Premenstrual Syndrome (PMS): Symptoms, & Treatment

By John Bernard, MD
Medically reviewed checkmarkMedically reviewed
May 1, 2020

Premenstrual syndrome (PMS) is a cluster of symptoms that affect women of reproductive age a week or two before they menstruate. More than 90% of women experience PMS symptoms at some point in their lives. PMS affects women’s emotional mood, physical well-being, and behavior, though the severity of its effects can widely vary from individual to individual and from cycle to cycle.

Some women only experience a mild headache or bloating before their menstruation, while others suffer symptoms so intense they must call out of work or school.

Very severe premenstrual syndrome symptoms may indicate that a woman is suffering from premenstrual dysphoric disorder (PMDD), a rare but debilitating and extreme form of PMS that can adversely affect a patient’s quality of life.

In most cases, if you are experiencing anxiety, mood swings, irritability, bloating, headache, digestive irregularity, or breast pain in the week leading up to your period, PMS is likely causing your symptoms.

What Is Premenstrual Syndrome (PMS)?

Often referred to by its acronym, “PMS,” or premenstrual syndrome, is a recurring condition that typically occurs a week or two before menstruation. The symptoms can vary and can affect you physically, emotionally, and behaviorally, widely varying from person to person and cycle to cycle. PMS is extremely common, impacting millions of women every year.

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Symptoms of PMS

Premenstrual syndrome symptoms can begin anywhere from 5-11 days before you begin to menstruate, and go away once you begin to menstruate. Symptoms can include physical pain, emotional mood swings, and behavioral changes. They usually recur in a predictable pattern, but can vary in intensity from day to day and cycle to cycle.

Most women who experience PMS exhibit one or more of the following symptoms in the weeks leading up to their cycle:

  • PMS headache: Premenstrual headaches happen the week before your period and are often accompanied by symptoms like joint pain, stomach ache, or acne flare-ups.
  • PMS nausea and stomach ache: Nausea is commonly experienced before your period begins—along with bloating, cramps, constipation, diarrhea and changes in your appetite. If you are experiencing new or intense nausea, call your doctor. Extreme stomach upset or vomiting can be a sign that you are pregnant, suffering from endometriosis, or have another underlying medical condition that requires treatment.
  • PMS depression, anxiety, or mood swings: Emotional instability, sadness or mild depression, tension or anxiety, sleep disturbances and irritability or anger are all symptoms that can be triggered and exacerbated by PMS.
  • PMS insomnia or fatigue: Some women report an increase in fatigue or insomnia as PMS can change your sleep patterns.

Other physical symptoms may include body aches or muscle pain, digestive irregularities (constipation or diarrhea), lack of coordination, facial acne, breast tenderness, or sore nipples.

PMS can also induce behavioral changes. Many women report that they withdraw socially, have trouble concentrating, experience changes in their libido, and they have changes in their appetite.

If your symptoms are related to PMS, they should recur every month and dissipate when you begin to menstruate. If you do not experience relief at the onset of your period, or if your symptoms feel new, extreme, difficult to manage, or directly impair the quality of your life, schedule an appointment with your doctor to rule out any underlying medical conditions that may be causing your symptoms.


While PMS is very common among women of reproductive age, some women—roughly 5-8%—experience symptoms so severe that they significantly impair their quality of life. In those rare instances, you may be suffering from premenstrual dysphoric disorder (PMDD), an acute form of PMS that is marked by intense or extreme mood swings that alter or impair your life, work, and relationships.

The symptoms of PMDD typically appear from ages 25-35, although the condition has been noted in teenagers all the way up to women in their forties.

If you have reason to believe you are suffering from the adverse effects of PMDD, you can take the International Association for Premenstrual Disorders online self-screening exam as a first step toward finding out more about the condition. The test will not formally diagnose you, but it can help you gain clarity around your symptoms.

If after taking the test, you still believe you have PMDD or would like more information, call your doctor to discuss your symptoms and explore treatment options.

PMDD can sometimes be difficult to distinguish from mood disorders like depression and bipolar disorder. The major way to differentiate PMDD from other disorders is the connection between your symptoms and your menstrual cycle but if you are concerned you may have PMDD, your medical professional can help you try to sort through the possibilities.

PMDD is sometimes treated with serotonin-selective reuptake inhibitors (SSRIs), which are a type of antidepressant. In some patients with this disorder, birth control pills can be prescribed to help control the symptoms of PMDD as well.

PMS is rarely dangerous, but if you are experiencing thoughts of self-harm or suicide, call your doctor or 911 to seek medical treatment immediately.

PMS vs. pregnancy symptoms

Wondering whether your symptoms are related to PMS or pregnancy? It can sometimes be difficult to tell. Many of the same symptoms of PMS, like fatigue, mood swings, nausea, food cravings, and even cramping can also indicate early pregnancy.

Although there are subtle differences in PMS symptoms and pregnancy symptoms, the best indication of whether or not you are pregnant is to compare your current experience with those from months prior. Tracking your individual PMS symptoms month over month can help you put your new feelings into context. If you are still unsure, take a home pregnancy test, or talk with your doctor about your questions and concerns.

What Causes PMS?

Doctors don’t know exactly what causes premenstrual syndrome, but many point to its cyclical nature as an indication that natural hormone fluctuations might be behind the PMS symptoms many women experience. Some researchers have suggested that certain women are more sensitive to shifts in hormones than others, which may cause them to feel the effects of PMS more intensely. It is also thought that unclear genetic factors may play a role in developing PMS.

Risk Factors and Complications

Premenstrual syndrome is an extremely common condition, affecting millions of people every month. The symptoms associated with it can range from mildly uncomfortable to painful and severe, but it is very rarely extreme enough to be considered PMDD, dangerous, or life-threatening.

Several risk factors raise the chances of an individual developing PMS. They include:

  • Sex: PMS only affects women, it does not affect men.
  • Age: PMS affects women of reproductive age, and does not affect young girls or women who do not get their period. It may get worse as women enter their late thirties and forties and approach perimenopause.
  • Genetics: Women with a family history of PMS may be likely to develop symptoms themselves.
  • Mental health: Women who have high stress levels or a history of mental health or mood disorders like depression and anxiety may see their everyday symptoms exacerbated by PMS.
  • Smoking, lack of exercise, and lack of nutrition: Poor lifestyle habits can put individuals at risk for developing more intense PMS symptoms.

PMS Treatment

There is no cure for premenstrual syndrome, but if you are suffering from its symptoms, there are steps you can take to treat your discomfort and find relief.

If you are currently experiencing PMS symptoms, these at-home remedies may help, but talk to your doctor before starting any new diet, exercise, or over-the-counter supplement or pain medication regimen.

  • Drink fluids: Stay hydrated to ease abdominal bloating.
  • Eat healthy foods: Cut down on sugar, caffeine, and alcohol to improve your general sense of well-being.
  • Take supplements: Vitamin D, folic acid, calcium, vitamin B6, and magnesium can help reduce symptoms like PMS cramps and mood swings.
  • Take over-the-counter pain medication: Ibuprofen, naproxen, and aspirin have all been shown to help relieve mild PMS headache, body aches, and PMS cramps.
  • Use warm compresses: Place a hot water bottle or warm towel over your stomach to ease PMS cramps.

Changing your everyday lifestyle can also help ease your PMS symptoms. Getting regular exercise, eating a healthy diet, sleeping for eight hours a night, and finding ways to cope with stress have all been shown to help improve PMS. Cognitive behavioral therapy has also been shown to help patients manage their PMS anxiety and other emotions. If you smoke, quitting the habit can help ease your symptoms, too.

If home remedies and over the counter treatments don’t offer relief, your doctor may be able to prescribe medications to help manage your pain. Hormonal birth control has been shown to reduce pain symptoms in some patients, though it can exacerbate discomfort for others. Antidepressant and anti-anxiety medications can help calm your mood swings, and certain diuretics help treat water retention, abdominal bloating, and breast tenderness.

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When to See a Doctor

PMS symptoms are recurrent—meaning they may vary in intensity, but they happen every month. If you are experiencing new or unusual symptoms, if your symptoms don’t go away when you begin to menstruate, or if your symptoms are intense enough to affect the quality of your daily life, call your doctor to make an appointment. You could be experiencing a rare and extreme form of PMS called premenstrual dysphoric disorder (PMDD), or another underlying condition that requires medical treatment.

PMS is very rarely dangerous, but if at any point you begin to experience thoughts of self-harm or suicide, call your doctor or 911 to seek medical treatment immediately.

How K Health Can Help

There may be no cure for PMS, but the condition is treatable. Did you know you can get affordable primary care with the K Health app? Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

John Bernard, MD

Dr. Bernard is an emergency medicine physician. He graduated from Jefferson Medical College in Philadelphia, and did his residency in emergency medicine at the University at Buffalo.