Premenstrual syndrome (PMS) is a combination of symptoms that affect many people in the two weeks before their period. Although PMS symptoms are usually mild, some people have symptoms severe enough to disrupt their daily lives.
There's also an extreme form of PMS called premenstrual dysphoric disorder (PMDD), which causes severe, debilitating symptoms.
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Premenstrual syndrome (PMS) is a combination of physical and mood-related symptoms that occur before your menstrual period each month. Symptoms usually begin about one to two weeks before your period starts and go away in the first few days of your period. But this can vary greatly from cycle to cycle and may worsen during times of increased stress.
It's common to have tender breasts, bloating, and muscle aches a few days before your period. But when these normal premenstrual symptoms interfere with your daily life, it's called premenstrual syndrome.
Most people first get PMS in their mid-20s. But it can start with your first period and can continue until menopause (when you stop getting a period). After menopause, PMS goes away because hormones are low and don't rise and fall each month.
The National Institutes of Health (NIH) estimates that 70% to 90% of menstruating people experience some physical and/or emotional symptoms of PMS.
About 20% of menstruating people experience symptoms of PMS that are severe enough to interfere with their daily lives.
Premenstrual dysphoric disorder (PMDD) is a severe and sometimes disabling condition with a wide range of physical and emotional symptoms. PMDD is an extreme form of PMS and is considered a psychiatric disorder.
In addition to both physical and emotional symptoms, PMDD causes significant distress and functional impairment that can significantly disrupt your everyday life. A person having a PMDD episode may have severe mood swings and be angry, anxious, depressed, fatigued, or exhibit a combination of emotions. Physical symptoms may include cramping and headaches.
PMDD also may negatively affect your social life and relationships.
For most people with PMDD, intense symptoms begin about six days before their period and are most severe two days before their period.
PMDD affects between 3% to 8% of menstruating people. A person with PMDD will have an estimated 6.8 days of severe PMDD-related symptoms per cycle. That amounts to eight years of debilitating symptoms throughout their lifetime.
PMS is tied to hormone changes that happen during the menstrual cycle. For instance, fluctuations in estrogen levels are often responsible for PMS-related mood changes. Doctors aren't sure why premenstrual symptoms are worse in some people than others, although PMS can run in your family.
The cause of PMDD is unknown. Studies have shown a relationship between PMDD and low levels of serotonin, a chemical in your brain associated with mood, attention, sleep, and pain. Monthly hormonal changes may cause a decrease in serotonin, which can worsen PMDD symptoms.
People with PMDD also may experience an abnormal reaction to the hormonal changes associated with menstruation. This reaction may cause symptoms of underlying depression and anxiety to worsen.
You may be more at risk of developing PMS or PMDD if you:
Nearly half of people who experience symptoms of PMS also have another health problem that PMS may worsen.
These health problems include:
Symptoms of PMDD are similar to those of PMS but more intensely felt.
Common physical symptoms of PMS and PMDD include:
It's also common to experience changes in your mood and behavior in the days leading up to your period.
These symptoms may include:
Symptoms of PMS may worsen in your late 30s and 40s as you approach menopause and during perimenopause, the process of change that leads up to menopause. During perimenopause, your hormone levels fluctuate, which may cause your PMS or PMDD to intensify.
PMDD can dramatically impact every aspect of your life, including your work, school, social life, and relationships. If you suspect that you may have PMDD, you should talk to your doctor immediately.
You should call your doctor if:
It's important to know that for either a PMS or PMDD diagnosis, it may take more than one visit for your doctor to diagnose your symptoms properly. There's no single test to diagnose PMS or PMDD.
Your doctor will ask you about your symptoms and do a physical exam.
They may want you to keep a written record of your symptoms for two to three months. This "menstrual diary" can help you track when your symptoms start, how bad they are, and how long they last. Your doctor can use it to help diagnose PMS.
Your doctor will also want to make sure that another condition isn't causing your symptoms. For example, thyroid problems can have symptoms similar to those of PMS. Your doctor may run a thyroid-stimulating hormone (TSH) blood test to see that your thyroid gland is working as it should.
A diagnosis of PMDD requires extreme experiences with five of 11 specific symptoms, including at least one mood-related symptom.
The 11 symptoms are:
Lifestyle changes, such as healthy eating, regular exercise, and cutting back on alcohol and caffeine, can often help with PMS and PMDD.
Medicine to treat PMS and PMDD
If lifestyle changes don't help relieve your symptoms after a few menstrual cycles, your doctor can prescribe or recommend medicine for problems like bloating or more severe PMS symptoms.
These medications may include:
For some people, the emotional symptoms of PMS and PMDD can be disruptive enough to affect their quality of life. Counseling and group therapy can help manage feelings of hopelessness, depression, anxiety, irritability, and significant mood imbalances.
Most complementary therapies aren't considered standard treatment for PMS, but you may find that one or more may relieve some of your symptoms. Before you try any of these therapies, you should talk with your doctor first.
Some complementary therapies that may help with PMS symptoms include:
While studies have shown that certain vitamins and minerals can alleviate some PMS symptoms, it's important to remember that the Food and Drug Administration (FDA) doesn't regulate supplements. Their quality can vary depending on the ingredients and manufacturer.
You should also consult your doctor before taking any supplements for PMS relief to make sure that they won’t interact negatively with other medicines or supplements you take.
Self-care for PMS means practicing healthy habits, managing pain, and reducing stress.
Here are some ways to practice self-care during your menstrual cycle:
It's best to try one or two of these home treatments for PMS at a time to help you figure out what's most helpful in the long term.
Last reviewed by a UPMC medical professional on 2024-09-05.
