Highlights

1. Common symptoms of PMS include anxiety, depression, acne, fatigue, and

headaches.
2. Premenstrual dysphoric disorder (PMDD) causes severe symptoms, such as suicidal
thoughts and insomnia.

Premenstrual syndrome (PMS) is a condition that affects a womans emotions, physical

health, and behavior during certain days of the menstrual cycle, generally just before her
menses. PMS is a very common condition. Its symptoms affect up to 85 percent of
menstruating women. It must impair some aspect of your life for your doctor to diagnose you.

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PMS symptoms start five to 11 days before menstruation and typically go away once
menstruation begins. The cause of PMS is unknown. However, many researchers believe that
its related to a change in both sex hormone and serotonin levels at the beginning of the
menstrual cycle.

Levels of estrogen and progesterone increase during certain times of the month. An increase
in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroids also
modulate activity in parts of your brain associated with premenstrual symptoms.

Serotonin levels affect mood. Serotonin is a chemical in your brain and gut that affects your
moods, emotions, and thoughts.

Risk factors for premenstrual syndrome include:

a history of depression or mood disorders, such as postpartum depression or bipolar

disorder
a family history of PMS
a family history of depression
domestic violence
substance abuse
physical trauma
emotional trauma

Associated conditions include:

dysmenorrhea
major depressive disorder
seasonal affective disorder
generalized anxiety disorder
schizophrenia

Symptoms of PMS
A womans menstrual cycle lasts an average of 28 days. Ovulation, the period when an egg is
released from the ovaries, occurs on day 14 of the cycle. Menstruation, or bleeding, occurs on
day 28 of the cycle. PMS symptoms can begin around day 14 and last until seven days after
the start of menstruation.

The symptoms of PMS are usually mild or moderate. Nearly 80 percent of women report one
or more symptom that does not substantially affect daily functioning, according to the journal
American Family Physician. Twenty to 32 percent of women report moderate to severe
symptoms that affect some aspect of life. Three to 8 percent report PMDD. The severity of
symptoms can vary by individual 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
changes in sleep patterns
anxiety
depression
sadness
emotional outbursts

When to see your doctor

See your doctor if physical pain, mood swings, and other symptoms start to affect your daily
life, or if your symptoms dont go away. The diagnosis is made when you have more than
one recurrent symptom in the correct time frame that is severe enough to cause impairment
and is absent between menses and ovulation. Your doctor must also rule out other causes,
such as:

anemia
endometriosis
thyroid disease
irritable bowel syndrome (IBS)
chronic fatigue syndrome
connective tissue or rheumatologic diseases

Your doctor may ask about any history of depression or mood disorders in your family to
determine whether your symptoms are the result of PMS or another condition. Some
conditions, such as IBS, hypothyroidism, and pregnancy, have symptoms similar to PMS.
Your doctor may do a thyroid hormone test to ensure that your thyroid gland is working
properly, a pregnancy test, and possibly a pelvic exam to check for any gynecological
problems.

Keeping a diary of your symptoms is another way to determine if you have PMS. Use a
calendar to keep track of your symptoms and menstruation every month. If your symptoms
start around the same time each month, PMS is a likely cause.

Easing the symptoms of PMS

You cant cure PMS, but you can take steps to ease your symptoms. If you have a mild or
moderate form of premenstrual syndrome, the treatment options include:

drinking plenty of fluids to ease abdominal bloating

eating a balanced diet to improve your overall health and energy level, which means
eating plenty of fruits and vegetables and reducing your intake of sugar, salt, caffeine,
and alcohol
taking supplements, such as folic acid, vitamin B-6, calcium, and magnesium to
reduce cramps and mood swings
taking vitamin D to reduce symptoms
sleeping at least eight hours per night to reduce fatigue
exercising to decrease bloating and improve your mental health
reducing stress, such as through exercising and reading
going to cognitive behavioral therapy, which has been shown to be effective

You can take pain medication, such as ibuprofen or aspirin, to alleviate muscle aches,
headaches, and stomach cramping. You can also try a diuretic to stop bloating and water
weight gain. Take medications and supplements only as directed by and after speaking with
your doctor.

Severe PMS: premenstrual dysphoric disorder

Severe PMS symptoms are rare. A small percentage of women who have severe symptoms
have premenstrual dysphoric disorder (PMDD). PMDD affects between 3 and 8 percent of
women. This is characterized in the new edition of the Diagnostic and Statistical Manual of
Mental Disorders.

The symptoms of PMDD may include:

depression
thoughts of suicide
panic attacks
extreme anxiety
anger with severe mood swings
crying spells
a lack of interest in daily activities
insomnia
 trouble thinking or focusing
binge eating
painful cramping
bloating

The symptoms of PMDD may occur due to changes in your estrogen and progesterone levels.
A connection between low serotonin levels and PMDD also exists.

Read more: 7 foods that could boost your serotonin

Your doctor may do the following to rule out other medical problems:

a physical exam
a gynecological exam
a complete blood count
a liver function test

They may also recommend a psychiatric evaluation. A personal or family history of major
depression, substance abuse, trauma, or stress can trigger or worsen PMDD symptoms.

Treatment for PMDD varies. Your doctor may recommend:

daily exercise
vitamin supplements, such as calcium, magnesium, and vitamin B-6
a caffeine-free diet
individual or group counseling
stress management classes
drospirenone and ethinyl estradiol tablet (Yaz), which is the only birth control pill the
Food and Drug Administration has approved to treat PMDD symptoms

If your PMDD symptoms still do not improve, your doctor may give you a selective serotonin
reuptake inhibitor (SSRI) antidepressant. This medication increases serotonin levels in your
brain and has many roles in regulating brain chemistry that are not limited to depression.
Your doctor may also suggest cognitive behavioral therapy, which is a form of counseling
that can help you understand your thoughts and feelings and change your behavior
accordingly.

You cant prevent PMS or PMDD, but the treatments outlined above can help reduce the
severity and duration of your symptoms.

Long-term outlook
PMS and PMDD symptoms can recur, but they typically go away after the start of
menstruation. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate
the symptoms for most women.

You asked, we answered

How do PMS symptoms change as a woman approaches perimenopause and
menopause?
As a woman approaches menopause, the ovulatory cycles become sporadic as the
ovarian sex hormone production decreases. The result of this is a heterogeneous and
somewhat unpredictable course of symptoms. Muddying the water is the use of
hormonal therapy to treat some of the symptoms of menopause, like hot flashes,
which can further alter the symptoms. As menopause approaches, women should
consult with their physician if the symptoms change or new symptoms are generated.