Premenstrual syndrome

Premenstrual syndrome (PMS) has a wide array of signs and symptoms, which includes but is not restricted to mood swings, food cravings, tender breasts, irritability, depression, and fatigue.

It’s estimated that as many as 90% of every menstruating women have experienced some form of PMS. Premenstrual syndrome (PMS) is a disorder that alters a woman’s emotions, physical health, and behavior during some days of the menstrual cycle, which can be just before her menses.

PMS is a widespread condition. Its symptoms affect about 4 in 5 every menstruating women. It can impair some aspects of a woman’s life. PMS symptoms typically begin five to 11 days before menstruation and can go away once menstruation begins.

Although the causes of Premenstrual syndrome (PMS) are still unknown, many researchers believe it is connected to changes in both sex hormones and serotonin levels at the beginning of the menstrual cycle.

Levels of estrogen and progesterone surge during certain times of the month. This increase can trigger irritability, mood swings, and anxiety. Ovarian steroids also control activity in parts of the brain associated with premenstrual symptoms.

An increase in Serotonin levels can have an impact on one’s mood. Serotonin is a chemical that can be found in the brain and gut that affects moods, emotions, and thoughts.

Risk factors for premenstrual syndrome include:

  • A family history of depression
  • Previous episodes of depression or mood disorders, such as postpartum depression or bipolar disorder
  • A family history of PMS
  • Domestic violence
  • substance abuse
  • Physical trauma
  • Emotional trauma

Associated conditions include:

  • Dysmenorrhea
  • Major depressive disorder
  • Seasonal affective disorder
  • Generalized anxiety disorder
  • Schizophrenia

Symptoms of Premenstrual syndrome (PMS)

A woman’s menstrual cycle lasts a minimum of 28 days.

Ovulation is the period when an egg is released from the ovaries, which occurs on day 14 of the cycle. Menstruation, or bleeding, starts on day 28 of the cycle. PMS symptoms can begin on day 14 and continue until seven days after the start of menstruation.

The symptoms of PMS can be mild or moderate. Eighty percent of women are estimated to report one or more sign that does not significantly affect day to day activities, according to the journal American Family Physician.

About 20 to 32 percent of women experience moderate to severe symptoms that can hinder day to day functioning—three to 8 percent report PMDD.

The severity of symptoms can be different individually and by month. The symptoms of PMS include:

  • Abdominal bloating
  • Abdominal pain
  • Sore breasts
  • Acne
  • Food cravings, especially for sweets
  • Constipation
  • Diarrhea
  • Headaches
  • Sensitivity to light or sound
  • Fatigue
  • Irritability petulance
  • Changes in sleep patterns
  • Anxiety
  • Depression
  • Sadness
  • Emotional outbursts

Emotional and behavioral signs and symptoms;

  • Tension or anxiety
  • Depressed mood
  • Crying spells
  • Mood swings and irritability or anger
  • Appetite changes and food cravings
  • Trouble falling asleep (insomnia)
  • Social withdrawal
  • Poor concentration
  • Change in libido

Physical signs and symptoms;

  • Joint or muscle pain
  • Headache
  • Fatigue
  • Weight gain related to fluid retention
  • Abdominal bloating
  • Breast tenderness
  • Acne flare-ups
  • Constipation or diarrhea
  • Alcohol intolerance

Causes Premenstrual syndrome (PMS)

The exact causes of premenstrual syndrome are unknown, but several factors can contribute to the condition:

  • Cyclic changes in hormones: Symptoms of premenstrual syndrome can alter with hormonal imbalance and stop completely with pregnancy and menopause.
  • Chemical changes in the brain: When there is a fluctuation of serotonin, a chemical present in the brain (neurotransmitter) is believed to play an essential role in the state of mood, and can trigger PMS symptoms. Insufficient serotonin quality can also contribute to premenstrual depression, sleep problems, food cravings, and fatigue.
  • Depression: Some women who suffer from severe premenstrual syndrome usually have undiagnosed depression, although depression alone does not cause all of the symptoms.The diagnosis is made when one has more than one recurrent symptom in the same time frame that is serious enough to result in impairment and is absent between menses and ovulation periods.

The doctor must also rule out other causes, such as:

  • chronic fatigue syndrome
  • Anemia
  • Endometriosis
  • Connective tissue or rheumatologic diseases
  • Thyroid disease
  • Irritable bowel syndrome (IBS)

The doctor may inquire about any family history of depression or other mood disorders to determine whether PMS or other conditions cause the symptoms.

Some conditions, such as pregnancy, hypothyroidism, and irritable bowel syndrome, have symptoms identical to PMS.

The doctor may also carry out a pregnancy test, and possibly pelvic exam to check for any gynecological problems and a thyroid hormone test to ensure one’s thyroid gland is working correctly.

Keeping documentation of one’s symptoms is another way to check if one has PMS. It is recommended for one to use a calendar to keep track of the signs and menstruation monthly.

If the symptoms start around the same time each month, PMS can be diagnosed as a likely cause.

When to see the doctor

If one hasn’t been able to manage the premenstrual syndrome with lifestyle alterations, it is advisable to see a doctor if physical pain, mood swings, and if symptoms start to affect one’s daily life, or if the symptoms don’t go away.

Easing the symptoms of PMS

There is no known cure for PMS, but one can take steps to lessen the symptoms. If one experience a mild or moderate kind of premenstrual syndrome, the treatment options can include:

  • Drinking a lot of fluids to reduce abdominal bloating.
  • Eating a nutrient balanced diet to enhance overall health and energy level, which means consuming plenty of fruits and vegetables and lessening the intake of sugar, salt, caffeine, and alcohol.
  • Using supplements like magnesium, vitamin B-6, calcium, and folic acid to ease cramps and mood swings.
  • Ingesting vitamin D to ease symptoms.
  • Resting for at least eight hours per night to ease fatigue and renew strength.
  • Keeping physically fit to lessen bloating and enhance one’s overall mental health.
  • Cutting down on strenuous activities to reduce stress, through exercising and reading and other relaxing activities.
  • Attending cognitive behavioral therapy, which has been discovered to be effective.
  • Taking of pain medication, such as ibuprofen or aspirin, to relieve headaches, stomach cramping and muscle aches.
  • Using diuretic can also stop bloating and water weight gain. One should only take medications and supplements only as instructed after speaking with the doctor.

Severe PMS: premenstrual dysphoric disorder

Severe PMS symptoms are not common. A small percentage of women who experience severe symptoms have premenstrual dysphoric disorder (PMDD).

PMDD affects about 3 and 8 percent of women. This is featured in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders.

The symptoms of PMDD can include:

  • Depression
  • Panic attacks
  • Extreme anxiety
  • Bloating
  • Anger with severe mood swings
  • Crying spells
  • Suicidal thoughts
  • A lack of interest in daily activities
  • Insomnia
  • Bloating
  • Painful cramping
  • Trouble thinking or focusing
  • Binge eating

The symptoms of PMDD can occur due to changes in estrogen and progesterone levels. Connections between low serotonin levels and PMDD have also been made.

The doctor may do the following examinations to rule out other possible medical problems:

  • A liver function test
  • A gynecological exam
  • A complete blood count
  • A physical exam
  • The doctor may also call for a psychiatric evaluation. A personal or family history of severe depression, trauma, stress, or substance abuse can trigger or worsen PMDD symptoms.


Treatment for PMDD can vary. The doctor may recommend:

  • A caffeine-free diet
  • Individual or group counseling
  • Stress management classes
  • Vitamin supplements, such as calcium, magnesium, and vitamin B-6
  • Daily exercise
  • Drospirenone and Ethinyl estradiol tablet (Yaz) are the only birth control pill the Food and Drug Administration has approved for the treatment of PMDD symptoms
  • If one’s PMDD symptoms still do not reduce, the doctor may prescribe a selective serotonin reuptake inhibitor (SSRI) antidepressant. This medication boosts serotonin levels in the brain and has many uses in regulating brain chemistry that is not only depression.

The doctor may also recommend cognitive behavioral therapy, which is a type of counseling that can help you understand your thoughts and feelings and change your behavior accordingly.

PMS or PMDD cannot be prevented, but the treatments listed above can help reduce the severity and duration of symptoms.

For some women, lifestyle modification can help reduce PMS symptoms. But this depends on the severity of the symptoms, and the doctor may prescribe one or more medications for premenstrual syndrome.

The success of medications in relieving symptoms can vary from woman to woman. Common medications prescribed for the treatment of premenstrual syndrome include:

  • Antidepressants such as Selective serotonin reuptake inhibitors (SSRIs) — which include sertraline (Zoloft), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), and others — have been successful in treating mood symptoms. SSRIs are the first-line treatment for severe PMS or PMDD. These medications are generally taken every day. But for some women with PMS, the use of antidepressants may be restricted to the 14 days before menstruation starts.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of one’s period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can reduce cramps and breast discomfort.
  • When exercising and reducing salt intake is not enough to reduce the weight gain, swelling, and bloating of PMS, taking water pills (diuretics) can help the body shed excess fluid through the kidneys. Spironolactone (Aldactone) is a diuretic that can help reduce some of the symptoms of PMS.
  • Hormonal contraceptives. These prescription medications stop ovulation, which can bring relief from PMS symptoms.

Lifestyle and home remedies

Sometimes one can manage or ease premenstrual syndrome symptoms by making changes in the one’s diets, by exercising regularly by trying these tips:

Modify one’s diet

  • Eat smaller food portions and more frequently to reduce bloating and the sensation of fullness.
  • Limit salt and salty foods intake to lessen bloating and fluid retention.
  • Choose foods high in healthy carbohydrates, such as fruits, vegetables, and whole grains instead of junks
  • Choose foods with calcium. If one has dairy products intolerance or is not getting adequate calcium in one’s diet, a daily calcium supplement may be prescribed.
  • Avoid caffeine and alcohol.

Incorporate exercise into one’s routine

Engaging in at least 30 minutes of cycling, swimming, brisk walking, or other aerobic activity most days of the week. Regular daily exercise can help improve overall health and assuage specific symptoms, such as fatigue and a depressed mood.

Reduce stress

  • Get plenty of rest.
  • Practicing progressive muscle relaxation or breathing exercises to help reduce headaches, anxiety, or insomnia.
  • Practicing yoga or massage can be relaxing and can relieve stress.

Recording of symptoms for a few months

Premenstrual syndrome

Keep a record and identifying the triggers and timing of symptoms. This will allow one to intervene with strategies that can help to reduce or eradicate them.

Alternative medicine

  • Vitamin supplements., vitamin E, calcium, magnesium, and vitamin B-6 have all been reported to ease symptoms, but the evidence is inadequate.
  • Herbal remedies. Some women report relief of PMS symptoms after using herbs, such as St. John’s wort ginkgo, evening primrose oil, ginger, and chaste berry (Vitex Agnus). However, few scientific evidence discovered the effectiveness of herbs for the relief of PMS symptoms.

Herbal remedies also are not ratified by the Food and Drug Administration, so there’s no record of product safety or effectiveness.

One should consult a doctor before taking any herbal products, as they can have side effects or interact with other medications one is taking. St. John’s wort, for instance, reduces the effectiveness of birth control pills.

Preparing for appointments

One is likely to start by seeing the family doctor or primary care provider. However, in some cases, when one calls to set up an appointment, one may be referred to a gynecologist who specializes in conditions affecting the female reproductive tract.

Here’s some information to help patients prepare for an appointment and what to expect from the doctor.

What you can do

  • Be aware of any pre-appointment restrictions.If one makes the appointment, it is advisable to ask if there’s anything one needs to do in preparation.
  • Writing down symptoms,including any that may seem unrelated to the reason for the scheduled appointment.
  • One should make a list of critical medical information,including any other conditions one has or is being treated and the names of any medications, vitamins, or supplements one is currently taking.

One should write down likely questions one would like to ask the doctor and write. It is also advisable to take along notepaper and a pen to write down information as the doctor addresses one’s concerns.

For premenstrual syndrome, some questions to ask the doctor include:

  • Is there anything one can do to lessen PMS symptoms?
  • Will the PMS symptoms go away eventually on their own?
  • Could the symptoms one is experiencing indicate a more severe medical condition?
  • Does the doctor recommends treatment for PMS symptoms, and what treatments are available?
  • Is there a generic alternative to the medication the doctor is prescribing?
  • Ask the doctor for any brochures or other printed material that one can take home? Ask the doctor for recommended websites to seek information?
  • It is advisable not to hesitate to ask any other questions that one wants to ask.

What to expect from the doctor

The doctor is likely to ask the patient several questions, such as:

  • The severity of symptoms?
  • The days during the menstrual cycle when symptoms are worst?
  • Do you have symptom-free days during your menstrual cycle?
  • Can you anticipate when your symptoms are coming on?
  • Does anything seem to make your symptoms better or worse?
  • Do your symptoms interfere with your daily activities?
  • Have you recently felt down, depressed, or hopeless?
  • Have you or has anyone in your family been diagnosed with a psychiatric disorder?
  • What treatments have you tried so far? How have they worked?

Long-term outlook

PMS and PMDD symptoms can recur, but they usually go away after menstruation starts. A healthy lifestyle and an all-inclusive treatment plan can lessen or eradicate the symptoms for most women.

There are no distinct physical findings or lab tests to diagnose premenstrual syndrome. The doctor may attribute specific symptoms to PMS if it’s part of one’s predictable premenstrual pattern.

To help establish a premenstrual pattern, the doctor may ask one to document signs and symptoms, the day that one first notice PMS symptoms, as well as the day they disappear for at least two menstrual cycles on a calendar or in a diary. Also, be sure to mark the days the day the period starts and ends.

Certain conditions may have the same symptoms with PMS, including chronic fatigue syndrome, thyroid disorders, and mood disorders, such as depression and anxiety.

The health care provider may recommend tests, such as a thyroid function test or mood screening tests, to help provide a precise diagnosis.

A lot of women all around the world suffer from PMS and as young woman I know how challenging that could be, share your experience down below and drop tips that have been helpful over the years.