PMS
PMS is extremely common, with most women of childbearing age experiencing at least one of the physical and/or psychological symptoms.
Is Treatment Available In My State?Table of Contents
- What is PMS?
- What are Typical PMS Symptoms?
- Other Behaviors that May be Related to PMS
- How is PMS Diagnosed?
- What Lifestyle Changes Can Help with PMS?
- How Can Psychotherapy Help Reduce PMS Symptoms?
- How Does Cognitive Behavioral Therapy Work?
- What Medication May Help Reduce PMS Symptoms?
- How Does PMS Change Over Time?
- Who Can Help Manage PMS Symptoms?
- References
- Frequently Asked Questions
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.
What are 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 experiencing, you do not have to let these symptoms control your life. Treatments and lifestyle changes can help you reduce and manage your PMS symptoms.
How is PMS Diagnosed?
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. It is recommended to meet and discuss these records with a mental health clinician to determine if you have PMS.
What Lifestyle Changes Can Help with PMS?
For many women, regular aerobic exercise lessens PMS symptoms, as do 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 help keep your blood sugar level stable and help lessen the severity of your symptoms.
How Can Psychotherapy Help 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 goal of CBT for PMS sufferers is to learn the coping skills needed to lessen the impact it has on your everyday life.
Lifestance Health specializes in PMS treatment with multiple locations in 33 states. Services and available treatments vary by location.
Find a provider near you:
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How Does Cognitive Behavioral Therapy Work?
Cognitive behavioral therapy (CBT) 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 much the coping techniques that you have learned are helping you manage your symptoms.
What Medication May Help Reduce PMS Symptoms?
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 seek to ease these symptoms 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 that, for women with PMS, taking an SSRI for the second half of the monthly cycle may be as effective as taking an SSRI every day.
How Does PMS Change Over Time?
There may be times in your life when symptoms of PMS aren’t noticeable, and other times when they are severe. They 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.
Who Can Help Manage PMS Symptoms?
If you are experiencing PMS symptoms, see your doctor or a licensed mental health clinician. They can help address the symptoms and can also help determine if medical or gynecological conditions, like endometriosis, fibroids, and hormone problems, or emotional problems like depression or panic disorders, are causing your symptoms.
References
Dr. Melanie Barrett received her medical degree from the University of Oklahoma College of Medicine following undergraduate studies in Psychology at Texas A&M University in College Station, Texas. She completed her psychiatry residency at the University of North Carolina Hospitals, Chapel Hill, where she served as Chief Resident. She maintains board certification through the American Board of Psychiatry & Neurology. Dr. Barrett specializes in interventional treatments for postpartum depression as well as Spravato (esketamine) and Ketamine IV therapy for treatment resistant depression. She regularly provides teaching and consultations to medical professionals interested in learning about postpartum depression.
Dr. Dalthorp is board certified by the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association. She is a former member of the board of directors for the American Association of Ketamine Physicians and founding board member of the nonprofit International Society of Reproductive Psychiatry. She currently serves as Secretary and member of the Executive Council, CME, and DEI committees of the Oklahoma Psychiatric Physicians Association.
PMS FAQ
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.
No. Stress and emotional problems, such as depression, do not cause PMS, but they may make symptoms of PMS more severe.
Yes. PMS symptoms may indicate other conditions such as a mood or anxiety disorder, early menopause, or a thyroid problem.
Yes. You may experience an increase in conditions like migraines, allergies, and asthma during the time prior to getting your period.
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.
No. Premenstrual dysphoric disorder (PMDD) is a severe and sometimes disabling extension of PMS that causes extreme mood shifts and disruptions to daily life.
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.
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.
The symptoms of PMDD are like those of PMS. However, they are generally more severe and debilitating and include at 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
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.