Table of Contents

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.

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

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.

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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

Hutner, L. A., Catapano, L. A., Nagle-Yang, S. M., Williams, K. E., & Osborne, L. M. (Eds.). (2022). Textbook of women’s reproductive mental health. American Psychiatric Association Publishing.
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Clinically Reviewed By:

Dr Melanie Barrett, MD
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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.

photo of LifeStance provider Dr Rachel J Dalthorp, MD

Clinically Reviewed By:

Dr Rachel J Dalthorp, MD
Head of Specialty Services
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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.