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What is PMS?

Premenstrual Syndrome, or PMS, as it is usually called, is a common condition that affects a woman’s emotions, physical health, and behavior in the 7-10 days prior to menstruation. The exact cause of PMS is unknown, but researchers believe that it is related to the rapid drop in sex hormones and serotonin levels during the luteal phase of the menstrual cycle. Because PMS tends to run in families, researchers also believe there is a genetic predisposition for PMS.

Almost every woman has experienced some aspect of PMS prior to her menstrual cycle, with many experiencing several physical and emotional symptoms each month.

Typical PMS Symptoms

Physical symptoms commonly experienced with PMS include fatigue, sleep problems, appetite changes, headache, joint and muscle pain, breast tenderness and abdominal pain. Emotional symptoms include feeling tense, anxious, depressed, irritable, or hopeless. Crying spells, mood swings and difficulty concentrating are also common.

These physical and emotional symptoms tend to recur in a predictable pattern and vary from slightly noticeable to completely debilitating. Whatever level you are at, you do not have to let these problems control your life. Treatments and lifestyle changes can help you reduce and manage your PMS symptoms.

Other Behaviors that May be Related to PMS

  • Feeling Overwhelmed
  • Sensitivity to Rejection
  • Social Withdrawal
  • Forgetfulness
  • Poor Concentration
  • Mood Swings
  • Sudden Sadness
  • Feeling Out of Control
  • Sleep Disturbances
  • Increased Appetite

Diagnosing PMS

There is no one test for PMS. The best way to determine if your symptoms are related to PMS is to record them daily for two full menstrual cycles so that you can see any set patterns you have. In someone with PMS, these symptoms will not be present between days 4 through 12 of your 28-day menstrual cycle.

Lifestyle Changes that Can Help with PMS

For many women, regular aerobic exercise lessens PMS symptoms, as does relaxation techniques like meditation. Making changes to your diet, like cutting down on fat, caffeine, and alcohol, or eating six small meals a day rather than three large ones, can keep your blood sugar level stable and help lessen the severity of your symptoms.

Behavioral Therapy for PMS

Some women find relief from the physical and emotional challenges of PMS with cognitive behavioral therapy (CBT). The aim of CBT is to help people cope better in their everyday lives by identifying and changing unhelpful thought patterns and behaviors. One aim of CBT for PMS sufferers is to learn the coping skills needed to lessen the impact it has on your everyday life.

How Cognitive Behavior Therapy Works

Cognitive therapy involves identifying and learning to manage negative thoughts that can leave you feeling down. In a typical first session you will talk with your therapist about your feelings and how they fluctuate during your menstrual cycle. Then, in regular therapy sessions, your therapist will work with you to identify the thought patterns and situations that trigger your negative feelings. Between sessions, your therapist may ask you to record your symptoms and menstrual cycle on a chart to see the relationship between the two, and to see how the coping techniques that you have learned are helping you manage your symptoms.

Medications that Reduce PMS Symptoms

Some women find relief from the physical and emotional challenges of PMS with cognitive behavioral therapy (CBT). The aim of CBT is to help people cope better in their everyday lives by identifying and changing unhelpful thought patterns and behaviors. One aim of CBT for PMS sufferers is to learn the coping skills needed to lessen the impact it has on your everyday life.

SSRIs for PMS Relief

SSRI (Selective serotonin reuptake inhibitors) medication may be prescribed to treat PMS. These medicines were developed to treat depression but have also been found to ease the symptoms of PMS, even if you do not experience depression and anxiety outside of the premenstrual period. SSRIs work by increasing the level of serotonin and preventing the breakdown of allopregnanolone, a neuro-steroid related to the hormone progesterone, in the brain Research suggests for women with PMS taking an SSRI for the second half of your monthly cycle is as effective as taking an SSRI every day.

Your Long-Term Outlook for PMS

There may be times in your life when symptoms of PMS aren’t noticeable, and other times when it is severe. It may get worse at certain times—like when you are stressed or during periods when hormones are fluctuating dramatically, like during puberty, after having a baby or during the transition to menopause.

Seeking Help for PMS

If you are experiencing PMS symptoms, see your doctor. They will be able to determine if medical or gynecological conditions, like endometriosis, fibroids, and hormone problems, or emotional problems like depression or panic disorders are causing your symptoms.

PMS FAQs

Do All Women have PMS?

PMS is extremely common. Most women of childbearing age experience at least one of the physical and/or psychological symptoms associated with PMS during the two weeks prior to getting their period.

Is PMS Brought on by Stress or Depression?

No. Stress and emotional problems, such as depression, do not cause PMS, but they may make those issues harder to tolerate.

Could my Symptoms be Something Other than PMS?

Yes. PMS symptoms may indicate other conditions such as a mood or anxiety disorder, early menopause, or a thyroid problem.

Can PMS Increase the Severity of Other Medical Issues?

Yes. You may experience an increase in conditions like migraines, allergies, and asthma during the time prior to getting your period.

Can I get PMS When I am Not Menstruating?

Yes. It is possible to get PMS when you do not get your period. You can get PMS when nursing, in perimenopause, and after a hysterectomy.

Is PMS the Same Thing as PMDD?

No. Premenstrual Dysphoric Disorder (PMDD) is a severe and sometimes disabling extension of PMS that causes extreme mood shifts and disruptions to daily life.

Premenstrual Syndrome (PMS)

PMS refers to a wide range of physical or emotional symptoms that typically occur about 5-11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when, or shortly after, her period begins.

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a condition in which a woman has severe depressive symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS). PMDD affects between 3% and 8% of women during the years when they are having menstrual periods.

What causes PMS and PMDD?

PMS and PMDD are caused by fluctuations in ovarian hormones during the menstrual cycle. These hormonal changes cause fluctuations in brain chemicals responsible for mood. Women with PMDD have brains that are sensitive to these rapid changes in hormone levels. Additionally, there is a genetic component to PMDD as it tends to run in families.

What are symptoms of PMDD?

The symptoms of PMDD are like those of PMS. However, they are generally more severe and debilitating and include a least one mood-related symptom. Symptoms occur during the week just before menstrual bleeding and usually improve within a few days after the period starts.
Five or more of the following symptoms must be present to diagnose PMDD, including one mood-related symptom:

  • No interest in daily activities and relationships
  • Fatigue or low energy
  • Feeling of sadness or hopelessness, possible suicidal thoughts
  • Feelings of tension or anxiety
  • Feeling out of control
  • Food cravings or binge eating
  • Mood swings with periods of crying
  • Panic attacks
  • Irritability or anger that affects other people
  • Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
  • Problems sleeping
  • Trouble concentrating

How is PMDD diagnosed?

No physical examination or lab tests can diagnose PMDD. A complete history, physical examination (including a pelvic exam), and psychiatric evaluation should be done to rule out other conditions.

Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times when they are likely to occur. This information can help diagnose PMDD and determine the best treatment.

This content has been reviewed by Dr. Rachel Dalthrop, Psychiatrist at LifeStance Health.