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Understanding PMS

Premenstrual syndrome (PMS) refers to changes in mood and emotions, physical health, and behavior that:

  • develop between ovulation and the start of your period (roughly the 2 weeks before your period)
  • last until a few days after your period begins
  • show up consistently each month
  • have some impact on everyday life and regular activities.

PMS is a very common concern. Nearly 48 percentTrusted Source of women who are of reproductive age experience PMS, and for about 20 percent of them, symptoms are severe enough to affect their regular routine.

Contrary to what some people may suggest, PMS is a real condition, one that can disrupt daily life and cause significant physical discomfort and emotional distress.

Below, we’ll cover the symptoms of PMS in detail, plus offer some tips on getting support and relief from your symptoms.

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Symptoms of PMS

While PMS often involves mild or moderate symptoms that don’t majorly affect daily life, symptoms can be severe enough to impact your everyday activities and overall well-being.

If you have PMS, you’ll experience symptoms consistently before each menstrual period. You might experience only some of the symptoms below, or several, but PMS typically involves at least a few different symptoms.

Emotional and behavioral symptoms

PMS-related changes in your mood, emotions, and behavior might include:

  • anxiety, restlessness, or feeling on edge
  • unusual anger and irritability
  • changes in appetite, including increased food cravings, especially for sweets
  • changes in sleep patterns, including fatigue and trouble sleeping
  • a sad or low mood, which might involve tearfulness or sudden, uncontrollable crying
  • rapid shifts in mood and emotional outbursts
  • decreased sex drive
  • difficulty concentrating or remembering information

Physical symptoms

With PMS, you’ll likely also notice some physical symptoms, such as:

  • abdominal bloating
  • cramping
  • sore and swollen breasts
  • acne
  • constipation
  • diarrhea
  • headaches
  • back and muscle pain
  • unusual sensitivity to light or sound
  • unusual clumsiness

When do PMS symptoms begin?

On average, the menstrual cycle lasts about 28 days. If you have an average-length cycle:

  • Ovulation, or the egg’s release from the ovaries, will occur around day 14, or the midpoint of the cycle.
  • PMS symptoms can begin any time after ovulation (though they typically begin in the week before your period) and last until 5 or so days after menstruation begins.
  • Menstruation, or bleeding, will begin on day 28 of the cycle.

What causes PMS?

Scientific research hasn’t led to a conclusive cause of PMS, or an explanation for why some people experience it more severely than others. That said, researchers have suggested a few different theories.

Cyclical changes in hormones

Many experts believe PMS happens in response to changing levels of the hormones estrogen and progesterone.

These hormones naturally fluctuate throughout your menstrual cycle. During the luteal phase, which follows ovulation, hormones reach a peak and then decline rapidly, which may lead to anxiety, irritability, and other changes in mood.

Chemical changes in the brain

The neurotransmitters serotonin and norepinephrine have several important functions in the body, including helping regulate mood, emotions, and behavior.

These chemical messengers may also factor into symptoms of PMS.

For example, a drop in estrogen may prompt the release of norepinephrine, which leads to declining production of dopamine, acetylcholine, and serotonin. These changes can trigger sleep problems and lead to a low or depressed mood.

Existing mental health conditions

Living with a mental health condition, such as depression or anxiety, could raise your chances of experiencing PMS or premenstrual dysphoric disorder (PMDD), a more severe form of PMS.

A family history of PMS, bipolar disorder, or depression, including postpartum depression, can also increase this risk.

You might also notice premenstrual exacerbation. This means symptoms of underlying mental health conditions, like bipolar disorder or depression, intensify shortly before your period begins.

Experts have yet to arrive at a conclusive explanation for the link between mental health symptoms and menstruation-related mood changes. But many believe it relates to the chemical changes in the brain discussed above.

Lifestyle factors

Certain habits might affect the severity of your PMS symptoms. Potential lifestyle factors that could worsen PMS symptoms include:

  • smoking
  • eating a lot of foods high in fat, sugar, and saltTrusted Source
  • a lack of regular physical activity
  • a lack of quality sleep

Research from 2018 also links alcohol use to increased risk of PMS. If you binge drink or drink heavily on a regular basis, you’re even more likely to experience PMS symptoms.

Could it be PMDD?

As with PMS, PMDD symptoms may occur due to fluctuations in levels of estrogen, progesterone, and serotonin.

Symptoms of PMDD might include:

  • depression, intense sadness, and crying spells
  • thoughts of suicide
  • panic attacks
  • anxiety, anger, or irritability
  • sudden shifts in mood
  • a lack of interest in daily activities
  • insomnia
  • trouble thinking or focusing
  • binge eating
  • painful cramping
  • bloating

If you have symptoms of PMDD, your doctor may recommend working with a therapist or psychiatrist, especially if you experience co-occurring mental health symptoms related to depression, trauma, or stress.

Other treatments and coping strategies that may help include:

  • daily exercise
  • limiting caffeine
  • practicing new methods of coping with stress
  • drospirenone and ethinyl estradiol tablet, the only birth control pill approved by the Food and Drug Administration (FDA) for PMDD symptoms
  • antidepressant or anti-anxiety medication, including selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs)

When to reach out to a doctor

Most people who menstruate report at least a few symptoms of PMS, but these symptoms won’t necessarily show up every month or affect your everyday life.

If PMS symptoms become severe enough to disrupt your regular routine on a monthly basis, a good next step involves reaching out to a doctor or clinician.

Healthcare professionals can diagnose PMS or PMDD and help you explore potential options for treatment, such as:

  • hormonal birth control
  • supplements, including calcium, magnesium, or vitamin B6
  • mefenamic acid

To make an accurate diagnosis, they may:

  • ask about your personal and family history of PMS, PMDD, and other mood and mental health conditions
  • ask about your family history of other health conditions, including hypothyroidism or endometriosis
  • recommend a pelvic exam to rule out gynecological conditions, depending on your symptoms
  • suggest keeping a diary and calendar to track menstruation and any related symptoms you experience for 2 to 3 months

If your symptoms show up consistently during the luteal phase of the menstrual cycle and disappear shortly after your period begins, a healthcare professional may diagnose PMS.

On the other hand, if they linger throughout the entire month or come and go without any regularity, they may link them to premenstrual exacerbation or another health condition.

Other conditions that may involve similar symptoms include:

  • anemia
  • endometriosis
  • thyroid disorder
  • irritable bowel syndrome (IBS)
  • chronic fatigue syndrome

Easing the symptoms of PMS

While there’s no cure for PMS, you can take steps to ease your symptoms.

To get relief from mild or moderate symptoms, it may help to give the following strategies a try:

  • Drink plenty of fluids to ease abdominal bloating. This includes herbal teas, like red raspberry leaf or chamomile, which may ease cramping.
  • Eat a balanced diet that includes plenty of fruits, vegetables, and whole grains.
  • Consider cutting back on sugar, salt, caffeine, and alcohol, especially if you’re particularly sensitive to their effects.
  • Ask a healthcare professional about trying supplements like folic acid, vitamin B-6, calcium, and magnesium to help reduce cramps and mood symptoms.
  • Try getting more vitamin D via natural light, food, or supplements.
  • Aim to get 7 to 9 hours of sleep each night to help relieve fatigue and improve overall well-being.
  • Try to get at least half an hour of physical activity each day, if you’re able. Exercise can not only help relieve bloating and cramping, but it can also help ease anxiety and depression symptoms.
  • Set aside time each day for self-care, which might include exercise, relaxation, time to yourself for hobbies, or time for social interaction.

Over-the-counter medications and treatments can also help reduce physical PMS symptoms. Options include:

  • pain relievers, like ibuprofen, aspirin, or acetaminophen, for head and muscle aches or stomach cramping
  • diuretics to help relieve bloating and sore or tender breasts
  • heat wraps or heating pads on your abdomen to relieve cramps

If you have severe mood symptoms that create complications in your daily life, cognitive behavioral therapy (CBT) or other therapy approaches can help you learn new ways to reframe and cope with distressing thoughts and emotions.

The bottom line

If PMS symptoms affect your routine and quality of life month after month, and home remedies and over-the-counter medications make little difference, it’s always best to connect with a healthcare professional.

Severe PMS symptoms may require a more in-depth treatment approach, but they do often improve with treatment. A doctor or clinician can offer more guidance on developing a personalized treatment plan that makes a difference for you.

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