Premenstrual syndrome (PMS) describes a range of physical and psychological symptoms that can occur in the two weeks before a woman has her period (also known as menstruation).
Most women experience some level of symptoms due to PMS in the two weeks before their period begins. Symptoms generally improve within a day or so of a period starting.
While PMS symptoms are generally relatively mild and manageable, for some women they can be severe to the point where they cause distress and disrupt normal activities.
The periodic shedding of the lining of a woman's uterus. Typically occurring about every four weeks between puberty and menopause (except during pregnancy). The menstrual period varies between individuals, but typically lasts 3-5 days.
Relating to, arising in, or affecting the mind.
PMS can have a wide range of symptoms.
Physical symptoms of PMS can include:
Psychological symptoms can include:
A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.
A state of exhaustion and weakness.
Relating to, arising in, or affecting the mind.
A menstrual cycle lasts an average of 28 days, although it can be longer or shorter in different women and vary with each cycle. Control of the menstrual cycle is complex, involving a range of glands and hormones.
In every cycle, about two weeks before the period begins, an egg (ovum) is released from the ovaries. This is called ovulation. Following ovulation, the ovaries release hormones called progesterone and estrogen. These help to prepare and maintain the lining of the uterus so an egg can attach to it if it is fertilized.
If a pregnancy doesn't occur and an egg does not attach, the hormone levels reduce. The uterus sheds its lining and the period begins.
The cause of PMS has not been clearly established. Some research suggests that the changes in levels of female sex hormone levels (such as estrogen and progesterone) are much the same in women who experience significant levels of PMS symptoms and those that don't. It may be that women who experience greater levels of symptoms are more sensitive to changes in hormone levels.
The menstrual cycle.
Any organ of the body that secretes substances, such as hormones or enzymes, that are used by other parts of the body.
A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.
One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.
The phase of the female menstrual cycle during which an ovum (egg) is released from one of the woman's two ovaries.
A mature female reproductive cell that is released from the ovary during ovulation, also called an egg.
The hollow organ of the female reproductive system that is responsible for the development of the embryo and fetus during pregnancy. Also known as the womb.
PMS may be more common in women who:
Lifestyle factors may also contribute to various symptoms experienced with PMS.
For example:
A state of exhaustion and weakness.
Relating to, arising in, or affecting the mind.
The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.
Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Around 8% of all women are affected by PMDD [1] .
While the symptoms in PMDD are similar to PMS, they tend to:
In severe cases of PMDD, some women may experience suicidal thoughts. If you or someone else is in immediate danger of suicide, you can call 911.
Other ways of finding help include:
Relating to, arising in, or affecting the mind.
Premenstrual conditions. The Royal Women’s Hospital. Accessed 18 August 2014 from
There is no single test for PMS. Diagnosis is made slightly more complex because:
Your doctor will ask questions about your medical history, your mental health history and your symptoms. You may be asked to keep a diary in which you record your symptoms for a number of months, so that it can be clearly established that your symptoms are worse in the couple of weeks before your period.
Other tests may include:
Your doctor may refer you to a mental health specialist for assessment.
A state of exhaustion and weakness.
An examination performed by your doctor or nurse that involves a speculum examination with a duck-bill instrument and an internal examination in which they may put two gloved fingers inside your vagina to check for lumps or tender regions.
Depending on the severity of your symptoms, a number of approaches to treating PMS may be recommended.
If your PMS symptoms are mild, they may be alleviated or managed by a range of lifestyle measures.
There are a number of dietary changes you can make to help reduce PMS symptoms:
If you are unable to get sufficient calcium through the foods you consume, your doctor may recommend a calcium supplement.
Pyroxidine (vitamin B6) and magnesium may be of some benefit for some women with PMS. Your doctor can discuss whether supplements are suitable for you.
Regular physical activity can help to reduce stress and improve symptoms of depression and anxiety. Thirty minutes a day of moderately vigorous exercise (such as walking, cycling or swimming) can offer a range of health benefits.
Physical activity can alleviate symptoms of premenstrual syndrome.
A range of complementary therapies may be helpful for some women in reducing stress, which can worsen symptoms of PMS. Examples include meditation and self-hypnosis.
There is evidence that a herb called vitex agnus castus (also known as chasteberry) may be helpful in reducing symptoms of PMS. A range of other dietary supplements have been suggested for relieving PMS, including evening primrose oil, black cohosh and ginkgo biloba. Evidence does not show that these are effective. Herbal supplements can also interact with other medications, so it is important to discuss them with your doctor before you start herbal medications.
Psychological therapy is sometimes referred to as 'talking therapy' and describes the process of treating mental health problems by helping people to understand their condition and manage their symptoms.
Therapies such as cognitive behavior therapy may be helpful for women with PMS or PMDD to alleviate anxiety, depression and stress.
If lifestyle and other measures cannot alleviate the symptoms of PMS effectively, medications may be recommended.
Antidepressants are the most common medications prescribed for PMS. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline have been found to be effective in treating symptoms of PMS and PMDD. They increase levels of serotonin, a chemical messenger in the brain that helps to elevate mood. SSRIs may be taken every day, or they may be taken only during the two weeks of the menstrual cycle when symptoms occur.
Other antidepressant medications may be recommended if SSRIs are not effective.
Oral contraceptives, such as the Pill, can stop ovulation and improve some symptoms of PMS for some women, although they are not effective for everyone and can also cause side effects that are similar to PMS, such as depression and breast tenderness.
Contraceptive medications are taken every day. They generally have an active version (taken for 21 days) and an inactive version (taken for seven days) so that you have a period.
Oral contraceptives also prevent pregnancy and it is important to take them as recommended by your doctor or they may not be fully effective.
Oral contraceptives can improve some symptoms of PMS.
These medications stop ovulation and stop the ovaries from producing estrogen and progesterone. They effectively create an artificial and temporary menopause and can cause menopause-like symptoms such as vaginal dryness and hot flushes.
GnRH analogues are delivered by injections and are generally only recommended if all other treatments are not effective. You may also be recommended hormone replacement therapy (HRT) if you are using these medications on an extended basis.
A feeling of tension, nervousness and dread about future events. It can trigger physical symptoms such as a rapid pulse or breathing difficulties.
A chemical element, important for many biological functions. Particularly central to maintaining bone and tooth health.
A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.
The use of either synthetic or natural hormones from external sources by women going through menopause.
One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.
The phase of the female menstrual cycle during which an ovum (egg) is released from one of the woman's two ovaries.
The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.
An important mineral that is essential for the development of bones and teeth, energy production and muscle contraction.
Most women can manage symptoms of PMS with lifestyle measures. For severe symptoms, medications can help. Symptoms of PMS generally improve after menopause.
The lifestyle measures listed above may help to prevent some PMS symptoms.