Premenstrual syndrome (PMS) symptoms are experienced by nearly three out of every four people who menstruate. These symptoms range from mild and manageable to so severe that they disrupt daily life. Each person who menstruates will have their own, relatively predictable pattern when it comes to PMS, but symptoms may be slightly different from cycle to cycle. PMS is experienced between puberty and menopause with a few exceptions, including during pregnancy: people who are pregnant or who have entered menopause do not menstruate; therefore, PMS subsides.
People experience PMS in many different ways. Some may have only one or two symptoms, while others experience several symptoms at a time. Not all of the side effects of PMS are physical; some are emotional and/or behavioral. In general, symptoms subside within four days of the beginning of the menstrual period.
Emotional or behavioral signs and symptoms include:
• Tension or anxiety
• Crying episodes
• Irritability, anger, and mood swings
• Change in appetite or food cravings
• Decreased concentration
• Change in libido
• Social withdrawal
Physical signs and symptoms include:
• Joint and muscle pain
• Fluid retention and resulting weight gain
• Bloating in the abdomen
• Breast tenderness
• Increase in acne
• Constipation and diarrhea
• Decreased tolerance for alcohol
Much is still unknown about what causes PMS. There are three main factors that experts believe contribute to the presence of PMS in people who menstruate.
1. Hormonal changes during the menstrual cycle
2. Changes in the levels of chemicals (serotonin) in the brain
3. Undiagnosed or untreated depression
Changes in hormones produced in the body during the menstrual cycle can contribute to PMS’s effects. Serotonin is an important neurotransmitter in the brain that affects a person’s mood, and its levels can change throughout the menstrual cycle as well. Lower levels of serotonin during PMS can contribute to side effects such as depression, food cravings, trouble sleeping, and feelings of fatigue. Symptoms of depression can be amplified due to PMS, especially if depression is undiagnosed or untreated.
There are several recommended ways to prevent or lessen the severity of PMS symptoms. Lifestyle choices can have an impact on PMS, and there are effective over-the-counter and prescribed medications that can alleviate some symptoms.
Lifestyle remedies include:
• Exercise, such as aerobic physical activities: Regular exercise has been shown to help combat depression, fatigue, and lack of concentration. (Speak to your healthcare provider before dramatically changing your activity levels.)
• Eating healthy foods such as fruit and vegetables: In the two weeks prior to menstruation, many people find it helpful to avoid or limit caffeine and to limit their intake of sugar and salt.
• Sleep: Getting enough sleep — between seven and nine hours a night for most adults — can help with some PMS symptoms, such as fatigue, depression, moodiness, and anxiety.
• Address stress in healthy ways: Talking to someone about the stress in your life, journaling, meditation, and yoga can help alleviate stress and lessen PMS symptoms.
• Avoid smoking tobacco: Tobacco use has been linked to increased severity of PMS symptoms.
Over-the-counter medications can help to lessen physical symptoms that PMS can cause. Ibuprofen, aspirin, and naproxen are all options typically available in drugstores.
Although PMS can typically be treated by lifestyle changes and/or over-the-counter painkillers, some people do experience severe symptoms. If your PMS symptoms are disrupting your daily life and negatively affecting your overall health, speak to your healthcare provider. They may prescribe medications such as hormonal birth control, antidepressants, diuretics, or anti-anxiety medications.
Severe PMS symptoms may be an indication of premenstrual dysphoric disorder (PMDD). PMDD has many of the same symptoms as PMS, but they are much more severe. The symptoms of PMDD typically severely inhibit a person’s inability to participate in regular life — disrupting work and relationships. In order to diagnose PMDD, doctors will commonly have the patient record symptoms and their severity for several months.
Treatments that may help with PMDD include:
• A healthy diet that limits the consumption of sugar, caffeine, alcohol, and salt
• A diet that is rich in protein
• Regular exercise
• Healthy stress relief
• Vitamins and mineral supplements such as vitamin B6, calcium, and magnesium
• Medication to prevent inflammation
• Birth control
People who menstruate and also suffer from anxiety and/or depression are more likely to experience heightened symptoms during the two weeks leading up to their period. Even those who do not normally suffer from mental health issues may experience an increase in anxiety or episodes of depression during PMS. Within the first days of a person’s period, these symptoms typically subside.
A relationship with a trusted healthcare provider is a key resource for overall health. Make an appointment today with your Carbon Health primary care provider to talk about whatever is on your mind. They are there for you, to answer your questions and support you as you reach your health goals. Download the Carbon Health app or visit carbonhealth.com.
Carbon Health’s medical content is reviewed and approved by healthcare professionals before it is published, but it is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Talk to your healthcare provider about questions you may have regarding your health or a medical condition, and before making changes to your healthcare routine.