Premenstrual syndrome (PMS) is the body’s natural signal that your period is coming soon. Possible symptoms include bloating, mood swings, trouble sleeping, and headaches.
Everyone’s experience with PMS is different, and that experience can vary month to month and over time.
While most people will have at least one sign of PMS every month, symptoms can fluctuate in strength and how long they last. They can also be physical, psychological, or a combination of both.
With so many possible signs of PMS, it can be tricky to identify and understand. This article will cover its symptoms and causes and help you to find strategies to manage it.
What are the symptoms of PMS?
Scientists have found it difficult to pin down how many people experience PMS.
However, one recent literature review of related research estimates that 75% of women experience some form of PMS. Others say that 37% to 90% of women can experience PMS symptoms, varying from mild to severe.
Symptoms can also be difficult to distinguish since they don’t conform to a consistent or universal “this is what PMS looks like” checklist.
They can range significantly in what they are, when they appear, how long they last, and how severe they are. However, some symptoms are more common than others.
Some common physical symptoms include:
light and sound sensitivity
thirst and appetite changes
aches and pains
increases in skin problems
changes to vaginal discharge
Some common psychological symptoms include:
feeling upset, anxious, or irritable
trouble sleeping or insomnia
changes in libido
While everyone experiences PMS differently, symptoms generally occur during the last half of a menstruation cycle, 1–2 weeks before your period. And they tend to stop when your period starts or shortly after.
Women with more severe psychological symptoms may be experiencing premenstrual dysphoric disorder. This severe mood disorder occurs more consistently during cycles and significantly impacts day-to-day functioning.
If you are experiencing severe or persistent symptoms and nothing seems to help, it’s best to speak with a doctor.
What causes PMS?
The causes of PMS are just as complex, variable, and imprecise as its symptoms. However, one likely culprit is changes in hormones that occur during the menstrual cycle.
During the first part of the cycle, estrogen and progesterone levels are low, but estrogen levels peak shortly before ovulation — the midpoint of the cycle.
Once the egg is released, levels fall rapidly before rising again. As estrogen rises, progesterone levels rise alongside, reaching a peak during the second half of the cycle.
Both hormone levels then return to baseline when the period begins.
These hormonal changes, in turn, affect the chemicals in the brain. Estrogen and progesterone affect levels of:
Serotonin: A neurotransmitter that regulates human behavior, including mood, appetite, memory, and libido.
Dopamine: A neurotransmitter that regulates a variety of functions, including the ability to experience pleasure, decision making, emotion, motivation, food intake, and motor control.
Glutamate and GABA: Neurotransmitters that stimulate or inhibit pathways in the brain, respectively.
Certain lifestyle factors can also increase both the likelihood of experiencing PMS and the severity of the symptoms.
For example, researchers have linked higher stress levels to an increased risk of severe symptoms.
Likewise, one study suggests that smoking means you could be 1.5 times more likely to experience PMS.
Furthermore, since sleep habits are so intertwined with mood and regulating bodily functions, poor sleep can lead to worse PMS.
Diet can also play a role in PMS. For example, consuming a lot of certain foods and drinks — like ultra-processed foods or coffee — may worsen PMS for some people.
At ZOE, we know that everyone responds to foods differently. If you would like to learn more about finding the best foods for your body, you can start by taking our free quiz.
How to manage symptoms
The good news is that while we still have a long way to go in understanding the symptoms and causes of PMS, there are many lifestyle changes you can consider to help reduce and manage your symptoms.
As with any intervention, you should consult your doctor before making large-scale changes.
While eliminating all stress from your life isn’t realistic, there are things you can do to manage your stress levels. Relaxation techniques or mindfulness-based meditation can sometimes help reduce the effects of PMS.
Physical activity offers a whole range of health benefits, and its positive impact on mood, concentration, and sleep quality can work to counteract PMS symptoms.
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Your body needs sleep to survive. Since your body is particularly vulnerable to insomnia during PMS, practicing good sleep hygiene, limiting caffeine, and getting the hours of quality rest you need can make a big difference.
Some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can help manage the psychological symptoms of PMS. Doctors can prescribe SSRIs to treat depression.
Combined oral contraceptives mimic your natural hormone cycle and contain estrogen and progesterone. They may help improve PMS symptoms, at least in more severe cases. However, scientists need to carry out more rigorous research.
Anti-inflammatory medications like ibuprofen can also be effective for mild discomfort from bloating or aches and pains.
Check with your doctor to find out if medication is suitable for your PMS symptoms.
Foods with unhealthy fats and added sugar and salt may exacerbate PMS symptoms.
Eating healthy, unprocessed foods might help. For instance, fruit and foods high in vitamins and minerals like vitamin B, vitamin D, and calcium may alleviate some symptoms.
At ZOE, we're at the forefront of nutrition science, and we know the importance of personalization — everyone responds differently to food.
With the ZOE program, you receive personalized nutrition advice so you can find the best foods for your body.
There is no one-experience-fits-all when it comes to PMS. Every body is unique, and so are the impacts of the hormonal and brain chemical changes that cause PMS.
Some people may experience more physical symptoms like bloating, fatigue, headaches, and breast tenderness. Others may experience psychological symptoms like irritability, depression, anxiety, or changes to sleep quality and libido.
And some may experience both types of symptoms or none at all.
However your symptoms manifest and however long they last, there are steps you can take to manage them.
Reducing stress, exercising regularly, getting better sleep, eating a diverse and nutrient-rich diet, and taking certain medications have all been linked to improving or relieving PMS symptoms.
Before making any significant lifestyle changes, and to get help with more persistent and severe symptoms, speak with your doctor to find out what might suit your unique body best.
You can also learn more about how your body responds to different foods and how your nutrition connects to your overall health and well-being through the ZOE program.
Assessment of premenstrual syndrome among reproductive aged Myanmar women. Asian Journal of Medical Sciences. (2016). https://www.nepjol.info/index.php/AJMS/article/view/13298
Association between smoking and premenstrual syndrome: a meta-analysis. Frontiers in Psychiatry. (2020). https://www.frontiersin.org/articles/10.3389/fpsyt.2020.575526/full
Calcium reduced PMS symptoms during the luteal phase of the menstrual cycle. Evidence-Based Nursing. (1999). https://ebn.bmj.com/content/2/2/43
Contraception counseling for women with premenstrual dysphoric disorder (PMDD): current perspectives. Open Access Journal of Contraception. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759213/
Contraceptive options for women with premenstrual dysphoric disorder: current insights and a narrative review. Open Access Journal of Contraception. (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683150/
Determining menstrual phase in human biobehavioral research: a review with recommendations. Experimental and Clinical Psychopharmacology. (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821777/
Dietary B vitamin intake and incident premenstrual syndrome. America Journal of Clinical Nutrition. (2011). https://pubmed.ncbi.nlm.nih.gov/21346091/
Dopamine receptors: from structure to function. Physiological Reviews. (1998). https://journals.physiology.org/doi/full/10.1152/physrev.1918.104.22.168
Estrogen. (2021). https://www.ncbi.nlm.nih.gov/books/NBK538260/
Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials. BJGP Open. (2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465566/
Factors associated with premenstrual syndrome in female high school students. Journal of Education and Health Promotion. (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963206/
High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecological Endocrinology. (2018). https://pubmed.ncbi.nlm.nih.gov/29447494/
Lifestyle factors associated with premenstrual syndrome among el-minia university students, Egypt. International Scholarly Research Notes. (2013). https://www.hindawi.com/journals/isrn/2013/617123/
Mindfulness-based stress reduction as a promising intervention for amelioration of premenstrual dysphoric disorder symptoms. Mindfulness. (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651211/
Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome. Journal of Sleep Research. (2012). https://pubmed.ncbi.nlm.nih.gov/22417163/
Perceived stress and severity of perimenstrual symptoms: the biocycle study. Journal of Women’s Health. (2010). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875955/
Period pains: can anti-inflammatory drugs help? (2019). https://www.ncbi.nlm.nih.gov/books/NBK279323/
Physiology, progesterone. (2022). https://www.ncbi.nlm.nih.gov/books/NBK558960/
Premenstrual dysphoric disorder. (2020). https://www.ncbi.nlm.nih.gov/books/NBK532307/
Premenstrual syndrome is associated with dietary and lifestyle behaviors among university students: a cross-sectional study from Sharjah, UAE. Nutrients. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723319/
Prevalence and clinical picture of premenstrual syndrome in females from Bulgaria. Annals of General Psychiatry. (2020). https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-019-0255-1
Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database of Systematic Reviews. (2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073417/
Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience. (2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335177/
Sleep hygiene. (2022). https://www.sleepfoundation.org/sleep-hygiene
The effect of relaxation on premenstrual syndrome in dormitory students of azad tonekabon university of Iran. Procedia - Social and Behavioral Sciences. (2013). https://www.sciencedirect.com/science/article/pii/S1877042813018661
The expanded biology of serotonin. Annual Review of Medicine. (2009). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5864293/
Trends in research related to premenstrual syndrome and premenstrual dysphoric disorder from 1945 to 2018: a bibliometric analysis. Frontiers in Public Health. (2021). https://www.frontiersin.org/articles/10.3389/fpubh.2021.596128/full