Premenstrual syndrome (PMS) | Office on Women’s Health

Premenstrual syndrome (PMS) is a combination of symptoms that many women get about a week or two before their period. Most women, over 90%, say they get some premenstrual symptoms, such as bloating, headaches, and moodiness.³ For some women, these symptoms may be so severe that they miss work or school, but other women are not bothered by milder symptoms. On average, women in their 30s are most likely to have PMS.⁴ Your doctor can help you find ways to relieve your symptoms.    

What is PMS?

PMS is a combination of physical and emotional symptoms that many women get after ovulation and before the start of their menstrual period. Researchers think that PMS happens in the days after ovulation because estrogen and progesterone levels begin falling dramatically if you are not pregnant. PMS symptoms go away within a few days after a woman’s period starts as hormone levels begin rising again.

Some women get their periods without any signs of PMS or only very mild symptoms. For others, PMS symptoms may be so severe that it makes it hard to do everyday activities like go to work or school. Severe PMS symptoms may be a sign of premenstrual dysphoric disorder (PMDD). PMS goes away when you no longer get a period, such as after menopause. After pregnancy, PMS might come back, but you might have different PMS symptoms.

Who gets PMS?

As many as three in four women say they get PMS symptoms at some point in their lifetime.⁵ For most women, PMS symptoms are mild.

Less than 5% of women of childbearing age get a more severe form of PMS, called premenstrual dysphoric disorder (PMDD).⁶

PMS may happen more often in women who:

• Have high levels of stress⁷
• Have a family history of depression⁸
• Have a personal history of either postpartum depression or depression^9,10

Does PMS change with age?

Yes. PMS symptoms may get worse as you reach your late 30s or 40s and approach menopause and are in the transition to menopause, called perimenopause.¹¹

This is especially true for women whose moods are sensitive to changing hormone levels during the menstrual cycle. In the years leading up to menopause, your hormone levels also go up and down in an unpredictable way as your body slowly transitions to menopause. You may get the same mood changes, or they may get worse.

PMS stops after menopause when you no longer get a period.

What are the symptoms of PMS?

PMS symptoms are different for every woman. You may get physical symptoms, such as bloating or gassiness, or emotional symptoms, such as sadness, or both. Your symptoms may also change throughout your life.

Physical symptoms of PMS can include:¹²

• Swollen or tender breasts
• Constipation or diarrhea
• Bloating or a gassy feeling
• Cramping
• Headache or backache
• Clumsiness
• Lower tolerance for noise or light

Emotional or mental symptoms of PMS include:¹²

• Irritability or hostile behavior
• Feeling tired
• Sleep problems (sleeping too much or too little)
• Appetite changes or food cravings
• Trouble with concentration or memory
• Tension or anxiety
• Depression, feelings of sadness, or crying spells
• Mood swings
• Less interest in sex

Talk to your doctor or nurse if your symptoms bother you or affect your daily life.

What causes PMS?

Researchers do not know exactly what causes PMS. Changes in hormone levels during the menstrual cycle may play a role.¹³ These changing hormone levels may affect some women more than others.

How is PMS diagnosed?

There is no single test for PMS. Your doctor will talk with you about your symptoms, including when they happen and how much they affect your life.

You probably have PMS if you have symptoms that:¹²

• Happen in the five days before your period for at least three menstrual cycles in a row
• End within four days after your period starts
• Keep you from enjoying or doing some of your normal activities

Keep track of which PMS symptoms you have and how severe they are for a few months. Write down your symptoms each day on a calendar or with an app on your phone. Take this information with you when you see your doctor.

How does PMS affect other health problems?

About half of women who need relief from PMS also have another health problem, which may get worse in the time before their menstrual period. ¹² These health problems share many symptoms with PMS and include:

• Depression and anxiety disorders.These are the most common conditions that overlap with PMS. Depression and anxiety symptoms are similar to PMS and may get worse before or during your period.
• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Some women report that their symptoms often get worse right before their period. Research shows that women with ME/CFS may also be more likely to have heavy menstrual bleeding and early or premature menopause.¹⁴
• Irritable bowel syndrome (IBS). IBS causes cramping, bloating, and gas. Your IBS symptoms may get worse right before your period.
• Bladder pain syndrome. Women with bladder pain syndrome are more likely to have painful cramps during PMS.

PMS may also worsen some health problems, such as asthma, allergies, and migraines.

What can I do at home to relieve PMS symptoms?

These tips will help you be healthier in general, and may relieve some of your PMS symptoms.

• Get regular aerobic physical activity throughout the month.¹⁵ Exercise can help with symptoms such as depression, difficulty concentrating, and fatigue.¹⁶
• Choose healthy foods most of the time.¹⁷ Avoiding foods and drinks with caffeine, salt, and sugar in the two weeks before your period may lessen many PMS symptoms. Learn more about healthy eating for women.
• Get enough sleep. Try to get about eight hours of sleep each night. Lack of sleep is linked to depression and anxiety and can make PMS symptoms such as moodiness worse.¹²
• Find healthy ways to cope with stress. Talk to your friends or write in a journal. Some women also find yoga,¹⁸ massage,¹⁹ or meditation²⁰ helpful.
• Don’t smoke. In one large study, women who smoked reported more PMS symptoms and worse PMS symptoms than women who did not smoke.²¹

What medicines can treat PMS symptoms?

Over-the-counter and prescription medicines can help treat some PMS symptoms.

Over-the-counter pain relievers you can buy in most stores may help lessen physical symptoms, such as cramps, headaches, backaches, and breast tenderness. These include:

• Ibuprofen
• Naproxen
• Aspirin

Some women find that taking an over-the-counter pain reliever right before their period starts lessens the amount of pain and bleeding they have during their period.

Prescription medicines may help if over-the-counter pain medicines don’t work:²²

• Hormonal birth control may help with the physical symptoms of PMS,¹² but it may make other symptoms worse. You may need to try several different types of birth control before you find one that helps your symptoms.
• Antidepressants can help relieve emotional symptoms of PMS for some women when other medicines don’t help. Selective serotonin reuptake inhibitors, or SSRIs, are the most common type of antidepressant used to treat PMS.²³
• Diuretics (“water pills”) may reduce symptoms of bloating and breast tenderness.
• Anti-anxiety medicine may help reduce feelings of anxiousness.

All medicines have risks. Talk to your doctor or nurse about the benefits and risks.

Should I take vitamins or minerals to treat PMS symptoms?

Maybe. Studies show that certain vitamins and minerals may help relieve some PMS symptoms. The Food and Drug Administration (FDA) does not regulate vitamins or mineral and herbal supplements in the same way they regulate medicines. Talk to your doctor before taking any supplement.

Studies have found benefits for:

• Calcium. Studies show that calcium can help reduce some PMS symptoms, such as fatigue, cravings, and depression.^24,25 Calcium is found in foods such as milk, cheese, and yogurt. Some foods, such as orange juice, cereal, and bread, have calcium added (fortified). You can also take a calcium supplement.
• Vitamin B6. Vitamin B6 may help with PMS symptoms, including moodiness, irritability, forgetfulness, bloating, and anxiety. Vitamin B6 can be found in foods such as fish, poultry, potatoes, fruit (except for citrus fruits), and fortified cereals. You can also take it as a dietary supplement.

Studies have found mixed results for:

• Magnesium.²⁴ Magnesium may help relieve some PMS symptoms, including migraines. If you get menstrual migraines, talk to your doctor about whether you need more magnesium. ²⁶ Magnesium is found in green, leafy vegetables such as spinach, as well as in nuts, whole grains, and fortified cereals. You can also take a supplement.
• Polyunsaturated fatty acids (omega-3 and omega-6). Studies show that taking a supplement with 1 to 2 grams of polyunsaturated fatty acids may help reduce cramps and other PMS symptoms.²⁷ Good sources of polyunsaturated fatty acids include flaxseed, nuts, fish, and green leafy vegetables.

What complementary or alternative medicines may help relieve PMS symptoms?

Some women report relief from their PMS symptoms with yoga or meditation. Others say herbal supplements help relieve symptoms. Talk with your doctor or nurse before taking any of these supplements. They may interact with other medicines you take, making your other medicine not work or cause dangerous side effects. The Food and Drug Administration (FDA) does not regulate herbal supplements at the same level that it regulates medicines.

Some research studies show relief from PMS symptoms with these herbal supplements, but other studies do not. Many herbal supplements should not be used with other medicines. Some herbal supplements women use to ease PMS symptoms include:

• Black cohosh.²⁸ The underground stems and root of black cohosh are used fresh or dried to make tea, capsules, pills, or liquid extracts. Black cohosh is most often used to help treat menopausal symptoms,²⁹ and some women use it to help relieve PMS symptoms.
• Chasteberry .³⁰ Dried ripe chasteberry is used to prepare liquid extracts or pills that some women take to relieve PMS symptoms. Women taking hormonal birth control or hormone therapy for menopause symptoms should not take chasteberry.
• Evening primrose oil. The oil is taken from the plant’s seeds and put into capsules. Some women report that the pill helps relieve PMS symptoms, but the research results are mixed. ²⁹

Researchers continue to search for new ways to treat PMS. Learn more about current PMS treatment studies at clinicaltrials.gov.

Did we answer your question about PMS?

For more information about PMS, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:

• Premenstrual Syndrome (PMS) — Information from the American Congress of Obstetricians and Gynecologists
• Premenstrual Syndrome — Information from the National Library of Medicine

Sources

1. Freeman, E., Halberstadt, M., Sammel, M. (2011). Core Symptoms That Discriminate Premenstrual Syndrome. Journal of Women’s Health; 20(1): 29–35.
2. Dennerstein, L., Lehert, P., Bäckström, T.C., Heinemann, K. (2009). Premenstrual symptoms—severity, duration and typology: an international cross-sectional study. Menopause International; 15: 120–126.
3. Winer, S. A., Rapkin, A. J. (2006). Premenstrual disorders: prevalence, etiology and impact. Journal of Reproductive Medicine; 51(4 Suppl):339-347.
4. Dennerstein, L., Lehert, P., Heinemann, K. (2011). Global study of women’s experiences of premenstrual symptoms and their effects on daily life. Menopause International; 17: 88–95.
5. Steiner, M. (2000). Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. Journal of Psychiatry and Neuroscience; 25(5): 459–468.
6. Potter, J., Bouyer, J., Trussell, J., Moreau, C. (2009). Premenstrual Syndrome Prevalence and Fluctuation over Time: Results from a French Population Survey. Journal of Women’s Health; 18(1): 31–39.
7. Gollenberg, A.L., Hediger, M.L., Mumford, S.L., Whitcomb, B.W., Hovey, K.M., Wactawski-Wende, J., et al. (2010). Perceived Stress and Severity of Perimenstrual Symptoms: The BioCycle Study. Journal of Women’s Health; 19(5): 959-967.
8. Endicott, J., Amsterdam, J., Eriksson, E., Frank, E., Freeman, E., Hirschfeld, R. et al. (1999). Is premenstrual dysphoric disorder a distinct clinical entity? Journal of Women’s Health & Gender-Based Medicine; 8(5): 663-79.
9. Richards, M., Rubinow, D.R., Daly, R.C., Schmidt, P.J. (2006). Premenstrual symptoms and perimenopausal depression. American Journal of Psychiatry; 163(1): 133-7.
10. Bloch, M., Schmidt, P.J., Danaceau, M., Murphy, J., Nieman, L., Rubinow, D.R. (2000). Effects of gonadal steroids in women with a history of postpartum depression. American Journal of Psychiatry; 157(6): 924-30.
11. Pinkerton, J.V., Guico-Pabia, C.J., Taylor, H.S. (2010). Menstrual cycle-related exacerbation of disease. American Journal of Obstetrics and Gynecology; 202(3): 221-231.
12. American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS).
13. Dickerson, L., Mazyck, P., Hunter, M. (2002). Premenstrual Syndrome. American Family Physician; 67(8): 1743–1752.
14. Boneva, R. S., Lin, J. M., & Unger, E. R. (2015). Early menopause and other gynecologic risk indicators for chronic fatigue syndrome in women. Menopause, 22, 826–834.
15. El-Lithy, A., El-Mazny, A., Sabbour, A., El-Deeb, A. (2014). Effect of aerobic exercise on premenstrual symptoms, haemotological and hormonal parameters in young women. Journal of Obstetrics and Gynaecology; 3: 1–4.
16. Aganoff, J. A., Boyle, G. J. (1994). Aerobic exercise, mood states and menstrual cycle symptoms. Journal of Psychosomatic Research; 38: 183–92.
17. Kaur, G., Gonsalves, L., Thacker, H. L. (2004). Premenstrual dysphoric disorder: a review for the treating practitioner. Cleveland Clinic Journal of Medicine; 71: 303–5, 312–3, 317–8.
18. Tsai, S.Y. (2016). Effect of Yoga Exercise on Premenstrual Symptoms among Female Employees in Taiwan. Int J Environ Res Public Health; 13(7).
19. Hernandez-Reif, M., Martinez, A., Field, T., Quintero, O., Hart, S. , Burman, I. (2000). Premenstrual symptoms are relieved by massage therapy. J Psychosom Obstet Gynaecol; 21(1):9-15.
20. Arias, A. J., Steinberg, K., Banga, A., Trestman, R. L. (2006). Systematic review of the efficacy of meditation techniques as treatments for medical illness. Journal of Alternative and Complementary Medicine; 12(8):817-32.
21. Dennerstein, L., Lehert, P., Heinemann, K. (2011). Global epidemiological study of variation of premenstrual symptoms with age and sociodemographic factors. Menopause International; 17(3): 96–101.
22. Rapkin A. (2003). A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder. Psychoneuroendocrinology; Suppl 3:39-53.
23. The Medical Letter. (2003). Which SSRI?. Med Lett Drugs Ther; 45(1170):93-5. 
24. National Institute for Health Research, U.K. (2008). Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy.  
25. Ghanbari, Z., Haghollahi, F., Shariat, M., Foroshani, A.R., Ashrafi, M. (2009). Effects of calcium supplement therapy in women with premenstrual syndrome. Taiwanese Journal of Obstetrics and Gynecology; 48(2): 124–129.
26. Office of Dietary Supplements. (2016). Magnesium. 
27. Rocha Filho, F., Lima, J.C., Pinho Neto, J.S., Montarroyos, U. (2011). Essential fatty acids for premenstrual syndrome and their effect on prolactin and total cholesterol levels: a randomized, double blind, placebo-controlled study. Reproductive Health; 8: 2. doi: 10.1186/1742-4755-8-2.
28. Johnson, T. L., Fahey, J. W. (2012). Black cohosh: coming full circle? Journal of Ethnopharmacolgy, 141(3): 775-9. doi: 10.1016/j.jep.2012.03.050.
29. Dietz, B. M., Hajirahimkhan, A., Dunlap, T. L., Bolton, J. L. (2016). Botanicals and their bioactive phytochemicals for women’s health. Pharmacological Reviews, 68(4): 1026-1073. doi: https://doi.org/10.1124/pr. 115.010843.
30. Girman, A., Lee, R., Kligler, B. (2003). An integrative medicine approach to premenstrual syndrome. American Journal of Obstetrics and Gynecology, 188 (5), S56–S65.

All material contained on these pages are free of copyright restrictions and maybe copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated.

Page last updated:
February 22, 2021

What it is, symptoms, and treatments

Premenstrual syndrome (PMS) refers to the physical and psychological symptoms that a person may experience before their menstrual period. These can include bloating, headaches, mood changes, and more.

Headaches, bloating, cramps, and mood swings are among the most common PMS symptoms. For some, these symptoms are a minor inconvenience. For others, the symptoms can be so severe that they miss work or school.

Most females experience some degree of PMS. In fact, over 90% report experiencing PMS symptoms in the week or two before their period.

In this article we look at PMS, including its symptoms, causes, treatments, and tips for coping. We also discuss when a person should see a doctor about their symptoms.

PMS refers to the diverse range of physical and psychological symptoms that people experience before their menstrual period.

The exact cause of PMS remains unknown. However, natural fluctuations in hormone levels, especially those of estrogen and progesterone, in the week or two before menstruation are likely responsible for the symptoms.

Estrogen and progesterone levels decrease dramatically after ovulation. This could play a major role in the development of PMS symptoms.

The drop in estrogen levels may affect a person’s serotonin levels. Serotonin is a brain chemical that helps regulate mood, sleep, and appetite, all of which PMS affects.

Severe or debilitating PMS symptoms are not common, and they may indicate the presence of an underlying health condition. Speak to a doctor about any severe PMS symptoms.

Image credit: Stephen Kelly, 2019.

PMS symptoms range from mild to severe. Some people get their periods without experiencing any PMS symptoms at all.

For other people, however, PMS symptoms can significantly affect their ability to perform regular activities and may even reduce their quality of life.

Physical symptoms of PMS can include:

• changes in appetite, such as food cravings
• tender or swollen breasts
• weight gain
• abdominal bloating
• pain in the lower abdomen or menstrual cramps
• constipation or diarrhea
• headaches
• fatigue
• oily skin
• acne, pimple breakouts, and other skin symptoms

Psychological symptoms of PMS can include:

• low mood
• feeling tearful or crying
• irritability or anger
• depression
• increased anxiety
• mood swings
• social withdrawal
• problems sleeping, such as insomnia
• difficulty concentrating
• decreased libido

In PMS, people may also notice that the symptoms of conditions such as diabetes, depression, and inflammatory bowel syndrome worsen.

Also, age can affect the severity of PMS. During perimenopause, which is the transitional period leading up to menopause, people may experience worsening PMS symptoms.

Share on PinterestA person who experiences severe PMS symptoms should speak to a doctor.

People may not realize straight away that their symptoms are related to menstruation, especially if they have an irregular cycle.

Keeping a diary of when symptoms occur can help a person notice patterns. If symptoms occur at roughly the same time each month, or at the same stage in a person’s menstrual cycle, they may be due to PMS. If not, the symptoms may have another cause.

Severe or debilitating PMS symptoms are not common. Speak to a doctor if PMS symptoms get in the way of daily life. In some cases, severe symptoms may indicate premenstrual dysphoric disorder (PMDD) or another medical condition.

Some conditions affecting the reproductive system, such as endometriosis and polycystic ovary syndrome, can cause severe PMS. A doctor can help treat these conditions and reduce a person’s symptom frequency and severity.

People may want to consider seeing a doctor if their PMS symptoms do not improve after trying over-the-counter (OTC) medications, home remedies, or lifestyle changes.

Sometimes, taking hormonal contraception can give rise to PMS-like symptoms. This is because these drugs change the levels of hormones in the body.

These symptoms may be less predictable depending on the type of contraception a person is using. People may notice their symptoms get better after they change birth control.

Estimates for how common PMS is vary.

The Office of Women’s Health explain that over 90% of females report experiencing some PMS symptoms.

A 2017 study into premenopausal females reported that although 75% experience at least one PMS symptom, only 8–20% meet the clinical criteria for a diagnosis of PMS.

According to the American College of Obstetricians and Gynecologists, a healthcare provider will make a clinical diagnosis of PMS when:

• symptoms interfere with daily activities
• symptoms appear 5 days before the period starts and end 4 days within it starting
• symptoms occur for at least 2–3 months

A smaller number of people experience a severe form of PMS called PMDD.

Treatment options for PMS vary depending on a person’s specific symptoms.

People can manage PMS symptoms by taking medications, making dietary changes, exercising, trying self-care methods, and making other lifestyle changes.

Medication

Taking OTC and prescription medication can help relieve painful symptoms, such as abdominal cramps and headaches.

Examples of medication that people take to treat PMS include:

• pain relievers such as acetaminophen, which can help relieve muscle pain, cramps, and headaches
• nonsteroidal anti-inflammatory drugs, which can reduce cramp pain, headaches, and muscle aches
• diuretics, which can help relieve bloating and breast soreness

For severe PMS symptoms, a doctor may recommend that a person starts taking hormonal birth control pills to reduce PMS symptoms. These drugs work by affecting the levels of estrogen and progesterone in the body.

Speak to a doctor about severe PMS. They may prescribe medications to relieve depression, anxiety, or other mood-related symptoms.

Use relaxation techniques

Share on PinterestGentle exercise, such as walking and stretching, can help ease PMS symptoms.

Managing stress and using relaxation techniques, such as deep breathing or meditation, can help regulate emotional imbalances due to PMS.

Other examples of stress management and relaxation techniques include:

• yoga
• tai chi
• stretching
• taking a bath
• going for a walk
• journaling
• speaking with a close friend or loved one
• meeting with a mental health counselor or therapist

Try gentle exercise

Exercising gently can increase estrogen and progesterone levels, which may help reduce PMS symptoms.

A 2018 study involving college-age females found that 1.5 hours of aerobic exercise each week led to improvements in the following physical PMS symptoms:

• nausea
• constipation or diarrhea
• swelling of breasts
• bloating
• flushing
• increased appetite

It is worth noting that uncontrolled external factors, such as sleep patterns, nutrition, and the participants’ living environments, could have affected these results.

In contrast, the results of a 2017 cross-sectional study did not find a significant association between physical activity and improvements in PMS symptoms.

Relieve bloating

Bloating can make a person feel heavy and lethargic. People can reduce PMS-related bloating by:

• not eating salty foods, which make bloating worse
• eating potassium-rich foods, such as bananas
• staying hydrated
• doing gentle exercise

Learn more about how to relieve menstrual bloating here.

Relieve menstrual cramps

Menstrual cramps usually arise a few days before the period starts and can last for several days. Trying home remedies such as applying heat to the abdomen, doing gentle exercise, trying massage, and using essential oils can help.

Learn more about how to relieve menstrual cramps here.

Eat certain nutrients

Making some dietary changes may reduce mild to moderate PMS symptoms. The following are some examples of nutrients that may help a person manage their PMS symptoms:

• Magnesium may help relieve migraine episodes related to PMS. Leafy green vegetables, such as kale and spinach, contain magnesium.
• Fatty acids may help reduce abdominal cramps related to PMS. Good sources include fish, nuts, and green vegetables.
• Calcium supports bone strength and density. Having adequate calcium levels also helps regulate mood, sleep, and food cravings. A 2017 double-blind trial study reported that college-age females who consumed 500 milligrams of calcium daily for 2 months had significant reductions in depression, anxiety, and water retention related to PMS.

Most females experience at least one symptom of PMS. Fluctuations in hormone levels might play a significant role in PMS, but the exact cause remains unknown.

A small percentage of people can develop a severe form of PMS called PMDD.

Taking OTC pain relievers, making appropriate dietary changes, and managing stress may all help reduce PMS symptoms.

People may wish to see their doctor if symptoms do not improve, if they worsen despite treatment, or if they interfere with their ability to perform daily tasks.

Premenstrual syndrome (PMS) – causes, what diseases it occurs in, diagnosis and treatment

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Premenstrual syndrome: causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Definition

Tearfulness, irritability, unreasonable anger (according to others), pain in the abdomen and lower back, feeling of melancholy and anxiety, headache, swelling – these and many other symptoms are associated with the development of premenstrual syndrome, or PMS. Is PMS a condition that needs to be treated?

Premenstrual syndrome is a complex of pathological symptoms that includes a variety of psycho-emotional, somatovegetative and metabolic-endocrine manifestations that begin during the luteal phase of the cycle, which lasts approximately 14 days before the onset of menstruation, and disappears in its first days.

Thus, all the symptoms of PMS can appear both immediately after ovulation, and one or two days before the start of the next menstruation.

Varieties of PMS

Depending on what symptoms prevail in the manifestation of premenstrual syndrome, the following forms are distinguished:

• edematous;
• cephalgic;
• crisis;
• neuropsychiatric;
• atypical.

The edematous form of PMS is characterized by swelling of the face, legs, fingers, and associated weight gain. Possible manifestations such as engorgement of the mammary glands, sweating, pruritus and functional bowel disorders (constipation, diarrhea, increased flatulence). All of these symptoms disappear at the onset of menstruation and rarely require medical attention.

The cephalgic form of PMS is characterized by severe headaches, often unilateral, throbbing, aggravated by movement. Such pains are accompanied by irritability, hypersensitivity to smells, aggression, nausea, pain in the heart area. The cephalgic form of PMS occurs in women who have suffered a traumatic brain injury or neuroinfection, as well as those suffering from arterial hypertension and other cardiovascular diseases. The pain disappears at the end of the luteal phase of the menstrual cycle.

The crisis form of PMS is characterized by a predominance of sympathoadrenal crises (something similar to panic attacks), accompanied by an increase in blood pressure, increased heart rate, pain in the heart area without changes in the ECG. Such attacks may result in increased urination.

The neuropsychic form of PMS includes a number of symptoms that a woman usually does not pay attention to. They regularly appear before the onset of menstruation and are a reason for consulting a doctor: irritability, tearfulness, insomnia, aggression, depression, fatigue, sexual disturbances, suicidal thoughts and various hallucinations.

The neuropsychic form often co-occurs with other forms, especially in severe cases of PMS.

The atypical form of PMS is rare, passes under the guise of other diseases – bronchial asthma, ulcerative gingivitis or stomatitis, iridocyclitis, myocardiopathy.

According to the severity of the course, a mild form of PMS is distinguished – 2–10 days before menstruation, up to four symptoms appear, while up to two symptoms are expressed to a significant extent.

In severe PMS, more than five symptoms appear 3 to 14 days before the onset of menstruation, and many of them are severe.

Possible causes of premenstrual syndrome

The incidence of PMS depends on the age of the woman. If at the age of 30 years, symptoms of PMS occur only in 20% of women, then after 30 years, PMS occurs in almost every second woman.

Emotionally labile women, asthenic physique, often with a lack of body weight are predisposed to the development of premenstrual syndrome.

Other risk factors for developing PMS include:

• frequent stressful situations at home and at work;
• complicated childbirth;
• history of abortion;
• surgical interventions;
• neuroinfections;
• frequent change of climatic zones;
• the presence of chronic gynecological diseases.

According to modern data, a change in sensitivity to the hormone progesterone is of decisive importance in the development of negative symptoms. The role of the trigger mechanism in the onset of PMS is played by the normal change in the level of sex hormones during the menstrual cycle. In the second half of the cycle (luteal phase), progesterone has the main effect on the woman’s body.

Progesterone indirectly affects the dynamic change in the level of serotonin secretion. It is this system that provides the regulation of mood at the level of neurons.

It is believed that in the luteal phase of the menstrual cycle, there is an increase in the processing time of negative emotions in the structures of the brain and a decrease in control over the level of expression of emotions.

Another mechanism that affects the change in the level of serotonin in the brain is constant stress, prolonged experiences of unresolved conflict situations, fear, expectation of real or imaginary events. Anxiety in most cases increases appetite, and “jamming in a bad mood” leads to the development of flatulence and other dyspeptic disorders (constipation and diarrhea), which contributes to the course of premenstrual syndrome.

Hereditary predisposition plays a huge role in the development of PMS.

Which doctors to contact for PMS

If the manifestations of PMS prevent you from leading a full social and personal life, to solve this problem, you should turn to
gynecologist.

It is important to exclude the presence of other somatic pathology that may worsen the course of the second phase of the menstrual cycle. For this you need to contact
therapist. If necessary, the doctor will refer you to the necessary laboratory and instrumental examinations and consultations of narrow specialists.

If the organic cause of the disease is not found, it is necessary to consult a psychiatrist to determine tactics to overcome anxiety and other stressful conditions.

Diagnostics and examinations for PMS

During the diagnosis of premenstrual syndrome, an important role is played by the patient’s diary for several cycles.

It notes all the symptoms of PMS, their severity in points from 0 to 10.
In the course of exclusion of somatic and neuroendocrine pathology, a complex of laboratory and instrumental diagnostics is performed depending on the symptomatic picture.

• Hormonal blood test: follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone, estradiol, adrenocorticotropic hormone (ACTH), thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH).

Follicle Stimulating Hormone (FSH)

Synonyms: Blood test for FSH; Follitropin. Follicle-Stimulating Hormone; follitropin; FSH.

Brief description of the analyte Follicle-stimulating hormone

…

Up to 1 working day

Available with house call

715 RUB

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Luteinizing Hormone (LH)

Synonyms: Glycoprotein gonadotropic hormone; luteotropin; Lutropin. luteinizing hormone; LH; Lutropin; Interstitial cell stimulating hormone; ICSH.

Brief description of the determined …

Up to 1 working day

Available with house call

715 RUB

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Prolactin (+ additional macroprolactin test if prolactin result is above 700 mU/l)

Synonyms: Prolactin blood test; Lactotropic hormone; lactogenic hormone; Mammotropin; mammotropic hormone. lactotropin; PRL; luteotropic hormone; LTH.
Short description …

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715 RUB

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Testosterone

Testosterone is the main androgenic hormone. The test is used in the diagnosis of disorders of sexual development and hypogonadism in men; cycle disorders, infertility, virili…

Up to 1 working day

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715 RUB

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Estradiol (E2, Estradiol)

Synonyms: Blood test for estradiol. 17-beta-estradiol.
Brief description of the analyte Estradiol
Estradiol is a steroid hormone with maximum estrogen. ..

Up to 1 working day

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715 RUB

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ACTH (Adrenocorticotropic hormone, corticotropin, Adrenocorticotropic Hormone, ACTH)

Adrenocorticotropic hormone is a pituitary hormone that regulates the production of glucocorticoids in the adrenal cortex.

Synonyms: Blood test for ACTH; Address…

Up to 1 business day

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RUB 1,125

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Free thyroxine (Free T4, Free Thyroxine, FT4)

Free thyroxine not bound to blood plasma transport proteins.
Synonyms: Blood test for free thyroxine. Free T4; Free Form of Thyroxin.
Short description …

Up to 1 business day

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665 RUB

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Free triiodothyronine (Free T3, Free Triiodthyronine, FT3)

Synonyms: Free triiodothyronine.
Free T3.
Brief description of the test substance Triiodothyronine free
Free triiodothyronine (T3free) belongs to the thyroid …

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RUB 685

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Thyroid Stimulating Hormone (TSH)

A pituitary hormone that regulates thyroid function. One of the most important tests in the laboratory diagnosis of thyroid diseases.

Synonym…

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620 RUB

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Glucose (in the blood) (Glucose)

Research material

Serum or blood plasma. If it is not possible to centrifuge the sample 30 minutes after collection for serum/plasma separation…

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335 RUB

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Cholesterol total (cholesterol, Cholesterol total)

Synonyms: Cholesterol, cholesterol. Blood cholesterol, Cholesterol, Chol, Cholesterol total.
Brief characteristics of the analyte Total cholesterol
Approximately 80% of total cholesterol is synthetic…

Up to 1 working day

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370 RUB

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Cholesterol – VLDL (VLDL Cholesterol, VLDL Cholesterol)

Synonyms: Very low density lipoprotein cholesterol;
Very Low Density Lipoprotein; VLDL; Very low density lipoproteins.
Brief characteristics of analyte Cholesterol – LPO…

Up to 1 working day

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420 RUB

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LDL Cholesterol (Low Density Lipoprotein Cholesterol, LDL, Cholesterol LDL)

Synonyms: LDL; Low density lipoproteins; LDL; LDL cholesterol; Low density lipoprotein cholesterol; Cholesterol beta-lipoproteins; Beta lipoproteins; Beta LP.
…

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370 RUB

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HDL Cholesterol (HDL Cholesterol)

Synonyms: High density lipoproteins; HDL; HDL; HDL cholesterol; alpha cholesterol; α-cholesterol. High density lipoprotein cholesterol; high density lipoprotein; Alpha-Lipoprotein Cholesterol; α-lipoprotein cholesterol; α-Lp c…

Up to 1 working day

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400 rub

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Glycated hemoglobin (HbA1С, Glycated Hemoglobin)

Synonyms: Blood test for glycated hemoglobin. Glycohemoglobin; HbA1c; Hemoglobin A1c; A1c; HgbA1c; Hb1c.

Brief characteristics of the analyte Glycated hemo…

Up to 1 working day

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820 RUB

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Ultrasound of the mammary glands and regional lymph nodes

Informative study for the diagnosis of neoplasms and determining the involvement of lymph nodes in the pathological process.

RUB 2,490

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Magnetic resonance imaging of the brain and adrenal glands.

Brain MRI

Safe and informative scanning of brain structures for diagnosing its pathologies.

RUB 5,640

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MRI of the lumbosacral spine

Diagnostic examination to determine the pathology of the lumbosacral spine and surrounding tissues.

RUB 5,990

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What to do with PMS

Prevention and reduction of the severity of premenstrual syndrome is based on a change in habitual lifestyle and vitamin therapy.

If possible, it is necessary to exclude stressful situations, sudden changes in climate, the use of combined oral contraceptives.

In addition, caffeine and alcohol should not be abused, it is also advisable to eat small meals throughout the day. To prevent irritability and fatigue, it is recommended to take vitamins B6 and E, magnesium, calcium.

PMS treatment

To reduce the level of anxiety that causes an increase in appetite (“stress eating”), leading, in turn, to dyspepsia, it is recommended to follow a diet aimed at increasing the content of serotonin.

Products with a large amount of tryptophan help in solving this issue: yogurt, cheese, cottage cheese, bananas, mushrooms, dates.

It is also important to observe the rest regime, because a tired person is more sensitive to external stimuli and is capable of inadequate reactions in response to exposure.

Other non-pharmacological methods of treatment include various types of massage, physiotherapy, reflexology and spa treatment.

To relieve stress, aerobic exercise for 20-30 minutes 3 times a week is recommended in the absence of contraindications.

In some difficult cases, and after conducting the necessary studies, the doctor may prescribe hormone therapy with progesterone or estrogen-gestagen preparations. Also, with some forms of PMS, the use of antidepressants and psychotherapy methods is recommended.

Sources:

1. Yakovleva E.B., Babenko O.M., Pilipenko O.N. Premenstrual syndrome. Emergency Medicine, journal. No. 3 (58), 2014, pp. 159-163.
2. Gulieva L.P., Yureneva S.V. Premenstrual syndrome: clinic, diagnosis and therapeutic approaches. Medical Council, journal. No. 2, 2017. P. 106-111.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories can use different research methods and units of measurement to perform the same analyzes.

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What is PMS (premenstrual syndrome)? Premenstrual syndrome (PMS) can manifest itself in a number of neuropsychiatric, metabolic-endocrine or vegetative-vascular disorders, and in each patient the symptoms of PMS are individual.

According to statistics, premenstrual syndrome (PMS) affects, according to various sources, from 50 to 80% of all women on the planet. Many of them are in a fairly mild form, in which there is no need to see a doctor. However, you need to know that over time and under appropriate circumstances, PMS can progress, so if you experience any pain or nervous breakdowns before your period, try not to let the situation worsen.

In general, PMS most often affects women aged 20 to 40 years, there are fewer cases of premenstrual syndrome along with the onset of menarche and even less often in the premenopausal period.

Symptoms of PMS (premenstrual syndrome) .

Gynecologists, specialists in this field, say that there are about 150 symptoms of premenstrual syndrome (PMS), which, moreover, occur in different combinations. However, the most common of them are the following: a small increase in body weight, pain in the lumbar region and in the pelvic organs, bloating, nausea, roughness and tenderness of the mammary glands, increased fatigue, irritability, insomnia or, in some cases, on the contrary, excessive sleepiness.

Most young women say that in the days before menstruation, they often experience not only physical but also emotional and psychological discomfort. Many experience bouts of unreasonable aggression, inadequate behavioral reactions, tearfulness, and a quick change of mood can be observed. At the same time, it has been noticed that some women unconsciously experience the fear of the onset of PMS and menstruation, and therefore become even more irritable and withdrawn, even before this period.

At one time, studies were carried out aimed at clarifying the effect of PMS on the activity and working capacity of a woman. Their results were very disappointing. So, the last few days of the menstrual cycle account for about 33% of cases of acute appendicitis, 31% of acute viral infections and respiratory diseases, about 25% of women are hospitalized during this period. 27% of women during the premenstrual syndrome begin to take tranquilizers or some other drugs that affect the neuropsychic state, which also negatively affects both the future state of health and the ability to work.

In clinical practice, four most common forms of premenstrual syndrome are distinguished: . Moreover, the latter, as a rule, prevails in young girls, while slightly older women are more likely to be depressed and melancholy.

The second – edematous form of PMS is coarsening, swelling and soreness of the mammary glands, swelling of the face, legs and hands, sweating. With this form of PMS, sensitivity to odors is sharply expressed, and a change in taste sensations is possible. Many women suffering from this type of premenstrual syndrome believe that the cause of such conditions is respiratory or viral infections and seek help from a therapist. Meanwhile, gynecologists recommend that you carefully observe yourself and, if symptoms occur only before the onset of menstruation, visit a gynecologist. In this case, only he will be able to prescribe the appropriate treatment for you.

The third form of PMS is called cephalgic . With this form of PMS, a woman experiences headaches, nausea, sometimes vomiting, and dizziness. Approximately one third have pain in the heart and a depressed psychological state. If in this situation a craniocerebral x-ray is performed, an increase in the vascular pattern can be seen in combination with hyperostosis (overgrowth of the bone layer). In addition, the amount of calcium in a woman’s body changes, which can lead to fragility and brittle bones.

And, finally, the last, so-called crisis form of premenstrual syndrome (PMS), manifests itself in the appearance of adrenaline crises, which begin with a feeling of pressure under the chest and are accompanied by a significantly increased heart rate, numbness and coldness of the hands and feet. Frequent and copious urination is possible. In addition, half of the women say that during such crises they experience a greatly aggravated fear of death, which negatively affects their mental and emotional state.

The crisis form of PMS is the most severe and requires mandatory medical intervention. However, it does not occur on its own, but is a consequence of the untreated previous three forms. Therefore, with any negative symptoms and a deterioration in general health in the days preceding menstruation, it is best to contact a gynecologist, as only he can determine how serious the situation is and prescribe the necessary treatment.

Causes of PMS (premenstrual syndrome).

For several decades, medical scientists have been trying to find out the causes and factors that lead to the occurrence of premenstrual syndrome. To date, there are several theories, but none of them is able to explain all the symptoms that accompany PMS.

The hormonal theory is still considered the most complete , according to which premenstrual syndrome is a consequence of an imbalance of estrogen and progesterone in a woman’s body. The most substantiated within this theory is the point of view that speaks of hyperestrogenism (an excess of estrogens). The action of these hormones is such that in large quantities they contribute to fluid retention in the body, which, in turn, causes swelling, swelling and soreness of the mammary glands, headache, and exacerbation of cardiovascular problems. In addition, estrogens can accumulate in the limbic system of the body, affecting the neuro-emotional state of a woman. Hence – depressive or aggressive states, irritability, etc.

Another theory – theory of water intoxication – says that the symptoms of PMS are manifested in violation of the water-salt exchange of fluid in the body. In addition, there is an opinion that PMS is a consequence of beriberi, in particular, a lack of vitamins B6, A, magnesium, calcium, zinc. However, this has not yet been fully tested in practice, although in some cases vitamin therapy has a positive result in the treatment of PMS. Also, some doctors talk about the genetic factor in the development of premenstrual syndrome.

Gynecologists and gynecologists-endocrinologists are of the opinion that premenstrual syndrome is based not on any one cause, but on their combination, and for each woman they can be individual.