This article will review the symptoms, causes, and management of premenstrual syndrome (PMS). Common symptoms include bloating, cramping, headaches, irritability, fatigue, and sleep and appetite changes.
What is premenstrual syndrome?
Premenstrual syndrome (PMS) is a condition that can produce emotional and physical symptoms in women in the days leading up to their menstrual cycle.
Common symptoms include bloating, cramping, headaches, irritability, fatigue, and sleep and appetite changes. These symptoms usually resolve with the onset of menses.
Once the severity of premenstrual syndrome has been determined, treatment options may include medications such as oral birth control pills and selective serotonin reuptake inhibitors (SSRIs).
You may recognize this diagnosis on your own due to the of the timing of your symptoms. Treatment can involve decreasing caffeine, salt and/or refined sugar, increasing exercise, and reducing stress. If symptoms become more severe, a doctor may prescribe an oral birth control pill or an anti-depressant.
Free, private, and secure to get you the best way to well. Learn about our technology.
Symptoms of premenstrual syndrome
The symptoms associated with PMS can be both emotional or physical and often can impact work performance or home life. These symptoms include:
- Mood swings
- Sad or depressed mood
- Increased appetite or food cravings
- Sensitivity to rejection
- Decreased interest in normal activities
- Abdominal bloating
- Breast tenderness
- Hot flashes
- Decreased interest in sex
- Difficulty with concentration
- Changes in sleep
Diagnostic criteria are used to determine if a woman’s symptoms are considered clinically significant as well as to determine if these symptoms classify as PMS or premenstrual dysphoric disorder (PMDD). The American College of Obstetrics and Gynecology defines clinically significant PMS as “at least one symptom associated with economic or social dysfunction that occurs during the five days before the onset of menses and is present in at least three consecutive menstrual cycles”.
The American Psychiatric Association’s Diagnostic and Statistical Manual Fifth Edition (DSM-V) defines PMDD as the presence of at least five of the symptoms listed above, including one symptom that alters the individual’s affect (mood swings, depression, or irritability). It is estimated that PMDD affects two to five percent of the population.
Causes of premenstrual syndrome
Studies suggest that significant PMS affecting a woman’s day-to-day life is present in three to eight percent of the population. The menstrual cycle is divided into two distinct phases — the follicular phase and the luteal phase. The luteal phase commences after ovulation. Toward the end of the luteal phase (the days leading up to the menstrual cycle), if the egg that was released during ovulation has not been fertilized, levels of the hormones estrogen and progesterone begin to rapidly decrease. While the exact mechanism is not yet clear, it is thought that these decreasing levels of estrogen and progesterone lead to changes in the neurotransmitters GABA and serotonin, which lead to the symptoms described above.
Free, secure, and powered by Buoy advanced AI to get you the best way to better. Learn about our technology.
Treatment options and prevention for premenstrual syndrome
Part of the diagnostic workup of PMS is to determine whether the condition is mild, moderate, or severe. The severity is generally determined by the impact on your life.
Mild PMS treatment
You are considered to have mild PMS if your symptoms do not cause significant distress or socioeconomic dysfunction. For mild PMS, physicians generally recommend exercise and relaxation techniques. While studies have shown improvement in symptoms of mild PMS with these measures, it is unclear whether this was due to this treatment course or placebo effect.
Moderate or severe PMS treatment
Women with moderate PMS or severe PMS (also known as PMDD) are generally treated with medication. Before initiating any medications for this condition, co-existing psychiatric conditions, substance use, or thyroid problems should be ruled out as the cause of your symptoms. As previously discussed, it is believed that the interaction of progesterone and estrogen with serotonin may be the cause of the condition. As such, selective serotonin reuptake inhibitors (SSRIs) are considered first-line therapy for moderate to severe PMS.
- SSRI efficacy: The medication is expected to take effect within the first menstrual cycle after the initiation of therapy. If not, the dose can be increased.
- SSRI frequency: Depending on the duration of your symptoms, your doctor may recommend an everyday course of SSRI or that you only take medication during the luteal phase of your menstrual cycle.
- SSRI side effects: While SSRIs are proven to be effective for moderate to severe PMS, they do have side effects in about 15 percent of people. Side effects include insomnia, headache, nausea, and decreased sex drive.
- Oral birth control: People who do not respond to SSRIs or wish to continue due to side effects may be trialed on birth control pills to alleviate PMS symptoms.
There are currently no measures recommended for the prevention of PMS beyond healthy lifestyle choices, including maintenance of a healthy diet, regular exercise, and management of stressors. If you believe you may be developing PMS or PMDD, the Daily Record of Severity of Problems (DRSP) can be used to do a personal home assessment of symptom severity.
When to seek further consultation for premenstrual syndrome
You should seek care from your healthcare provider if any of the above symptoms lower your quality of life or day-to-day functioning. While PMS and PMDD are rarely a medical emergency, proper management of these conditions will often be worthwhile to your health.
Questions your doctor may ask to determine premenstrual syndrome
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Do you have trouble sleeping?
- Do you currently smoke?
- Are your symptoms causing difficulty at work, socializing, or spending time with friends & family?
- Have you lost your appetite recently?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
- Premenstrual syndrome (PMS). Office on Women’s Health. OWH Link
- Premenstrual syndrome (PMS). American College of Obstetrics and Gynecology. Published May 2015. ACOG Link
- Epperson CN, Steiner M, Hartlage SA, et al. Premenstrual dysphoric disorder: Evidence for a new category for DSM-5. Am J Psychiatry. 2012;169(5):465-475. NCBI Link
- Potter J, Bouyer J, Trussell J, Moreau C. Premenstrual syndrome prevalence and fluctuation over time: Results from a French population-based survey. J Women’s Health (Larchmt). 2009;18(1):31–9. PubMed Link
- Deuster PA, Adera T, South-Paul J. Biological, social, and behavioral factors associated with premenstrual syndrome. Arch Fam Med. 1999;8(2):122-8. PubMed Link
- Aganoff JA, Boyle GJ. Aerobic exercise, mood states and menstrual cycle symptoms. J Psychosom Res. 1994;38(3):183-192. PubMed Link
- Marjoribanks J, Brown J, O'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013;(6):CD001396. PubMed Link
- Endicott J, Nee J, Harrison W. Daily record of severity of problems (DRSP): Reliability and validity. Arch Womens Ment Health. 2006;9(1):41-9. PubMed Link