Premenstrual syndrome (PMS) – Symptoms and Management

Premenstrual syndrome or PMS is a set of signs and symptoms that most women experience before the onset of menstruation in every cycle. Symptoms are predictable in pattern for every person and may vary from slightly noticeable to very intense. Premenstrual syndrome is experienced by almost 90% of menstruating females affecting them emotionally, physically, and psychologically but can be easily managed by making lifestyle adjustments.

Symptoms of premenstrual syndrome

Every female experience a different set of signs and symptoms, which are classified into psychological and physical;


  • Anxiety and depression
  • A constant feeling of sadness
  • Emotional outbursts and crying spells
  • Irritability
  • Sensory overload
  • Cravings, often for sweets like chocolates
  • Change in sex drive
  • Insomnia
  • Lack of concentration


Every female experience different symptoms and can predict the onset of periods by identifying these.

How long does PMS last before the period?

Symptoms vary in intensity from mild to intense, beginning around one to two weeks before the onset of the period but this is different for every female. Some females might have a shorter or longer span of these but they typically start after ovulation.

Causes of premenstrual syndrome

Even though 90% of menstruating females experience PMS, the doctors still don’t know its exact cause but most studies suggest that fluctuating levels of hormones around the time of menstruation are responsible for these symptoms. The sex hormones also influence the brain chemicals called neurotransmitters, especially serotonin, that are responsible for mood swings. The fluctuations may affect some females more than others and thus different symptoms of varying intensity are experienced by every individual.

Risk factors of PMS

Some females are more prone to get PMS due to the following risk factors:

  • Family history of depression
  • Personal history of postpartum depression or any depressive disorder
  • Physical or emotional trauma
  • Disturbed sleeping pattern
  • Females in late 20s to early 40s
  • Substance abuse
  • High alcohol intake
  • High consumption of salt, sugar, processed foods, or red meat
  • Smoking
  • Menstrual disorders

Conditions associated with PMS

Females who experience premenstrual syndrome may also experience some other disorders like:

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

Premenstrual syndrome and pregnancy

The symptoms experienced by a pregnant female in early pregnancy are very similar to PMS and are often misinterpreted. Some common symptoms are:

  • Nausea
  • Bloating
  • Fatigue
  • Breast tenderness
  • Mood swings
  • Gastrointestinal disturbances

Premenstrual dysphoric disorder or severe PMS

Although it is a rare but life-threatening and serious form of PMS that should be timely diagnosed and addressed. This is characterized by symptoms of premenstrual syndrome in their highest intensity. Some of these include:

  • Suicidal thoughts
  • Crying spells
  • Binge eating
  • Severe anger and extreme anxiety
  • Panic attacks

PMDD is classified as an endocrine disorder that requires proper treatment and therapy in case of severe psychological and behavioral symptoms.

Management of premenstrual syndrome

PMS can be easily managed once the female can identify her symptoms. The syndrome can be easily avoided or the symptoms can be eased down by taking some medicines or making adjustments after a proper diagnosis is made.


Since it is a syndrome there is not a single test to determine, but your doctor will take a detailed history of your symptoms, including their onset and intensity for proper diagnosis. The history is followed by a physical exam, complete blood picture, and hormonal profile to rule out any other similar medical problem and avoid any sort of misdiagnosis. Other than these a psychiatric evaluation to exclude any depressive disorder, substance abuse, or stress is recommended.

Medical treatment:

The treatment of PMS is symptomatic as every person experiences a different manifestation of the condition.

  • Nonsteroidal anti-inflammatory drugs for cramps and breast soreness
  • Hormonal contraceptives to stop ovulation
  • Antiemetics for nausea
  • Antidepressants for depressive disorders
  • Mood enhancers like serotonin for low mood
  • Diuretics for bloating
  • Drospirenone and Ethinyl estradiol is the only FDA-approved contraceptive pill for the treatment of PMDD

Vitamins and other supplements for premenstrual syndrome:

  • According to some studies, certain minerals and vitamins help relieve PMS symptoms.
  • Vitamin B6 for mood disorders and bloating
  • Calcium supplement for appetite changes and fatigue
  • Magnesium for fluid retention and breast tenderness
  • Chaste berry for psychological symptoms and breast tenderness
  • Evening primrose oil

Lifestyle modification and home remedies

  • Hydrate yourself
  • Exercise to decrease the bloating
  • Avoid excessive alcohol or caffeine intake
  • Try therapy and stress management
  • Join support groups for motivation and better insight into your condition
  • Use of hot water bottle for cramps
  • Get adequate sleep
  • Try to eat healthily and avoid any sort of processed food

When to consult a doctor?

Although PMS is a very common condition, but sometimes, symptoms that may appear to be associated with PMS, are indicative of a serious manifestation called PMDD. In such conditions, the symptoms are intense and females face suicidal thoughts, crying spells, fatigue, and debilitating cramps, such females should consult the doctor as soon as possible.


How early does PMS start?

PMS can start as early as two weeks before the onset of your period, right after the ovulation.

Is PMDD a disability?

No, but the high intensity of symptoms experienced by the patient may temporarily affect the ability to perform daily tasks.

What are the worst PMS symptoms?

Any symptom that is affecting your day-to-day life is the worst for you, these can be different for every individual. Some commonly experienced manifestations of PMS are crying spells, anxiety attacks, cramps, and irritability.

How is PMS affected by age?

Females in their late 20s to early 40s experience higher intensity of premenstrual syndrome.

Last medically reviewed on July 31, 2021.