Premenstrual Syndrome: Symptoms & How to Get Relief

What is premenstrual syndrome?

Premenstrual syndrome (PMS) can cause physical and emotional symptoms in the days leading up to your menstrual cycle.

Common symptoms include bloating, cramping, headaches, irritability, fatigue, and sleep and appetite changes. These symptoms usually improve within a few days of getting your period.

Depending on how severe your symptoms are, treatment options may include medications such as birth control pills and antidepressants like selective serotonin reuptake inhibitors (SSRIs).

Treatment may also include at-home approaches like decreasing caffeine, salt, and refined sugar, increasing exercise, and reducing stress.

Symptoms of premenstrual syndrome

Main symptoms

PMS can cause both emotional or physical symptoms that can often impact school and work performance or home life. These symptoms include:

• Mood swings
• Irritability
• Anxiety
• Sad or depressed mood
• Increased appetite or food cravings
• Decreased interest in normal activities
• Abdominal bloating
• Fatigue
• Breast tenderness
• Dizziness
• Headaches
• Hot flashes
• Decreased interest in sex
• Difficulty with concentration
• Changes in sleep

Diagnosis

There are diagnositic criteria that can determine if you have PMS or if you have a more serious but less common disorder called premenstrual dysphoric disorder (PMDD).

PMS is usually diagnosed if you have symptoms in the 5 days before your period for 3 months in a row. Symptoms usually stop within 3 or 4 days of getting your period.

The American Psychiatric Association defines PMDD as having at least 5 of the symptoms listed above, including one symptom that affects your mood, like depression or irritability. PMDD is much less common and is estimated to affect 2—5% of the population.

Causes

The menstrual cycle is divided into two distinct phases—the follicular phase and the luteal phase. The luteal phase starts after ovulation. If the egg that was released during ovulation is not fertilized, levels of the hormones estrogen and progesterone begin to drop rapidly toward the end of the luteal phase (the days leading up to your period).

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 PMS symptoms.

Treatment

Treatment is generally based on how severe your symptoms are and how much they affect your daily life.

Mild PMS treatment

If you have mild PMS, it means your symptoms do not cause significant distress or disrupt your life. For mild PMS, studies have shown that regular exercise and relaxation techniques can help relieve symptoms. Try to exercise daily throughout the month, not just when you have symptoms.

Moderate or severe PMS treatment

Women with moderate or severe PMS (also known as PMDD) are generally treated with medication. Before starting any medications, it's important to rule out other psychiatric conditions, substance use, or thyroid problems.

Antidepressants

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are often recommended for moderate to severe PMS. SSRIs should take effect within the first menstrual cycle after starting therapy. If not, the dose can be increased.

Depending on how long you usually have symptoms, your doctor may recommend you take an SSRI every day or that you only take it during the luteal phase of your menstrual cycle.

About 15% of people taking SSRIs experience side effects. These may include insomnia, headache, nausea, and decreased sex drive.

Birth control pills

If SSRIs are not helpful enough or you cannot tolerate the side effects, you can consider taking birth control pills to reduce your PMS symptoms.

Prevention

Lifestyle choices can help reduce PMS symptoms. These include:

• Eating a healthy diet, low in sugar, salt, and fats
• Reducing caffeine, alcohol, and nicotine
• Exercising at least 30 minutes a day on most days
• Managing stress with relaxation techniques like deep breathing, meditation, and yoga

When to see a healthcare provider

You should see your healthcare provider if your PMS symptoms lower your quality of life or day-to-day functioning. While PMS and PMDD are rarely a medical emergency, getting the right treatment can improe your physical and mental health.