- Common symptoms of PMS include anxiety, depression, acne, fatigue, and headaches.
- Premenstrual dysphoric disorder (PMDD) causes severe symptoms, such as suicidal thoughts and insomnia.
Premenstrual syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before her menses. PMS is a very common condition. Its symptoms affect up to 85 percent of menstruating women. It must impair some aspect of your life for your doctor to diagnose you.
PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown. However, many researchers believe that it’s related to a change in both sex hormone and serotonin levels at the beginning of the menstrual cycle.
Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroids also modulate activity in parts of your brain associated with premenstrual symptoms.
Serotonin levels affect mood. Serotonin is a chemical in your brain and gut that affects your moods, emotions, and thoughts.
Risk factors for premenstrual syndrome include:
- a history of depression or mood disorders, such as postpartum depression or bipolar disorder
- a family history of PMS
- a family history of depression
- domestic violence
- substance abuse
- physical trauma
- emotional trauma
Associated conditions include:
- major depressive disorder
- seasonal affective disorder
- generalized anxiety disorder
Symptoms of PMS
A woman’s menstrual cycle lasts an average of 28 days. Ovulation, the period when an egg is released from the ovaries, occurs on day 14 of the cycle. Menstruation, or bleeding, occurs on day 28 of the cycle. PMS symptoms can begin around day 14 and last until seven days after the start of menstruation.
The symptoms of PMS are usually mild or moderate. Nearly 80 percent of women report one or more symptom that does not substantially affect daily functioning, according to the journal American Family Physician. Twenty to 32 percent of women report moderate to severe symptoms that affect some aspect of life. Three to 8 percent report PMDD. The severity of symptoms can vary by individual and by month. The symptoms of PMS include:
- abdominal bloating
- abdominal pain
- sore breasts
- food cravings, especially for sweets
- sensitivity to light or sound
- changes in sleep patterns
- emotional outbursts
When to see your doctor
See your doctor if physical pain, mood swings, and other symptoms start to affect your daily life, or if your symptoms don’t go away. The diagnosis is made when you have more than one recurrent symptom in the correct time frame that is severe enough to cause impairment and is absent between menses and ovulation. Your doctor must also rule out other causes, such as:
- thyroid disease
- irritable bowel syndrome (IBS)
- chronic fatigue syndrome
- connective tissue or rheumatologic diseases
Your doctor may ask about any history of depression or mood disorders in your family to determine whether your symptoms are the result of PMS or another condition. Some conditions, such as IBS, hypothyroidism, and pregnancy, have symptoms similar to PMS. Your doctor may do a thyroid hormone test to ensure that your thyroid gland is working properly, a pregnancy test, and possibly a pelvic exam to check for any gynecological problems.
Keeping a diary of your symptoms is another way to determine if you have PMS. Use a calendar to keep track of your symptoms and menstruation every month. If your symptoms start around the same time each month, PMS is a likely cause.
Easing the symptoms of PMS
You can’t cure PMS, but you can take steps to ease your symptoms. If you have a mild or moderate form of premenstrual syndrome, the treatment options include:
- drinking plenty of fluids to ease abdominal bloating
- eating a balanced diet to improve your overall health and energy level, which means eating plenty of fruits and vegetables and reducing your intake of sugar, salt, caffeine, and alcohol
- taking supplements, such as folic acid, vitamin B-6, calcium, and magnesium to reduce cramps and mood swings
- taking vitamin D to reduce symptoms
- sleeping at least eight hours per night to reduce fatigue
- exercising to decrease bloating and improve your mental health
- reducing stress, such as through exercising and reading
- going to cognitive behavioral therapy, which has been shown to be effective
You can take pain medication, such as ibuprofen or aspirin, to alleviate muscle aches, headaches, and stomach cramping. You can also try a diuretic to stop bloating and water weight gain. Take medications and supplements only as directed by and after speaking with your doctor.
Severe PMS: premenstrual dysphoric disorder
Severe PMS symptoms are rare. A small percentage of women who have severe symptoms have premenstrual dysphoric disorder (PMDD). PMDD affects between 3 and 8 percent of women. This is characterized in the new edition of the Diagnostic and Statistical Manual of Mental Disorders.
The symptoms of PMDD may include:
- thoughts of suicide
- panic attacks
- extreme anxiety
- anger with severe mood swings
- crying spells
- a lack of interest in daily activities
- trouble thinking or focusing
- binge eating
- painful cramping
The symptoms of PMDD may occur due to changes in your estrogen and progesterone levels. A connection between low serotonin levels and PMDD also exists.
Your doctor may do the following to rule out other medical problems:
- a physical exam
- a gynecological exam
- a complete blood count
- a liver function test
They may also recommend a psychiatric evaluation. A personal or family history of major depression, substance abuse, trauma, or stress can trigger or worsen PMDD symptoms.
Treatment for PMDD varies. Your doctor may recommend:
- daily exercise
- vitamin supplements, such as calcium, magnesium, and vitamin B-6
- a caffeine-free diet
- individual or group counseling
- stress management classes
- drospirenone and ethinyl estradiol tablet (Yaz), which is the only birth control pill the Food and Drug Administration has approved to treat PMDD symptoms
If your PMDD symptoms still do not improve, your doctor may give you a selective serotonin reuptake inhibitor (SSRI) antidepressant. This medication increases serotonin levels in your brain and has many roles in regulating brain chemistry that are not limited to depression. Your doctor may also suggest cognitive behavioral therapy, which is a form of counseling that can help you understand your thoughts and feelings and change your behavior accordingly.
You can’t prevent PMS or PMDD, but the treatments outlined above can help reduce the severity and duration of your symptoms.
PMS and PMDD symptoms can recur, but they typically go away after the start of menstruation. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate the symptoms for most women.
You asked, we answered
- How do PMS symptoms change as a woman approaches perimenopause and menopause?
As a woman approaches menopause, the ovulatory cycles become sporadic as the ovarian sex hormone production decreases. The result of this is a heterogeneous and somewhat unpredictable course of symptoms. Muddying the water is the use of hormonal therapy to treat some of the symptoms of menopause, like hot flashes, which can further alter the symptoms. As menopause approaches, women should consult with their physician if the symptoms change or new symptoms are generated.- Chris Kapp, MD