Tender chests, weight gain, a surprise tear shed during a commercial break…
For most of us with menstrual cycles, the upcoming arrival of a period is typically marked by at least one premenstrual symptom — which makes sense when you consider that during this time your uterus is physically metamorphosing from a plush home for a developing fetus into an inflamed evacuation zone for uterine lining.
Although PMS is often used in pop culture to describe any premenstrual symptom, not everyone labels their symptoms as premenstrual syndrome (PMS) — nor should they have to. Premenstrual symptoms are rooted in your biology. However, if your symptoms interfere with your life on a monthly basis, then you might want to learn more about how healthcare providers approach and address PMS.
"Women tend to discount or blame themselves for PMS more than they should. It’s a medical condition and we have treatments and therapies that can help," explains OB-GYN and Modern Fertility medical advisor Dr. Jane van Dis, MD, FACOG. "The most important thing is to start the conversation with your gynecologist or NP."
We wrote this article to get you up to speed on what is currently known about PMS, how it’s treated, and some of the evidence for treating it with different medications, therapies, lifestyle choices, and supplements. All in an effort to arm you with the info you need to feel your best throughout your menstrual cycle.
- Premenstrual syndrome (PMS) lacks a consistent definition, but it's most often marked by premenstrual symptoms that interfere with your daily life.
- Premenstrual symptoms include more than 200 physical and emotional symptoms that are only experienced toward the end of the menstrual cycle.
- Not much is known about what causes PMS. But we do know that it's linked to the change in estrogen and progesterone levels during the luteal phase of the menstrual cycle.
- There are many different medications, therapies, lifestyle habits, vitamins, and supplements that are frequently recommended for treating PMS. Some of them, though, are based on more clinical research than others.
What is PMS?
Despite the fact that some people still hang on to the notion that premenstrual syndrome (PMS) is a cultural phenomenon, it's a very real clinical condition with recommended treatment plans. The definition of PMS centers around a range of premenstrual symptoms (which we'll cover in the next section), that coincide with fluctuations in hormones triggered by the menstrual cycle.
When does PMS end? These symptoms may stop, often abruptly, shortly after menstruation starts.
How long does PMS last? While most of us may have PMS only for a few days, it can also last for the full two-ish weeks between ovulation and menstruation.
What are PMS symptoms?
During the days leading up to a period, we can experience a wide variety of symptoms that impact our bodies, emotions, and/or behaviors. And since each of us is unique, one person’s PMS might be completely different from another’s. In total, more than 200 different premenstrual symptoms have been reported (way too many to list all of them here).
Some of the more common emotional symptoms include:
- Mood swings
- Crying spells
- Difficulty concentrating
- Libido changes
- Sleep pattern disruption
Some of the more common physical symptoms include:
- Weight gain
- Breast/chest tenderness
- Food cravings
- Swelling of the hands or feet
- Body aches and pain
- Skin problems
- Gastrointestinal upset
"For some women, headaches are the worst component and for others, diarrhea and water retention — for still others, mood irritability or insomnia," says Dr. van Dis. "It's important to remember that there is no one 'way' that women experience PMS."
Your version of PMS could include some, all, or none of these symptoms. The only requirement for your symptoms to qualify as a premenstrual symptom is for them to appear in the days leading up to your period and end within a few days of starting your period.
Can PMS symptoms get worse with age?
PMS symptoms may worsen as you get closer to menopause. Since hormone fluctuations might be less predictable later in your "reproductive years," mood changes may follow suit. Lower estrogen levels during menopause can also intensify shifts in mood.
What makes PMS a syndrome?
Having at least one premenstrual symptom, regardless of whether or not that one symptom impacts someone's life, is incredibly common — the prevalence of this is easily 80% or higher. In order to qualify as a syndrome (PMS), though, most experts agree that premenstrual symptoms don’t need to merely exist, but they need to significantly affect a person’s ability to perform their daily activities. Research suggests that the percentage of us who are significantly distressed by these symptoms (in a clinician’s perspective) might be closer to 15%.
There are two other conditions that are closely related to PMS:
- Premenstrual dysphoric disorder (PMDD): Between 2% and 6% of people who get periods have a more severe form of PMS called premenstrual dysphoric disorder (PMDD). Unlike PMS, PMDD requires a diagnosis from a medical professional.
- Premenstrual exacerbation (PME): Many people may also experience premenstrual exacerbation, which is what happens when general health conditions (i.e., asthma, migraines, or mood disorders) affect a person all month long but get worse leading up to a menstrual period. About 50% of migraines in people with ovaries are cycle-related, and period-triggered asthma exacerbation has been reported in up to 40% of asthmatic people with ovaries. Anxiety is also commonly exacerbated by menstruation.
On PMS definitions and prevalence estimates
Estimates of PMS can vary widely depending on how the condition is defined. This especially becomes an issue when trying to understand how common PMS is in different countries — systematic reviews on this topic are challenged by different countries’ definitions of PMS. Here's a good example of this:
- One review reported that the country with the least PMS prevalence was France (12%) while the one with the most was Iran (98%).
- But if you look closer at the data, when the Iranian study narrowed down their PMS definition in the same way the French study did, that 98% statistic decreased to 16%.
Why do some people experience PMS and others don't?
PMS researchers agree that we know very little about what causes the condition. Although PMS is influenced by fluctuating hormone levels, it’s not clearly linked to a deficiency or overabundance of any particular hormone. It also appears to be tied into our brain chemistry through its effect on neurotransmitter signaling (aka chemical messaging for nerve cells), especially for serotonin and GABA.
There are also a number of risk factors that are associated with PMS, although researchers can’t necessarily say that one causes the other. Alcohol consumption, cigarette smoking, stress, depression, and genetics have all been linked to worse PMS symptoms.
Even with all of these theories and associations, we have yet to find an easy, concise answer for the very important question of what causes PMS. We're hoping to see a lot more research here soon.
How is PMS treated?
When it comes to treating premenstrual symptoms, there's no one-size-fits-all solution. Some of the less bothersome symptoms might not need any treatment other than gentle acceptance. Other symptoms might be managed through nutrition and other lifestyle changes. And for those of us who suffer from severe PMS, PMDD, or particularly challenging symptoms, medical intervention might be recommended.
"I do recommend talking to your healthcare provider (doctor or NP) about symptoms that bother you or take away from your quality of life," says Dr. van Dis. This means any symptoms that impact your pain levels, work, sleep, relationships, nutrition, exercise, or general ability to enjoy life.
Below are some of the recommended treatments for PMS you might come across and what the research says about each one.
- Exercise: Most resources (like this one) recommend getting aerobic physical activity on a regular basis as a way to reduce PMS symptoms (and get lots of other potential health benefits). However, a meta-analysis on this topic concluded that the results are highly variable from person to person.
- Nutritional choices: Various studies have shown an association between nutritional choices and PMS symptoms. Namely, Western-style eating (high in calories, fat, sugar, and salt, and low in whole grains) is frequently associated with PMS symptoms — as is alcohol. If you opt for a nutritional approach to manage your PMS, it can help to keep a food diary to determine what works best for your body.
- Stress management: Since stress levels are associated with PMS severity, it’s often recommended to pick up habits and techniques that reduce stress. You could try breathing exercises, meditation, yoga, reading a book, or any number of different relaxing activities. A few small studies have examined the benefits of various techniques — like classical music chakra meditation, for one — but these types of studies can be biased or lack appropriate controls. Ultimately, though, there's no harm in doing things that make you feel more relaxed (even if there isn't a ton of evidence to support their efficacy for treating PMS symptoms).
Vitamins and supplements
- Calcium: The American College of Obstetricians and Gynecologists (ACOG) recommends taking a daily supplement of 1,200 milligrams (mg) of calcium to help reduce both the physical and emotional symptoms of PMS. Numerous studies have observed positive effects from calcium supplementation, and a review of 28 papers on the topic suggested that it’s an inexpensive and low-risk intervention to try.
- Magnesium: Some evidence suggests that a daily dose of 250 mg of magnesium can help reduce premenstrual symptoms, and a number of studies have observed lower levels of magnesium in the red blood cells of PMS sufferers. However, due to some conflicting evidence from other studies, the jury is still out on this supplement.
- Other supplements: Many people take other vitamins and supplements for their premenstrual symptoms — ones that include certain micronutrients or the herb chasteberry. But without more research on the topic, it's difficult to say which supplements might work better than others.
- Cognitive behavioral therapy: While PMS is not purely a mental health disorder, cognitive behavioral therapy (CBT) has an established history of helping improve the symptoms of various somatic, or body-based, diseases. A large number of studies have found that CBT can help improve PMS symptoms, although a more rigorous review of these studies argues that there’s not enough significant evidence to make any conclusions about its effectiveness.
- Alternative therapies: With even fewer studies on different alternative therapies than on cognitive behavioral therapy, there is not currently enough clinically documented evidence for the medical system to recommend alternative therapies to treat PMS. However, on an individual basis, many PMS sufferers do report improvement from acupuncture and other alternative practices. Similar to different relaxation techniques, if you find an alternative therapy that works for you and poses no risks, then go with it!
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Some of PMS’s physical symptoms (like joint pain, tender breasts/chests, and abdominal cramping) can be improved with simple over-the-counter pain relievers (like Ibuprofen or Naproxen).
- Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are a common first-line treatment for PMS symptoms related to mood — a recommendation that's supported by numerous controlled clinical trials. However, depending how you choose to interpret the data, the improvement is somewhere between mild to moderate — which means they might not be worth it for everyone. If you choose to go this route, your healthcare provider can help you troubleshoot which antidepressant to take, as well as whether it’s better for you to take it daily or just in the weeks leading up to your period.
- Diuretics (aka water pills): Diuretics can help manage the discomfort that comes with water retention. Speak with your doctor if you’d like to try a diuretic, and always discuss any potential side effects or interactions with other drugs you're currently taking.
- Hormonal contraceptives and other hormone therapies: Although there's mixed evidence on the effectiveness of treating PMS with drospirenone-containing birth control pills and other hormones, some people recommend these medications to prevent ovulation (and related hormonal fluctuations) as PMS treatment. Although these medications might help reduce premenstrual symptoms, they could also induce worse mood changes for some. It's important to discuss this option with your doctor to see if it's right for you.
Whatever treatment method you decide to take on, tracking your PMS symptoms is important for understanding what improves them and what makes them worse. This information can guide you toward treatments that really work for you and away from things that have the opposite effect.
When is it time to discuss premenstrual symptoms with your healthcare provider?
The Mayo Clinic suggests that you try to manage PMS symptoms yourself with lifestyle changes before seeking medical advice. But if your premenstrual symptoms are disruptive to your daily life, don’t hesitate to discuss them with your healthcare provider (and seek out a second opinion if you need to). The right medical professional can help you determine if you're actually dealing with PMDD and can help you rule out other underlying health issues (like thyroid conditions) that sometimes masquerade as PMS symptoms. They can work with you to sort through the available treatments and research to find the right approach for you.
For those who do take the DIY treatment path, Dr. van Dis' advice is to "avoid supplements or other therapeutics that aren’t FDA-approved, as they have been known to contain ingredients that can be harmful or of no clinical value."
If your premenstrual symptoms are interfering with your life, we hope this article helps you on your search for relief — whether that’s through a simple dose of self-compassion, lifestyle changes, or a medical intervention. Your symptoms are real, and they deserve to be heard.
This article was medically reviewed by Dr. Jane van Dis, MD, FACOG. Dr. van Dis is a practicing OB-GYN, volunteer clinical faculty at USC Keck School of Medicine where she serves on the Gender Equity in Medicine and Science Committee, CEO of Equity Quotient, co-founder of OB Best Practice, and co-founder of TIME'S UP Healthcare.