Premenstrual Syndrome (PMS)

What Is Premenstrual Syndrome (PMS)?

Most women of reproductive age experience mild behavioral or physical symptoms a few days before their menses; however, these do not cause severe distress and functional impairment and are not considered premenstrual syndrome (PMS).

PMS causes a plethora of different behavioral and physical signs and symptoms and typically occurs in a predictable pattern. A small number of women experience symptoms that are so severe they may be diagnosed with premenstrual dysphoric disorder (PMDD). Regardless of symptom severity, PMS symptoms generally disappear with the onset of menses or several days after the start of menses.

What Are the Signs and Symptoms of PMS?

There are not any lab tests or images needed to diagnose PMS, rather it is a collection of signs and symptoms. There are some conditions that share similar signs or symptoms of PMS – such as thyroid disorders and other mood disorders such as depression or anxiety. It is important to discuss concerns with a provider.

Common behavioral changes may include:

  • Mood swings
  • Depressed mood
  • Irritability
  • Anxiety
  • Sadness, crying spells
  • Food cravings
  • Social withdrawal
  • Poor concentration

Common physical changes may include:

  • Abdominal bloating
  • Extreme sense of fatigue
  • Breast tenderness
  • Headaches
  • Dizziness

What Causes PMS?

PMS can start as early as within the first year after establishing menarche. Hormonal changes during a menstrual cycle and chemical changes in the brain can contribute to PMS.

A woman’s provider will obtain a detailed menstrual history because the relationship between symptoms and the menstrual cycle phase is important. To confirm a diagnosis of PMS, a woman has at least one symptom that is physical or behavioral in at least three consecutive menses, and must impair functioning in some way in the days leading up to the menses and disappear once menses begins or shortly after the onset of menses.

How Is PMS Treated?

PMS symptoms should not cause a woman to miss school or activities or ruin relationships. A woman can reduce their symptoms of PMS first by lifestyle changes such as a healthy diet (decreasing salt and caffeine intake and increasing fruits, vegetables, whole grains and calcium), decreasing stress, incorporating exercise in their routine, and ensuring they are getting enough sleep.

If symptoms are challenging to manage a woman should schedule an appointment with a provider. Commonly prescribed medications to help relieve PMS symptoms are nonsteroidal anti-inflammatories, hormonal contraceptives and antidepressants. Some have reported improvement in PMS symptoms by alternative medicine such as herbal remedies, vitamins and acupuncture; however, evidence to support this is lacking.