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Written By
Dr. Swati Mishra
BDS
Reviewed By
Dr. Rajeev Sharma
MBA, MBBS
Last updated on:
20 Jul 2023 | 04:10 PM (IST)

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Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS)

Also known as Premenstrual syndrome, Ovarian cycle syndrome, and Premenstrual tension

Overview

Premenstrual syndrome, commonly known as PMS is characterized by a set of physical, emotional, and behavioral symptoms that usually occurs a week or two before the menses. 

The physical symptoms of PMS may include breast tenderness, bloating or heaviness in the abdomen, headache, constipation or diarrhea, acne, and muscle pains, while the emotional symptoms may present in the form of restlessness, anxiety, anger, irritability, cravings and mood swings.

While a combination of many factors like hormonal changes, chemical changes in the brain and lifestyle factors are considered to cause PMS, some factors that can increase the risk of PMS symptoms include being overweight or obese, smoking, personal or family history of depression or certain nutritional deficiency of vitamins and minerals.

Lifestyle adjustments can help you reduce or manage the signs and symptoms of PMS. The conservative approaches such as exercise, yoga, and meditation, help in alleviating depressive symptoms. Also, your doctor can help you find ways to relieve your symptoms with the help of certain drugs.

Key Facts

Usually seen in
  • Women between 20 to 30 years of age
Gender affected
  • Women
Body part(s) involved
  • Uterus
Prevalence
  • Worldwide: 47.8% (2020)
Mimicking Conditions
  • Depression
  • Anxiety
  • Perimenopause
  • Chronic fatigue syndrome
  • Irritable bowel syndrome (IBS)
  • Thyroid disease
Necessary health tests/imaging
  • Pelvic exam test
  • Patient record
Treatment
Specialists to consult
  • General physician
  • Gynecologist
  • Psychiatrist 
  • Counselor

Symptoms Of PMS


There are various physical and emotional symptoms associated with PMS. They can also vary from month to month and are sometimes so severe that they affect the daily lives of women. Symptoms usually peak two days before menstruation and disappear within four days of menstruation. Symptoms might include:

Physical symptoms

Worried about what’s to come after PMS? Here are 6 effective ways to manage period pain.

Emotional symptoms

  • Crying

  • Mood swings 

  • Irritability

  • Anger

  • Feelings of tension

  • Disinterest in daily activities

  • Fatigue

  • Feeling overwhelmed or out of control

In some women with PMS, severe, debilitating symptoms occur which can affect the daily routine activities of women, known as premenstrual dysphoric disorder (PMDD). It causes extreme mood shifts such as: 

  • Severe depression

  • Panic attacks

  • Feelings of hopelessness

  • Low self-esteem

  • Anger and irritability

  • Crying spells

  • Suicidal thoughts

Did you know?

Symptoms of PMS are very similar to the symptoms of early pregnancy. Listen to our experts explain PMS better.



Causes Of PMS


The exact cause of PMS is not known. The hormone fluctuations may play a role in developing symptoms of PMS. Some women react more to these fluctuations than others, which can be linked to genetic factors or chemicals released in the brain. The following changes in the hormones that may cause PMS include:

1. Estrogen

The fluctuations in estrogen levels cause mood swings. Studies also suggest that a decreased amount of estrogen stimulates common symptoms of PMS such as insomnia, fatigue, and depression. 

2. Progesterone

PMS is also influenced by the hormone progesterone. Low progesterone levels or progesterone levels falling too rapidly during the second half of the menstrual cycle can lead to PMS symptoms.

3. Serotonin

There is an increase in serotonin precursors between days 7 to 11 and 17 to 19 of the menstrual cycle. This rise in serotonin causes mood swings which is a significant symptom of PMS.

4. Prolactin

Women with PMS symptoms have high levels of prolactin, especially in the premenstrual time. Studies suggest that high prolactin levels clubbed with low levels of progesterone can lead to anxiety and depression. 

Most of the women have a lot of questions about periods. And one of the most common ones is: Are my periods normal? Have a question about periods?


Risk Factors Of PMS


Though the exact cause of PMS is still unknown, there are an array of risk factors that are associated with PMS. They include:

1. Age

PMS is a disease that is linked with menstrual cycles, so it affects women after menarche (the first occurrence of menstruation) till menopause. It is mostly seen between mid 20s to late 30s. 

There are several changes in the woman’s body as she turns 30. So let’s explore what 30s have in store for every woman!


2. Lifestyle factors

There are various lifestyle factors that can increase the chances of PMS.  

  • Diet: Excess intake of sugar, coffee, packaged and processed food is associated with an increased risk of PMS. 

  • Sedentary lifestyle: Some studies also suggest the role of sedentary and inactive lifestyles in PMS. 

  • Poor sleep quality: Inadequate and poor quality sleep predisposes women to PMS. 

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  • Stress: Stress increases menstrual pain by stimulating the body’s response. 

Read to know more about 10 effective tips to manage stress.

  • Alcohol consumption: The drinking of alcohol increases the risk of PMS moderately. 

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3. Hormonal disorders

Some hormonal disorders such as deficiency of serotonin – a chemical produced by the brain that aids in digestion, sleeping, and stabilization of mood increase the risk of developing PMS.

The increase in another female sex hormone progesterone is also seen in women having PMS symptoms. 

4. Family history

Some studies also suggest that women who have a family history of depression are at higher risk of PMS. 

5. Medical history

Women who have a personal history of postpartum depression or other mood disorders are at higher risk of PMS. 

6. Certain vitamin and mineral deficiencies

Low levels of certain vitamins and minerals particularly magnesium, manganese, Vitamin E and Vitamin D also increases the risk of PMS. 

Did you know?
Vitamin deficiency can also affect your hair and nails. There are numerous reasons for brittle hair and nails and one of those is the deficiency of Vitamin B7, commonly known as biotin. Here are some of the common signs of vitamin deficiency you need to be aware of!
Did you know?

Diagnosis Of PMS


PMS cannot be diagnosed by any specific tests and it is determined through symptoms experienced by the individual. Diagnosis of PMS includes the following: 

1. Tracking the symptoms: PMS is diagnosed through tracking the duration, onset and severity of symptoms. Patients are asked to maintain a diary for at least 2 to 3 months.
The patient should keep a record of: 

  • Daily symptoms 
  • Details of the menstrual cycle
  • First and last day of the menstrual period

2. Pelvic exam: It is recommended to check for any other gynecological problems.

Specialist To Visit


Most of the women remain undiagnosed due to lack of knowledge, not reporting, or difficulty in diagnosing the symptoms by the clinician. The specialty of doctor that may help in diagnosing PMS include: 

  • General physician
  • Gynaecologist
  • Psychiatrist
  • Psychologist

A general physician can be the first point of contact for the patient. If required the patient can be referred to a gynecologist who specializes in the disease of the female reproductive system. A psychiatrist and psychologist help in managing the mental aspect of PMS.

When to see a doctor?

The symptoms of PMS should not be ignored. The women should consult the doctor if symptoms : 

  • Starts 5 days before the start of a period for at least three consecutive cycles

  • End within 4 days after a period starts

  • Interfere in normal daily activities

To get the right diagnosis, it is important to consult the right doctor. Consult India’s best doctors online.

Prevention Of PMS


Emotions are a very basic trait of a human being. So, every mood swing or other emotional symptom may not be associated with PMS. It can be part of your behavior as well. To avoid this confusion, symptoms should be discussed with the doctor. 

PMS is not life-threatening but it can impact overall productivity and health. The following Do’s and Don'ts  are helpful in preventing PMS:

Do’s

  • Drink plenty of water and fluids, like coconut water, fruit juices, soups and herbal teas to ease abdominal bloating. 
  • Eat a well-balanced healthy diet containing whole grains, fruits, vegetables, good fats, and protein.

Here’s more on what to have and what to avoid during periods. 

  • Consume nutrition supplements such as calcium, magnesium, omega 3, 6 fatty acid and Vitamin B complex, if required. Do consult your doctor before taking these supplements.

Bridging gaps in daily diet can help deal with PMS symptoms. Explore our wide range of nutritional supplements.

  • Do light, regular exercises, yoga, aerobics, swimming, or jogging for at least 30 minutes a day for physical fitness and overall well-being.

Too lazy to sweat it out?
These tips might help you get your daily dose of physical activity.

  • Get sufficient sleep. A sound sleep of around 8 hours, especially during the premenstrual period, can prevent and reduce the symptoms of PMS. 

  • Bask in the morning sun. Try to get sufficient vitamin D via natural sunlight. Diet or supplements can also be taken to cover any deficiency.

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  • Learn healthy ways to cope with stress. Take a walk in nature, talk to your friends or write in a journal. Deep breathing exercises,  massage, or meditation can come in handy too.

Listen to our specialist about several methods to deal with stress.

  • Consult a doctor, if general care at home is not relieving the symptoms. Sometimes, your doctor can advise medicines to help you manage the symptoms.

Don'ts

  • Do not smoke. Women who smoke report more and worse PMS symptoms than women who do not smoke.

Looking to quit smoking? Try our range of smoking cessation products.

  • Do not consume excessive alcohol. Too much alcohol can exacerbate PMS symptoms and worsen cramps.
  • Do not include excessive salt or salty foods in your diet as they can cause bloating and fluid retention.
  • Do not overindulge in sugar, packaged, ultra-processed foods, and caffeine. They can worsen the symptoms of PMS.


Early to bed, early to rise is not just a proverb!
A few studies have shown that aligning your waking up and sleep time in tune with sunrise and sunset, respectively, holds promise in the management of PMS.

Treatment Of PMS


While mild symptoms can be managed with conservative treatment options including home care remedies, regular exercise, relaxation techniques, vitamin and mineral supplementation, etc, severe symptoms require medical intervention. Various treatment options include:

Medications

  • Painkillers: They help in easing the pain associated with PMS and periods. The common medications include:

  • Antidepressants: Antidepressants are given to ease emotional symptoms. Selective serotonin reuptake inhibitors, or SSRIs are the most commonly prescribed antidepressants. They include: 

Note: SSRIs are taken for two consecutive months to assess their effect. In case of failure of therapy, alternative medication such as Venlafaxine is recommended.
 

  • Birth control pills (oral contraceptives): The hormonal preparations of the birth control pills prevents changes in the hormones. This helps in reducing mood swings. Drugs include:

  • Gonadotropin-releasing hormone agonists: These medications temporarily stop the menstrual cycle by blocking the synthesis of hormones estrogen and progesterone. This helps in improving physical symptoms such as bloating.The common examples include:

  • Diuretics: This class of drug is used to reduce symptoms associated with fluid retention such as bloating and breast tenderness. Spironolactone is a common example diuretic used in PMS.

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Home-care Of PMS


For home care of PMS adhere to all the pointers mentioned in the ‘Prevention’ section. Along with that adding the following to your diet can help in soothing the symptoms of PMS. Do consult your healthcare provider before starting any of the following: 

  • Nutritional supplements such as calcium, magnesium, omega 3, 6 fatty acids, Vitamin B complex, and Vitamin D should be consumed in case of specific deficiencies. 

Bridging gaps in daily diet can help deal with PMS symptoms. Explore our wide range of nutritional supplements.

  • Turmeric (Haldi): Turmeric helps in alleviating stomach cramps due to its anti-inflammatory effect.

Want to know more about the health benefits of turmeric?

  • Fennel (Saunf): Fennel helps in reducing bloating due to its diuretic effect. It is also found to relieve stomach cramps. 

  • Chamomile: This herb has antispasmodic, analgesic, and anti-inflammatory properties. It’s tea relaxes the muscles of the uterus and helps in relieving cramps.

  • Chasteberry extract: This herb is used to manage various hormonal disorders. It is used to get relief from PMS symptoms such as breast tenderness and hot flashes. It reduces the release of prolactin which is a contributory factor of PMS.

  • St. John’s wort: It is a herb that is used to control behavioral symptoms associated with PMS.

  • Ginkgo biloba: It is a well-known herb that has been used for years in Traditional Chinese Medicine. Some studies suggest its role in reducing the severity of PMS symptoms.

Complications Of PMS

PMS can aggravate several clinical conditions such as migraine, mood disorders, asthma, epilepsy, multiple sclerosis, systemic lupus erythematosus (SLE), inflammatory bowel disease, and irritable bowel syndrome.

Untreated PMS can also disturb sexual life which can lead to relationship issues and psychological distress. Other complications of PMS include:

  • Premenstrual Dysphoric Disorder (PMDD): It is the most severe form of PMS that is characterized by intense mood swings, anger, irritability, and anxiety.
  • Depression: The intense symptoms of PMS can also lead to depression. 
  • Substance abuse: It is seen that cravings for substances such as alcohol, drugs, and nicotine increases in PMS.
Did you know? 
COVID-19 can have an impact on your menstrual health. Certain studies suggest COVID-19-associated depression, anxiety, and stress and the high prevalence of PMS. Get the latest updates on COVID-19
Did you know? 

Alternative Therapy For PMS


Along with the general treatment, there are a few complementary therapies that have proven to be beneficial. They include:

Cognitive and behavioral therapy (CBT)

It is helpful to manage moderate to severe physical and emotional symptoms. In this, psychotherapists conduct sessions to normalize the individual's thoughts and behavior. The therapy focuses on memory and judgment to rectify the person’s overall feelings, mood, and behavior. 

Acupuncture

It is a very ancient technique that is used in China and Japan. In this, fine metal needles are inserted into the skin at specific points. This helps in alleviating symptoms of PMS. Sometimes, needles are stimulated by electricity which is known as electro-acupuncture. 

Acupressure

In this, the specific points of the body are stimulated using fingers or thumbs instead of needles. It can be done by the individual itself. 

Relaxation response

This technique is used to reduce stress. It involves methods such as quiet sitting, progressive muscle relaxation, and repetition of a particular word during inhale and exhale.  Practicing for 10-20 minutes daily helps in providing emotional stability. 

Light therapy

Exposure to light plays a very important role in improving mood-related symptoms. During light therapy, the individual is exposed to artificial light that mimics natural light. It stimulates the release of serotonin which elevates the mood. A reduction in symptoms such as depression is shown in women who are continuously exposed to bright light. 

Massage therapy

Massage helps in reducing cramps by relaxing the nervous system. Studies suggest that regular massages help in relieving mood swings and pain.  

Biofeedback

The technique records the responses of the individuals such as heart rate, muscle tension, brain activity, etc after stimulation.  It helps in alleviating physical and emotional symptoms by analyzing the triggers. 

Homeopathy

There are several homeopathic medicines used to calm PMS symptoms. Examples include sepia, Ignatia, pulsatilla, and Lachesis. 

Living With PMS

PMS is not a life-threatening condition, but it can take a toll not just on your body but your mind as well. PMS can be managed well with certain conscious lifestyle modifications. 

The physical and emotional symptoms experienced by women during PMS have a negative impact on relationships also. Emotional support from family, friends, and colleagues helps to cope with PMS symptoms. The following measures can be taken to manage a good relationship:

  • Communicate: Effective communication, especially by the partner helps to reduce the stress experienced by the women during this period.

  • Give space: Sometimes, a woman needs emotional and physical space. This helps the women to tackle the PMS symptoms. 

  • Help: Family members can ease the life of PMS patients by helping them with their routine work such as household chores.

Note: The symptoms of PMS vary from woman to woman. So, it is very important to keep a record of the timings and types of symptoms. This will help to analyze the triggers that may help to lessen the symptoms. 

Remember to prioritize your mental health! Explore our mind care range.

Frequently Asked Questions

References

  1. ACOG,The American College Of Obstetricians and Gynecologists, Last Updated On: May 2021.External Link
  2. OASH, Office On Women’s Health, Last Updated On: February 22, 2022. External Link
  3. Gudipally PR, Sharma GK. Premenstrual Syndrome. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls.External Link
  4. Rad M, Sabzevary MT, Dehnavi ZM. Factors associated with premenstrual syndrome in Female High School Students. J Educ Health Promot. 2018 May 3;7:64.External Link
  5. Ford O, Lethaby A, Roberts H, Mol BW. Progesterone for premenstrual syndrome. Cochrane Database Syst Rev. 2012 Mar 14;2012(3). External Link
  6. Dinh Trieu Ngo V, Bui LP, Hoang LB, Tran MT, Nguyen HV, Tran LM, Pham TT. Associated factors with Premenstrual syndrome and Premenstrual dysphoric disorder among female medical students: A cross-sectional study. Plos one. 2023 Jan 26;18(1):e0278702. External Link
  7. Dutta A, Sharma A. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: A systematic review and meta-analysis. Health Promot Perspect. 2021 May 19;11(2):161-170.External Link
  8. Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.External Link
  9. Reid RL. Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome) [Updated 2017 Jan 23]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Table 1, Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD) External Link
  10. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Premenstrual syndrome: Treatment for PMS. [Updated 2017 Jun 14].External Link
  11. Aolymat I, Khasawneh AI, Al-Tamimi M. COVID-19-Associated Mental Health Impact on Menstrual Function Aspects: Dysmenorrhea and Premenstrual Syndrome, and Genitourinary Tract Health: A Cross Sectional Study among Jordanian Medical Students. Int J Environ Res Public Health. 2022 Jan 27;19(3):1439. External Link
  12. Armour M, Ee CC, Hao J, Wilson TM, Yao SS, Smith CA. Acupuncture and acupressure for premenstrual syndrome. Cochrane Database Syst Rev. 2018 Aug 14;8(8):CD005290. External Link
  13. Chasteberry, NIH, National Center for Complementary and Integrative Health. Last Updated on: July, 2020.External Link
  14. Baker FC, Driver HS. Circadian rhythms, sleep, and the menstrual cycle. Sleep Med. 2007 Sep;8(6):613-22. doi: 10.1016/j.sleep.2006.09.011. Epub 2007 Mar 26. PMID: 17383933. External Link
  15. Shechter A, Boivin DB. Sleep, Hormones, and Circadian Rhythms throughout the Menstrual Cycle in Healthy Women and Women with Premenstrual Dysphoric Disorder. Int J Endocrinol. 2010;2010:259345. doi: 10.1155/2010/259345. Epub 2010 Jan 18. PMID: 20145718; PMCID: PMC2817387. External Link
  16. Abdi F, Ozgoli G, Rahnemaie FS. A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstet Gynecol Sci. 2019 Mar;62(2):73-86. doi: 10.5468/ogs.2019.62.2.73. Epub 2019 Feb 25. Erratum in: Obstet Gynecol Sci. 2020 Mar;63(2):213. PMID: 30918875; PMCID: PMC6422848. External Link
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