PMS (Premenstrual Syndrome)

By: Tina Shahian, PhD

Last Updated: Mar 1, 2019

Overview

It’s normal for girls and women to experience some physical and mood changes related to the menstrual cycle. Typically, these show up one to two weeks before a period and disappear one to two days after bleeding begins. When these changes occur regularly and are intense enough to interfere with daily activities, they’re called premenstrual syndrome (PMS).

The American College of Obstetricians and Gynecologists estimates that 85 percent of women have at least one PMS symptom, and about 3-8 percent have a severe form of PMS called premenstrual dysphoric disorder (PMDD).

PMS can begin anytime after a girl’s first menstrual period (known as menarche). The condition is most common in women with children, those with a family history of depression, and those who have been diagnosed with a mood disorder. PMS symptoms cease temporarily during pregnancy and permanently after menopause.

Causes and Risk Factors

Though it is not completely clear what causes PMS, researchers suspect the condition is linked to natural hormonal fluctuations. Following ovulation (when an ovary releases an egg), ovaries produce a considerable amount of progesterone. Specifically, the progesterone comes from the remains of the ovarian follicle that released the egg; this follicle’s remains are known as the corpus luteum at this stage in the menstrual cycle. Estrogen production also increases several days after ovulation. Together, the estrogen and progesterone act to thicken and prepare the inner wall of the uterus (endometrium) for pregnancy.

An egg only lives unfertilized for roughly a day. When fertilization and implantation do not occur (usually a fertilized egg will take a handful of days to travel down the fallopian tube to the uterus), ovaries significantly slow the production of progesterone and estrogen. This drop results in the uterus shedding its extra layering and expelling both that and the deceased egg from the body in the event called menstruation. Some women may be more sensitive than others to this reduction in progesterone and estrogen toward the end of their menstrual cycle.

Other possible factors that contribute to PMS include:

• Fluctuations in levels of the brain chemical serotonin
• Alcohol and caffeine intake
• A diet high in sodium, which promotes water retention and bloating
• Certain vitamin and mineral deficiencies

Stress and emotional issues don’t cause PMS, but they may make symptoms worse. In fact, about half of all women who seek medical care for PMS also have a depressive disorder or anxiety disorder.

Symptoms

The symptoms, timing and severity of PMS vary greatly among women, and even in the same woman from month to month.

Common emotional symptoms include:

• Mood changes (depression, sadness, irritability)
• Feeling tense or anxious
• Crying spells
• Sleeping too little or too much
• Social withdrawal
• Increased appetite or food cravings
• Decreased memory and concentration
• Changes in sexual desire

Common physical symptoms of PMS include:

• Aches and pains (especially in the head, back, joints and muscles)
• Breast swelling or tenderness
• Stomach upsets
• Bloating and water weight gain
• Diarrhea and constipation
• Acne flare-ups
• Tiredness, feeling sluggish

Diagnosis and Treatment

PMS is usually diagnosed based on personal history. Some physicians ask patients to track their symptoms across several menstrual cycles so that patterns can be pinpointed.

The physician may also order tests to rule out conditions that share symptoms with PMS, including anxiety disorders, depression, hypothyroidism, menopause and irritable bowel syndrome.

PMS is usually only treated if symptoms are distressing or interfering with a woman’s daily activities. Common therapies include:

• Over-the-counter painkillers like ibuprofen and aspirin to help relieve aches and pains.
• Oral contraceptives (birth control pills), which decrease or eliminate symptoms in some women.
• Diuretic medications to reduce bloating (usually in conjunction with a low-salt diet).
• Supplements of folic acid, calcium, vitamin D, magnesium, vitamin B-6 and vitamin E to relieve nutritional deficiencies that worsen symptoms. (You can check for vitamin D deficiency using a vitamin D home test.)
• Antidepressants and anti-anxiety medication to regulate severe mood symptoms.

Some women report that herbal remedies like black cohosh, chasteberry, evening primrose oil and natural progesterone creams help them feel better around the time of their period. Check with your doctor before trying these, especially if you also take prescription medications.

The preventative strategies listed in the section below may also help to control existing PMS symptoms.

With treatment and lifestyle modification, the outlook for alleviating PMS symptoms is very good. While symptoms may not go away completely, most women find they can continue with their daily activities.

Prevention

Not all PMS symptoms are preventable, but the following lifestyle changes may help:

• Engage in 30 minutes of moderate-to-vigorous physical activity on most days of the week, plus strength training on at least two days.
• Eat more fruits, vegetables and whole grains, all of which are rich in complex carbohydrates.
• Limit your intake of salt, alcohol and caffeine, especially in the second half of the menstrual cycle.
• Eat smaller meals more frequently to help prevent bloating and keep blood sugar levels stable.
• Take a multivitamin to prevent deficiencies.
• Get adequate sleep.
• Find healthy ways to manage stress, like breathing exercises, meditation, yoga, massage or progressive muscle relaxation.

Sources

• “Premenstrual syndrome.” MedlinePlus Encyclopedia, 2012. http://www.nlm.nih.gov/medlineplus/ency/article/001505.htm. Accessed April 14, 2014.
• “Coping With Period Problems.” Nemours Foundation, 2014. http://kidshealth.org/teen/sexual_health/girls/menstrual_problems.html. Accessed April 14, 2012.
• “Premenstrual syndrome.” Mayo Foundation for Medical Education and Research, 2012. http://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/basics/definition/con-20020003. Accessed April 14, 2014.
• “Premenstrual Syndrome FAQ.” American College of Obstetricians and Gynecologists, 2011. http://www.acog.org/~/media/For%20Patients/faq057.pdf. Accessed April 14, 2014.
• “Premenstrual syndrome (PMS) fact sheet.” U.S. Office on Women’s Health, 2012. http://www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.html. Accessed April 14, 2014.