you experience:
Physical symptoms and mood changes before your period
A repetitive pattern of these symptoms during each menstrual cycle
Symptoms that go away within a few days after bleeding begins
If you're experiencing symptoms after your period ends, your healthcare provider may order tests to rule out other possible conditions that may be causing your symptoms. They may use one of the following diagnostic measures to better understand your symptoms:
Symptom tracking: Self-recording your symptoms for several menstrual cycles to help your healthcare provider understand your symptom patterns
Physical or pelvic exam: Rules out conditions affecting your reproductive organs
Blood tests: Checks for anemia or thyroid disorders
Urine test: Assesses whether you have a urinary tract infection or are pregnant
Psychological assessment: Examines the possibility of having a mental health condition that may be causing symptoms
Imaging tests: Helps your provider take a better look at your reproductive organs for signs of scarring or inflammation
Treatment
Unfortunately, there is no cure for PMS at this time. But, there are treatments to help manage your symptoms. Your healthcare provider may recommend one or more of the following at-home remedies, lifestyle changes, medications, or therapies.
Heat therapy: A warm bath or heating pad relaxes muscles and helps reduce back pain and cramping.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter (OTC) medicines like Advil (ibuprofen), Tylenol (acetaminophen), or Midol (naproxen), can help alleviate physical symptoms.
Hormonal contraceptives: Birth control pills, intrauterine devices (IUDs), or a birth control shot can help regulate hormone levels.
Antidepressants: The most common antidepressants are selective serotonin reuptake inhibitors (SSRIs), as these can help reduce the severity of emotional symptoms. Examples include Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Paxil paroxetine, and Lexapro (escitalopram).
Diuretics: These medications can improve fluid retention in your body, which may reduce breast tenderness and swelling.
Psychotherapy: Cognitive behavioral therapy (CBT) or talk therapy with a mental health professional can help you manage emotional symptoms and develop coping strategies for stress.
Alternative therapy: Some studies show that practices such as acupuncture, acupressure, yoga, and meditation can reduce stress, improve mood, and alleviate pain.
Cannabidiol (CBD) oil: According to the Online Journal of Complementary & Alternative Medicine, CBD oil may help with PMS-related headaches, mood swings, sleep disturbances, stress, and cramping.
How to Prevent PMS
While it may not be possible to prevent PMS completely, there are lifestyle changes that may lessen the severity of your symptoms. These prevention strategies include:
Managing stress through methods such as spending time in nature, trying breathing techniques, journaling, engaging in hobbies you enjoy, and hanging out with your loved ones
Engaging in physical activities such as aerobic exercise, strength training, or sports
Avoiding alcohol, caffeine, and tobacco
Drinking plenty of water throughout the day
Getting eight hours of sleep per night
Related Conditions
About 50% of those with PMS have an additional health condition that may worsen before or during their period. These conditions include:
Mental health conditions such as depression, anxiety, or bipolar disorder
Irritable bowel syndrome (IBS)
Chronic bladder or pelvic pain
If you notice that underlying health conditions are getting worse during your period, talk to your healthcare provider about treatment options to keep symptoms at bay.
Living With PMS
Most people who have menstrual periods experience mild to moderate PMS symptoms throughout their lifetime. Those with symptoms may experience a combination of physical and emotional symptoms, including breast pain, bloating, stomach pain, sadness, and difficulty sleeping, among other symptoms.
While there is no cure for PMS, there are a variety of at-home remedies, therapies, and over-the-counter medications that can help reduce symptoms. If you notice physical or emotional symptoms prior to the start of your period, you may be experiencing PMS. If your symptoms feel painful or disruptive, it's a good idea to see your healthcare provider for an official diagnosis and treatment options that are right for you.
Frequently Asked Questions
How long is PMS supposed to last?
PMS symptoms occur one to two weeks before the start of your the menstrual period and go away within a few days of beginning your period.
What makes PMS worse?
PMS symptoms can worsen if you consume too much caffeine or alcohol, smoke cigarettes, eat foods high in salt or sugar, and skip physical activity during your day.
Does PMS get worse with age?
Research suggests that PMS symptoms can get worse as you age—specifically during your 30s and early 40s. This happens because your body is undergoing hormonal changes as it gets closer to menopause, which can affect the severity of both physical and emotional PMS symptoms.
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