Understanding PMS

Premenstrual syndrome (PMS) is a collection of physical and emotional symptoms that typically occur one to two weeks before menstruation. Up to 75% of people who menstruate experience PMS at some point in their lives.

The intensity and type of symptoms vary widely. Common signs include mood changes, irritability, fatigue, bloating, breast tenderness, and food cravings. While PMS can disrupt daily life, there are many ways to manage and relieve its effects.

Symptoms

Most PMS symptoms appear after ovulation and fade once bleeding begins. They can be mild for some people and quite disruptive for others. If symptoms are severe or interfere with work, school, or relationships, you might be dealing with premenstrual dysphoric disorder (PMDD)—a more intense form of PMS that affects 3–8% of menstruating individuals.

Physical Symptoms

  • Breast tenderness

  • Bloating or gas

  • Headache or migraine

  • Weight gain (from water retention)

  • Back or joint pain

  • Stomachache or cramps

  • Fatigue or sleepiness

Emotional and Behavioral Symptoms

  • Irritability or anger

  • Mood swings

  • Sadness or crying easily

  • Anxiety or nervousness

  • Low sex drive

  • Trouble concentrating

  • Feeling overwhelmed

  • Changes in appetite or food cravings

  • Sleep disturbances

Causes

The exact cause of PMS isn’t fully understood. However, researchers believe that hormone fluctuations during the menstrual cycle play a key role.

After ovulation, estrogen and progesterone levels drop, affecting brain chemicals like serotonin, which regulate mood and energy levels. Low serotonin can contribute to irritability, fatigue, and cravings.

Other contributing factors may include stress, poor diet, smoking, lack of sleep, or limited physical activity.

Risk Factors

Certain factors increase the likelihood of developing PMS, such as:

  • Being between ages 20 and 40

  • Having a family history of depression or anxiety

  • Experiencing high stress levels

  • Smoking tobacco

  • Eating a diet high in salt, sugar, or caffeine

Diagnosis

There’s no single test to diagnose PMS. Your healthcare provider will review your medical history, symptoms, and lifestyle habits.

You may be diagnosed with PMS if you experience:

  • Symptoms before your period each cycle

  • A repetitive pattern of these symptoms

  • Relief from symptoms soon after your period begins

If symptoms continue after your period, further tests may be needed to rule out other conditions like thyroid disorders, anemia, or depression.

Diagnostic tools may include:

  • Symptom tracking over several months

  • Pelvic exam to rule out reproductive issues

  • Blood tests for thyroid or hormone levels

  • Urine test to exclude infection or pregnancy

  • Psychological assessment for mood disorders

  • Ultrasound or imaging for pelvic abnormalities

Treatments for PMS

Although there’s no cure, many treatments can significantly ease symptoms. Your provider may suggest a combination of lifestyle changes, medications, and therapies.

Common Treatment Options

  • Heat therapy: Applying a heating pad or taking a warm bath to relax muscles and reduce cramps.

  • Pain relievers: Over-the-counter options like ibuprofen, naproxen, or acetaminophen help with cramps and headaches.

  • Hormonal birth control: Pills, IUDs, or injections can stabilize hormone levels and reduce PMS symptoms.

  • Antidepressants (SSRIs): Medications like fluoxetine (Prozac), sertraline (Zoloft), or escitalopram (Lexapro) help with mood-related symptoms.

  • Diuretics: Reduce bloating and breast tenderness by decreasing fluid retention.

  • Cognitive behavioral therapy (CBT): Teaches coping techniques to manage stress and emotional changes.

  • Alternative therapies: Acupuncture, yoga, and meditation can reduce stress and promote relaxation.

  • CBD oil: Some studies suggest CBD may relieve headaches, cramps, and mood swings.

How to Prevent PMS Symptoms

While PMS can’t always be prevented, certain habits can minimize its severity:

  • Manage stress with deep breathing, journaling, or spending time outdoors.

  • Exercise regularly—aim for aerobic activity or strength training several times a week.

  • Avoid caffeine, alcohol, and tobacco.

  • Stay hydrated and eat balanced meals with whole grains, fruits, vegetables, and lean protein.

  • Maintain a consistent sleep schedule with at least eight hours per night.

Related Conditions

About half of people with PMS also have another chronic condition that worsens around their period, such as:

  • Depression or anxiety

  • Irritable bowel syndrome (IBS)

  • Chronic fatigue syndrome

  • Chronic pelvic or bladder pain

If underlying conditions worsen before or during your period, talk to your doctor about adjusting treatment plans.

Living With PMS

Most people experience mild to moderate PMS symptoms throughout their lives. Common complaints like bloating, fatigue, irritability, and breast pain can be managed with self-care and over-the-counter remedies.

However, if PMS symptoms interfere with your daily routine or emotional health, it’s important to seek professional help. Your healthcare provider can help create a personalized plan involving medication, therapy, and lifestyle guidance to improve your comfort and quality of life.