What is PMS and how does it affect women. How are PMS symptoms diagnosed and managed. What are the common physical and emotional symptoms of PMS. How does PMS change with age and impact other health conditions. What causes PMS and who is most likely to experience it.

What is Premenstrual Syndrome (PMS)?

Premenstrual syndrome, commonly known as PMS, is a collection of physical and emotional symptoms that many women experience in the days leading up to their menstrual period. These symptoms typically begin after ovulation and subside within a few days of the onset of menstruation. PMS affects a significant portion of women, with over 90% reporting at least some premenstrual symptoms.

The severity of PMS can vary widely among individuals. For some women, the symptoms are mild and manageable, while others may find them severe enough to interfere with daily activities. Understanding the nature of PMS is crucial for effective management and improved quality of life during the menstrual cycle.

When does PMS occur?

PMS symptoms typically manifest about 5-14 days before the start of menstruation. This timing coincides with the luteal phase of the menstrual cycle, during which significant hormonal fluctuations occur. The symptoms generally peak just before the onset of menstruation and alleviate as the period begins.

Common Symptoms of PMS

PMS symptoms can be broadly categorized into physical and emotional manifestations. It’s important to note that every woman’s experience with PMS is unique, and symptoms may vary from cycle to cycle.

Physical Symptoms

• Breast tenderness or swelling
• Bloating and water retention
• Abdominal cramps
• Headaches or backaches
• Fatigue
• Changes in appetite or food cravings
• Acne flare-ups
• Joint or muscle pain
• Constipation or diarrhea

Emotional and Behavioral Symptoms

• Mood swings
• Irritability or anger
• Anxiety or tension
• Depression or feelings of sadness
• Difficulty concentrating
• Sleep disturbances
• Social withdrawal
• Decreased interest in usual activities

Do all women experience the same PMS symptoms? No, the experience of PMS can vary greatly from one woman to another. Some may predominantly experience physical symptoms, while others may be more affected by emotional changes. The severity and duration of symptoms can also differ significantly among individuals.

Causes and Risk Factors of PMS

The exact cause of PMS remains unclear, but researchers believe that hormonal fluctuations play a significant role. The dramatic changes in estrogen and progesterone levels after ovulation are thought to be a primary factor in triggering PMS symptoms.

Several risk factors may increase the likelihood or severity of PMS:

1. Age: Women in their late 20s to early 40s are more likely to experience severe PMS symptoms.
2. Family history: Having a close relative with PMS may increase your risk.
3. Stress: High levels of stress can exacerbate PMS symptoms.
4. Diet: Poor nutrition, including high consumption of caffeine, salt, or alcohol, may worsen symptoms.
5. Lack of exercise: A sedentary lifestyle is associated with more severe PMS.
6. History of depression or anxiety: Women with a history of mood disorders may be more susceptible to severe PMS or PMDD.

Is PMS influenced by genetics? While there isn’t a specific “PMS gene,” research suggests that genetic factors may play a role in a woman’s susceptibility to PMS. Studies have shown that women with a family history of PMS are more likely to experience symptoms themselves, indicating a potential genetic component to the condition.

Diagnosing PMS: Challenges and Approaches

Diagnosing PMS can be challenging due to the wide range of symptoms and their similarity to other health conditions. There is no single definitive test for PMS. Instead, healthcare providers rely on a combination of symptom tracking and clinical evaluation to make a diagnosis.

Diagnostic Criteria

To be diagnosed with PMS, a woman typically needs to meet the following criteria:

• Symptoms occur consistently during the luteal phase of the menstrual cycle (5-14 days before menstruation)
• Symptoms interfere with daily activities or relationships
• Symptoms are not due to another underlying medical condition
• Symptoms resolve within a few days of the onset of menstruation

How can women track their PMS symptoms effectively? One of the most useful tools for diagnosing PMS is a symptom diary. Women are encouraged to track their symptoms daily for at least two to three menstrual cycles. This can be done using a paper calendar, a smartphone app, or a digital tracker. Important information to record includes:

• The specific symptoms experienced each day
• The severity of each symptom
• The dates of menstruation
• Any factors that seem to worsen or alleviate symptoms

This detailed record can help healthcare providers identify patterns and make an accurate diagnosis of PMS or other related conditions.

PMS vs. PMDD: Understanding the Difference

While PMS is common and affects many women to varying degrees, a small percentage of women experience a more severe form known as Premenstrual Dysphoric Disorder (PMDD). PMDD is characterized by intense emotional and physical symptoms that significantly disrupt daily life.

Key Differences Between PMS and PMDD

What are the specific diagnostic criteria for PMDD? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a diagnosis of PMDD requires the presence of at least five of the following symptoms during most menstrual cycles in the past year:

1. Marked mood swings
2. Intense irritability or anger
3. Depressed mood or feelings of hopelessness
4. Severe anxiety or tension
5. Decreased interest in usual activities
6. Difficulty concentrating
7. Fatigue or low energy
8. Changes in appetite
9. Sleep disturbances
10. Feeling overwhelmed or out of control
11. Physical symptoms such as breast tenderness or bloating

These symptoms must significantly interfere with work, school, social activities, or relationships to meet the criteria for PMDD. If you suspect you may have PMDD, it’s crucial to consult with a healthcare provider for proper evaluation and treatment.

Management Strategies for PMS

While PMS can be challenging, there are numerous strategies and treatments available to help manage symptoms and improve quality of life. A comprehensive approach often involves a combination of lifestyle changes, natural remedies, and medical interventions.

Lifestyle Modifications

• Regular exercise: Engaging in physical activity can help reduce bloating, improve mood, and alleviate fatigue.
• Stress management: Techniques such as meditation, yoga, or deep breathing exercises can help reduce stress-related symptoms.
• Dietary changes: Reducing salt, caffeine, and alcohol intake may help minimize bloating and mood swings.
• Sleep hygiene: Maintaining a consistent sleep schedule can help manage fatigue and mood-related symptoms.
• Smoking cessation: Quitting smoking may help reduce the severity of PMS symptoms.

Natural Remedies

Some women find relief from PMS symptoms through natural supplements and remedies. While scientific evidence varies, the following options may be beneficial for some individuals:

• Calcium supplements
• Magnesium supplements
• Vitamin B6
• Evening primrose oil
• Chasteberry (Vitex agnus-castus)

It’s important to consult with a healthcare provider before starting any new supplements, as they may interact with other medications or have side effects.

Medical Treatments

For women with more severe PMS symptoms, medical treatments may be necessary. These can include:

• Hormonal contraceptives: Birth control pills or patches can help regulate hormonal fluctuations.
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) may be prescribed for severe mood-related symptoms.
• Diuretics: These medications can help reduce bloating and water retention.
• Pain relievers: Over-the-counter or prescription pain medications can help manage cramps and headaches.
• Cognitive-behavioral therapy: This form of psychotherapy can be effective in managing mood-related symptoms.

How can women determine the best management strategy for their PMS symptoms? The most effective approach to managing PMS often involves a combination of lifestyle changes, natural remedies, and medical treatments tailored to individual needs. It’s essential to work closely with a healthcare provider to develop a personalized management plan. This may involve trying different strategies and monitoring their effectiveness over several menstrual cycles to find the optimal combination of treatments.

The Impact of PMS on Daily Life and Relationships

PMS can have a significant impact on various aspects of a woman’s life, including work performance, social interactions, and personal relationships. Understanding these effects is crucial for developing coping strategies and fostering supportive environments.

Effects on Work and Productivity

PMS symptoms can affect work performance in several ways:

• Decreased concentration and focus
• Increased absenteeism or presenteeism (being present at work but less productive)
• Difficulty in meeting deadlines or handling stress
• Challenges in interpersonal interactions with colleagues

How can employers support employees experiencing PMS? Employers can create a more supportive work environment by:

• Offering flexible work arrangements when possible
• Providing education about PMS to reduce stigma
• Ensuring access to comfortable rest areas
• Encouraging open communication about health needs

Impact on Personal Relationships

PMS can also affect personal relationships, particularly with partners, family members, and close friends. Common challenges include:

• Mood swings leading to conflicts or misunderstandings
• Decreased interest in social activities
• Changes in sexual desire or intimacy
• Feelings of guilt or frustration over symptom-related behavior

Open communication, education, and mutual understanding are key to navigating these challenges. Partners and family members can provide support by:

• Learning about PMS and its symptoms
• Offering emotional support and understanding
• Helping with household tasks during symptomatic days
• Encouraging healthy coping mechanisms

PMS Across the Lifespan: Changes and Considerations

The experience of PMS can vary throughout a woman’s reproductive years, influenced by factors such as age, hormonal changes, and life events. Understanding these variations can help women anticipate and manage symptoms more effectively.

PMS in Adolescence

Many young women begin experiencing PMS symptoms soon after they start menstruating. During adolescence, PMS may be characterized by:

• Irregular cycles and unpredictable symptoms
• More pronounced mood swings due to hormonal fluctuations
• Difficulty in distinguishing normal adolescent mood changes from PMS

Education and support are crucial during this time to help young women understand and manage their symptoms.

PMS in Adulthood

For many women, PMS symptoms stabilize in adulthood but may be influenced by factors such as:

• Pregnancy and childbirth
• Stress levels and life changes
• Overall health and lifestyle habits

Women in their 30s often report the most severe PMS symptoms, possibly due to a combination of hormonal factors and life stressors.

PMS and Perimenopause

As women approach menopause, they may experience changes in their PMS symptoms. During perimenopause, which can begin in the late 30s or 40s, women might notice:

• Increased severity or duration of PMS symptoms
• More erratic menstrual cycles and unpredictable symptom patterns
• Overlap between PMS symptoms and early signs of menopause

How does PMS change after menopause? PMS symptoms typically cease after menopause when menstrual cycles end. However, some women may experience similar symptoms due to hormonal fluctuations during the menopausal transition. It’s important to consult with a healthcare provider to distinguish between PMS, perimenopausal symptoms, and other health conditions during this time.

The Connection Between PMS and Other Health Conditions

PMS doesn’t exist in isolation; it can interact with and be influenced by various other health conditions. Understanding these connections is crucial for comprehensive healthcare and symptom management.

PMS and Mental Health

There is a strong link between PMS and mental health conditions, particularly mood disorders. Key points to consider include:

• Women with a history of depression or anxiety may experience more severe PMS symptoms
• PMS can exacerbate existing mental health conditions
• Some women may be misdiagnosed with a mood disorder when they are actually experiencing severe PMS or PMDD

It’s essential for healthcare providers to consider the cyclical nature of symptoms when evaluating mental health concerns in women of reproductive age.

PMS and Chronic Health Conditions

Several chronic health conditions can interact with or be affected by PMS:

1. Irritable Bowel Syndrome (IBS): Many women report worsening of IBS symptoms during the premenstrual phase.
2. Migraines: Hormonal changes associated with the menstrual cycle can trigger or exacerbate migraines in some women.
3. Autoimmune disorders: Conditions such as lupus or rheumatoid arthritis may flare up during the premenstrual period.
4. Thyroid disorders: Thyroid function can affect menstrual regularity and PMS symptoms.

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

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What is premenstrual syndrome (PMS)?

Premenstrual syndrome, or PMS, is a group of physical and emotional symptoms that start one to two weeks before your period. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. The symptoms may range from mild to severe.

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a severe type of PMS. With PMDD, the symptoms are severe enough to interfere with your life. PMDD much less common than PMS.

What causes premenstrual syndrome (PMS)?

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

What are the symptoms of premenstrual syndrome (PMS)?

PMS symptoms are different for everyone. You may get physical symptoms, emotional symptoms, or both. Your symptoms may also change throughout your life.

Physical symptoms may include:

• Breast swelling and tenderness
• Acne
• Bloating and weight gain
• Headache
• Joint pain
• Backache
• Constipation or diarrhea
• Food cravings

Emotional symptoms may include:

• Irritability
• Mood swings
• Crying spells
• Depression
• Anxiety
• Sleeping too much or too little
• Trouble with concentration and memory
• Less interest in sex

How is premenstrual syndrome (PMS) diagnosed?

You may wish to see your health care provider if your symptoms bother you or affect your daily life.

There is no single test for PMS. Your provider will talk with you about your symptoms, including when they happen and how much they affect your life. To be diagnosed with PMS, your symptoms must:

• 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

Your provider may wish to do tests to rule out other conditions which may cause similar symptoms.

What are the treatments for premenstrual syndrome (PMS)?

No single PMS treatment works for everyone. If your symptoms are not severe, you may be able to manage them with:

• Over-the-counter pain relievers such as ibuprofen, aspirin, or naproxen, to help ease cramps, headaches, backaches, and breast tenderness
• Getting regular exercise
• Getting enough sleep
• Eating healthy foods
• Avoiding salt, caffeine, sugar, and alcohol in the two weeks before your period

Some studies have shown that certain vitamins may help with some symptoms of PMS. They include calcium and vitamin B6.

Some women take certain herbal supplements for PMS symptoms. But there is not enough evidence to prove that supplements are effective for PMS. Check with your provider before taking any vitamins or supplements.

If you are not able to manage your PMS symptoms, your provider may suggest prescription medicines. These medicines may also be used to treat PMDD. They include:

• Hormonal birth control, which may help with the physical symptoms of PMS. But sometimes they may make the emotional symptoms worse. You may need to try several different types of birth control before you find the right one.
• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), which may help with emotional symptoms.
• Diuretics (“water pills”) to reduce symptoms of bloating and breast tenderness.
• Anti-anxiety medicine to ease symptoms of anxiety.

Dept. of Health and Human Services Office on Women’s Health

• Premenstrual Syndrome (PMS)

  (Mayo Foundation for Medical Education and Research)

• Premenstrual Syndrome (PMS)

  (Department of Health and Human Services, Office on Women’s Health)

  Also in Spanish

• Premenstrual Syndrome (PMS) FAQ

  (American College of Obstetricians and Gynecologists)

• Black Cohosh

  (National Center for Complementary and Integrative Health)

• Chasteberry

  (National Center for Complementary and Integrative Health)

• Evening Primrose Oil

  (National Center for Complementary and Integrative Health)

• Mittelschmerz

  (Mayo Foundation for Medical Education and Research)

  Also in Spanish

• Premenstrual Dysphoric Disorder (PMDD)

  (American Academy of Family Physicians)

• Premenstrual Dysphoric Disorder (PMDD): Different from PMS?

  (Mayo Foundation for Medical Education and Research)

  Also in Spanish

• Water Retention: Relieve This Premenstrual Symptom

  (Mayo Foundation for Medical Education and Research)

  Also in Spanish

• ClinicalTrials. gov: Premenstrual Syndrome

  (National Institutes of Health)

• Article: The effect of progressive muscle relaxation technique and myofascial release technique. ..

• Article: Effect of curcumin on inflammatory biomarkers and iron profile in patients…

• Article: The role of purity and frequency in the classification of perimenstrual. ..

• Premenstrual Syndrome — see more articles

• Normal Female Reproductive Anatomy

  (National Cancer Institute)

• Department of Health and Human Services, Office on Women’s Health

  Also in Spanish

• Find an Ob-Gyn

  (American College of Obstetricians and Gynecologists)

• Menstrual Period: Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

  (Boston Children’s Hospital)

  Also in Spanish

• PMS, Cramps, and Irregular Periods

  (Nemours Foundation)

  Also in Spanish

• Premenstrual Syndrome (PMS)

  (Department of Health and Human Services, Office on Women’s Health)

pms hotel management system: which one to choose

The purpose of this article is to show hoteliers and business owners the points to pay attention to at the initial stages of work, when choosing or replacing an existing PMS.

Personal experiences and decisions

I have been in the hotel business for 15 years now. During this time, a certain experience in managing various types of hotels has been accumulated. And today I want to share with you my experience in choosing a hotel management system.

It so happened that during my work in hotels I managed to approach the issue of using PMS from different angles. In some hotels, I was just a user of an already existing product. In others, I had the opportunity to initially choose the system. Still others had to deal with the transition from one system to another.

It was the experience gained that made it possible to objectively evaluate the process of choosing and owning a PMS, not only as a user at the monitor, but also as the owner of this system with all the operational and content characteristics. Agree, these are different approaches, each of which has its own nuances. For example, someone wants speed and stability, but for someone saving in program and server maintenance is important. Also, when was the last time you asked your employees about the convenience of working on an existing PMS?

Network, franchise and free float

I note right away that in the article I focus on the Russian market and on colleagues who have the opportunity to influence the choice. However, this information will also be useful to other representatives of the hotel business.

You know that many chain or franchise hotels do not have the right to choose systems on their own and are completely dependent on the decision of the head office. This is primarily due to the rules of networks and the presence of already approved standards for the quality of work, as well as maintenance procedures.

Independent hotels themselves decide this issue and often more than once during the entire cycle of the hotel. Personally, I know several cases of transition from one PMS to another. The reasons that led to such decisions and the results obtained will be explained below.

Are you familiar with PMS?

So what is PMS, what is it for, and how to choose it?

If we talk about a short and closer definition for me that explains this concept, then PMS (Property Management System, from the English “Property Management System”) is a system that allows the owner or manager to automate all cycles of guest service: from booking and check-in to the final payment of the guest. And also PMS is an opportunity to organize all business processes in the hotel: from the work of the maid service to full financial reporting.

I would like to note that a number of PMS are not recommended to be implemented in the work of chain hotels. The reason for this is the inconvenience and lack of functionality required for the full operation of the network. As an example, the reasons may be the following:

× Lack of a common database with the possibility of loading guests in any of the hotels.

× Lack of access to deposits of the company or individuals.

× And most importantly – the lack of the possibility of generating general reporting for the network.

Principles for choosing a PMS or 3 steps to choosing an assistant

At the moment, due to the exchange rate of the ruble and a number of other points, Russian products get a big advantage. Undoubtedly, some of them are competitive and worthy of choice. At the same time, our task is not just to fit into the budget and save money, but to acquire the best assistant in business, both for employees and owners. Therefore, I urge you to be objective and focus on functionality, not cost.

How to choose one and only PMS from such a huge range on the market? I would highlight the following steps:

STEP 1. Write down the points that you may not like in the system, including cost indicators.

STEP 2. Compare all these points and compare offers on the market.

Typically, at this stage, your list will narrow down to 3-5 solutions.

STEP 3. This is where things get interesting. Below are my recommendations for this stage:

× It is obligatory to personally meet both the company’s management and the technical management implementing the product. And here it is necessary to solve two nuances:

1. Development and integration.

Often sellers and future users understand the main functions in the program a little differently. It’s good if you manage to see in the eyes of sellers not only the desire to sell the product, but also the desire to make it better, update and adjust it to the modern market. After all, every year more and more applications are released into the world to improve the operation of the hotel, and, as a result, increase the profit of the enterprise. This is where you need to think ahead of time about integrating them with your PMS. It is worth immediately understanding whether the developers are ready to move in this direction or not.

2. Development of an additional interface.

As a rule, system vendors do not refuse to develop new interfaces, but request funds for this that are comparable to the cost of the PMS itself. All this leads to a stalemate, when the user becomes a hostage between the desire to automate the business, on the one hand, and the inability to implement it for financial reasons, on the other.

All this can be avoided thanks to a single meeting with the company’s management. Moreover, they love to do it and will be happy to chat with you!

Important: according to the result of the meeting, there must be a protocol, which should cover all the agreed points and the conditions for their implementation, even if in the form of a regular letter between both parties. At the same meeting, it would be right to ask about previous projects. Be sure to specify which of them were unsuccessful, what is the reason for what happened .

× It is desirable to meet with the current users of this system and those who have changed the system.

Discuss the experience of use, the pros and cons of working. If you are not from a million-plus city, then it makes sense to send your employee on a business trip for personal communication.

Checklist of questions for a personal meeting:

• · Are there any cases where the program freezes/crashes and how often?
• Is information lost after crashes?
• · Support response time, especially at night, on weekends and holidays?
• · Estimated time to resolve the issue?
• · Average time spent on training a new employee?
• · A list of stages and moments where the staff most often makes mistakes?
• · Required Internet speed for stable operation?
• · Regularity of changes in the cost of system maintenance?
• How often are updates released?
• · What is the nature of these updates: a new version or an improvement of the current work?
• · Do I need a separate server?
• · Is there a backup of the entire database and how often does it happen?

etc.

These and other important points must be reflected later in the contract, protecting yourself from unnecessary waste of time in the future.

Basic criteria for system selection or re-evaluation.

For all the time I have worked in the hotel business, I would single out the following:

1. Spectrum of functionality.
2. Operating speed.
3. Easy to use.
4. Reliability.
5. Possibility of development and renewal
6. Use of modern software products in the system.
7. Plasticity of settings.
8. Intuitive and clear interface.
9. The ability to customize the system in accordance with the standards of the hotel.
10. Multiuser.
11. Differentiation of access rights.
12. Orientation to the peculiarities of work on the territory of the Russian Federation (taxes, etc.).
13. Availability of user manual.
14. Timing of complete implantation of the system.
15. Scope of interfaces with other systems.
16. Availability and scope of internal interfaces.
17. Implementation cost.
18. Usage/support cost.
19. Failure statistics and root causes.
20. Product geography.
21. Opportunities and conditions for developers to modify the system for a specific market or the wishes of the customer.

What about data retention law?

A separate point that I would like to draw attention to concerns not only those who are faced with choosing a system, but also those who have been using PMS for a long time and are satisfied with everything.

Surely, each of you, one way or another, heard about the law on the storage of data of citizens of the Russian Federation on servers in Russia. This is the so-called “Lugovoy’s law”, initiated by the Deputy Chairman of the State Duma Committee on Security and Anti-Corruption, a member of the LDPR faction Andrey Konstantinovich Lugovoi. In other words, any PMS falls under the monitoring of this legislation.

At the same time, I would like to draw your attention to the fact that PMS belonging to a Russian product does not mean that it will not be 100% subject to the law that comes into force on September 1, 2015. After all, most services in the Russian Federation use foreign servers for storing and processing data. You will ask why? Good price, stability, technical support and other reasons. We have it much more expensive and less stable. If today the issue of price has been resolved by itself due to the exchange rate, and the foreign server has become comparable to the domestic one, then other parameters have remained unchanged.

Of course, the law can be further pushed back in terms of implementation, but I try to reason on the fact and within the framework of the legislative situation that exists today in the country. Therefore, today it is necessary to pay close attention to this point and ask the creators of PMS to provide their vision of resolving this issue.

PMS demos

As a rule, a potential buyer is given the opportunity to get acquainted with the demo version. I want to draw everyone’s attention to the fact that these versions are completely “raw”, and they lack certain functionality or they have it in a stripped down form.

Of course, the brand of the company and its fame play a role. However, most people in charge of choosing a system make a number of mistakes.

– The first of them, and perhaps the most common: the initial choice of the system according to its own criteria – and only then adapting it to the necessary requirements in the hotel. But it should be the other way around: from the features and requirements of the object to the capabilities of the system itself.

– The second mistake is an attempt to immediately evaluate the return on investment spent on the product.

Here, rather, you need to be patient and wait for an objective understanding of the need for this product for business.

Escort: to be or not to be?

After choosing a system, the most voluminous issue becomes the maintenance of the system in the process of work. As a rule, the following components of service exist in the market:

· Telephone support.

· Helpdesk via e-mail.

· Free swimming and resolving issues through the system administrator, who is in the state.

Technical support can be round the clock or hourly. The manufacturer gives the choice to the consumer which option is preferable. There is usually a monthly fee for this.

Here I would like to draw attention to the fact that a good program does not require constant intervention from outside and provides the necessary and proven functionality in no more than 2-4 months. From experience, the real process of implementation and “grinding in” with the staff and the facility takes place just during this time. Further, a reliable system is simply obliged to work without any significant failures.

Important: these points must also be reflected in the agreements. For example, maintenance payments start only from the third or fourth month of use, and not immediately after installation or pre-installation settings.

At some point, it may seem that you are completely managing on your own and can easily refuse to be accompanied. I would recommend not to do this, since maintenance is not only solving problems, but also various cleaning of databases, clarification and implementation of changes related to legislation or other innovations, support in difficult situations, and so on.

There are programs that require licensed maintenance or updates. In such a case, you should seek free maintenance and updates, that is, at no additional cost, and as new versions are released by the developer. Especially if you pay monthly for maintenance.

Total per PMS?

Let’s talk about the total cost of ownership PMS . I would love to help you see the maximum product pricing listing.

So, what do you pay when implementing PMS? What makes up the price?

Try to fill in the empty lines by putting your price in front of each item. This way you will get the final PMS ownership figure.

Instead of terminals

Always try to take a modular system, and not a system that completely automates all hotel services due to its original functionality. There are two reasons:

1. You always have the opportunity to replace obsolete modules without touching others.

2. You do not create the basis for increasing the cost of maintenance in the event of a 100% need to replace something in the system, for example, due to changes in legislation.

09/05/2015

How digital solutions help to optimize the work of hotels

Is CRM necessary in the hotel business?

The answer to this question is extremely easy to find. You just need to ask yourself another question: where, no matter how in the field of hospitality, interaction with guests is important?
Therefore, Customer Relationship Management (CRM) system is needed in your property, because CRM records the entire history of your relationship with existing and potential guests, their data and information about completed or planned bookings.

CRM, CRM-system, abbreviation from English. Customer Relationship Management – Customer Relationship Management System.
This is software for organizations to automate strategies, interact with customers by storing information about them and the history of relationships with them, establishing and improving business processes, and then analyzing the results.
Purpose:
1. Increasing the level of sales.
2. Marketing optimization.
3. Improving customer service

Benefits of using a CRM system

• This is a large database in which all hotel employees interact with guests. And if you decide to leave an employee, the guest data will be stored in the hotel, and not in the notebooks or Excel spreadsheets that the employee kept.
• Another problem that CRM solves is the forgetfulness of managers. And in sales, the price of a call not made on time is very high. Therefore, a CRM system is also a planning system. CRM will remind the employee what time and when he should call the guest. Thus, the CRM system disciplines employees.
• Continuing the topic of employees, the CRM system minimizes the percentage of unaccounted for bookings and theft of administrators, since all incoming calls and requests fall into CRM. System settings allow you to make sure that administrators cannot delete information. Thus, the transparency of business processes is achieved.
• CRM-system also allows you to evaluate the effectiveness of marketing costs and give an answer to the question: how much does it cost to attract one guest and which sources of guest acquisition bring more money.

What is the sales funnel in a property?

The concept of a sales funnel is a reflection of your business process.
The sales funnel represents the stages in the transition of your relationship with the guest, from the first contact to the fulfillment of obligations. At each stage of the funnel, the number of potential guests decreases as they move from the first interest to the completion of the transaction, due to the possible “losses” in the sale process. CRM-system allows you to minimize these “losses”.
The funnel can be built for the company as a whole, for a specific department or employee.
The division of the sales process into funnel stages is determined based on the specifics of the company’s activities and management tasks. For example, in a hostel and in a hotel, these stages may be different.

An example of sales funnel stages for a hotel:

This is how the sales funnel stages look like on the example of amoCRM:

Why do we need PMS and CRM integration?

As we said above, CRM works with your guests’ data. Two-way integration of Bnovo PMS with a CRM system will save you from having to transfer information about guests from one system to another twice.
Read more about the process of connecting CRM and Bnovo in the Bnovo knowledge base

Watch a short video on how reservations get from Bnovo to the CRM system using the example of amoCRM.

Examples of working with the sales funnel in the property

In the sales funnel, the reservation is moved to the “Create booking” stage.
According to statistics, it is precisely such bookings that are canceled and turn into cancellations. In order to reduce their number, it is important to contact the guest in time and further clarify his intentions.
How can a CRM system help us here?
You can set up automatic sending of letters or a reminder of a call to the manager / administrator so that he contacts the guest and finds out whether he will come or not.

In this case, remember to put a baby cot in the room.
In the CRM system, we can set up an automatic rule to set the task for the administrator “Check the crib for the reservation, where a number above zero was passed in the field “Children”.

In the CRM system, we can set up the rules at each stage (both before arrival and during stay). For example, 3 days before check-in, we send the guest an offer to book a transfer.
And if the number of days of his stay is more than 2 days, we send by mail information about what services he can use in our hotel (restaurant, gym, neighboring restaurants where the guest will be given a discount by code word, information about the theater ticket ordering service, etc.

Look at examples of working with a sales funnel and setting up automatic rules:

90 266 How can a CRM system help you measure your marketing effectiveness?

Thanks to the CRM integration with PMS, you can analyze the cost of attracting guests and evaluate the conversion from each booking source, including both OTA and advertising channels. Those. how much money each channel brings.

When filling in the “Source” column in the CRM system, you can also mark any user action as separate channels (went to the site, clicked on the banner). And with further analysis, you will see where the guest came from.
CRM data collection for source analysis:
1. Yandex Metrica and Google Analytics
2. Call tracking \ PBX
3. Website – applications and mail
4. Yandex Direct and Google Ads
5. PMS
6. Channel Manager
7. Social networks

us mistakes. Process automation solves this problem.
In particular, CRM integration with Bnovo PMS.

An example of a report on sources in CRM:

An example of how you can analyze the data that is in the integration of PMS and CRM – a portrait of a guest who makes direct bookings:

Conclusions:

1. The CRM system is effective even in small accommodation facilities, where it is easier to build a personalized approach to each guest.
2. CRM-system gives total control of sales.
3. CRM-system give a clear understanding of where you have money. Which channel brings in the most money.
4. The CRM system allows you to record guest preferences, save the history of their bookings, and analyze what guests buy from you most often in order to form the right package offers.
5. CRM-system helps to solve the problem of theft (“left armor”).

leave a request for integration of Bnovo PMS with amoCRM or Bitrix24

Full recording of the webinar “Effective use of the CRM system in your property” with an invited expert – DigitallWill CEO Sergey Skorbenko.

Vasilisa Twitter

She graduated with honors from the SZAGS under the President of the Russian Federation and has been successfully working in the field of public relations for more than 20 years.