PMS: Signs, Symptoms, and Treatment

Medically Reviewed by Zilpah Sheikh, MD on May 09, 2024
Written by WebMD Editorial Contributor, Stacey Jones, MS, BA
7 min read

Premenstrual syndrome, or PMS, is a cluster of symptoms that usually show up each menstrual cycle a week or two before your period. About 80% of women report having at least one PMS symptom each month. PMS can impact you in many ways. Your symptoms can be physical, mental, or behavioral. Once your period starts or soon after, PMS symptoms usually go away.

PMS vs. PMDD

If your premenstrual symptoms are so intense that they greatly affect your daily life at home or work or your relationships, you may have a more severe form of PMS called premenstrual dysphoric disorder (PMDD). PMDD affects about 2% of those who menstruate. PMDD symptoms are more intense, especially in terms of mood, anger, and anxiety. PMDD is a long-term and serious condition that needs medical attention.

Most people who menstruate have at least one sign of PMS each month. But it’s not the same for everyone and can change as you get older.

Symptoms of PMS

PMS shows up in many different ways. Everything in this list could be a sign of PMS. But most people get just a few of these symptoms, not all:

  • Breast swelling and tenderness
  • Cramps and backache
  • Headache
  • Gastrointestinal issues including constipation, diarrhea, bloating, and gas
  • Irritability or mood swings
  • Depression
  • Fatigue
  • Too much or too little sleep (insomnia)
  • Changes in appetite and cravings
  • Issues with memory or concentration
  • Loss of interest in sex
  • Muscle aches and joint pain
  • Swollen hands and feet
  • Acne
  • Weight gain

Those with PMS deal with it in lots of ways. You can make changes to improve your diet, sleep, and exercise. You can also learn ways to relax your mind and body.

However, if PMS symptoms begin to disrupt your life, you should talk to your doctor.

When do PMS symptoms begin?

Anyone who gets periods can get PMS. But it’s most common in those who:

PMS symptoms usually show up 1-2 weeks before menstruation begins (also called the luteal phase). More typically, symptoms begin about 5 days before the start of your period and stop about 4 days after. Symptoms usually come back around 2 weeks later.

PMS symptoms tend to be consistent for each person, although their severity can vary from month to month.

Even though PMS is common, doctors don’t know exactly what causes it. It probably has to do with changes in your body chemistry around the time of your period.

Some conditions affect PMS but don’t cause it. PMS can be brought on or can get worse if you:

  • Smoke
  • Are under lots of stress
  • Don’t exercise
  • Don’t sleep enough
  • Drink too much alcohol or eat too much salt, red meat, or sugar
  • Are depressed

If you have other health problems, you may find those problems get worse before your period. Some of these are migraine headaches, asthma, and allergies.

There's no test or symptom that can confirm that you have PMS.

If your symptoms appear regularly before your menstrual cycle, it helps your doctor know you have PMS. To see if there's a pattern, your doctor might ask you to keep a symptom diary over several cycles. Keep track of the day your symptoms appear and when they go away. Also, note the days your period begins and ends.

Because the symptoms of PMS may be similar to those of thyroid conditions, chronic fatigue syndrome, or mood disorders, your doctor may ask for other tests to rule out those conditions.

There are lots of ways to manage PMS. Try to:

  • Exercise about 30 minutes a day.
  • Eat nutritious foods such as whole grains, fruits, and vegetables.
  • Get enough calcium from foods (think dairy, green leafy vegetables, and canned salmon).
  • Avoid salt, caffeine, and alcohol.
  • Not smoke.
  • Get enough sleep.
  • Lower stress.
  • Track your moods and symptoms in a journal.
  • Use over-the-counter pain relievers such as ibuprofen, acetaminophen, or naproxen. (Be sure to follow the dosing instructions exactly as it says on the label.

If you’ve tried different things but still have bad PMS, it’s probably time to get help. Make an appointment with your doctor or gynecologist. They’ll ask about your symptoms, your health, and the medicines you take. They may take some blood tests to rule out other problems.

If you have notes about your symptoms, bring them to the appointment. Plan ahead about the questions you want to ask. That way, you’ll get the best help from your doctor.

Your doctor may suggest a treatment plan including:

  • Talk therapy, a way to feel better and learn new skills to overcome challenges by talking with a mental health counselor.
  • Over-the-counter (OTC) medicines
  • Prescription medications

Your doctor has several types of medicine to consider.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are painkillers that can also reduce inflammation (swelling). You can buy NSAIDs such as aspirin, ibuprofen, and naproxen over the counter, or your doctor may prescribe a stronger dosage of these drugs.

Diuretics

If you retain water when you have PMS, you may gain a little weight and feel very bloated. Your doctor might prescribe a diuretic, which is a medicine that helps you shed the extra water weight through natural means (by peeing more often).

Be sure to tell your doctor if you’re taking any other medications, especially NSAIDs. Taking NSAIDs and diuretics at the same time can damage your kidneys.

Antidepressants

There’s a connection between PMS and depression — roughly half of women who go to their doctor for PMS also have depression and anxiety. PMS often causes mood problems, including depression during the time of the month that PMS symptoms appear, even among those who don’t have it at other times.

If your doctor thinks your depression needs treatment, they may prescribe an antidepressant. People respond differently to different antidepressants, so it may take time to find the one that’s right for you.

You may have success with selective serotonin reuptake inhibitors (SSRIs), including:

It can take 3-4 weeks before you see any benefits from an SSRI.

Birth control pills (hormone-regulating pills)

Many of those with PMS have fewer unpleasant symptoms when they take birth control pills. This is probably because, when you take them, you don’t ovulate (release an egg from your ovary each month). Doctors think that not ovulating is probably the reason for milder PMS symptoms.

Taking the pill may also improve your cramps, headaches, or other body aches and help with the way PMS affects your moods.

If you prefer to manage PMS on your own, there are several ways to ease its symptoms:

Change your diet. Eat smaller meals several times a day to ease symptoms of bloating and feeling too full. Reduce salt intake to avoid retaining fluid, which leads to bloating.

Reduce stress. Practice deep-breathing exercises to treat headaches, anxiety, or sleep issues.

Apply warmth. Take a warm bath or shower. Place a heating pad or hot water bottle on your stomach.

Alternative medicine. Alternative remedies may lessen PMS symptoms. Some take vitamins and minerals such as folic acid, magnesium, vitamin B6, vitamin E, and calcium with vitamin D. Others find herbal remedies to be helpful. If you take any vitamins or supplements, check with your doctor first to make sure they are safe for you. Some get PMS symptom relief after acupuncture treatments, in which sterilized needles are inserted at specific points of the body.

A majority of women are estimated to have at least some PMS symptoms during their monthly menstrual cycle. PMS can cause physical, mental, or behavioral changes, as well as symptoms such as sore breasts, bloating, moodiness, and irritability. Most can manage PMS symptoms on their own, but if you find that PMS interferes greatly with your life, contact your doctor.

What triggers bad PMS symptoms?

It's not known what exactly causes PMS, but it's believed that hormonal swings may play a role. And so can fluctuations in the brain chemical serotonin, which could trigger changes in mood, cravings, sleep, and energy levels. Depression may be a cause as well, especially in cases of PMDD, a more severe form of PMS.

Does PMS ever go away?

PMS goes away with pregnancy and menopause -- when periods end.

At what age does PMS start?

PMS can begin at any time after you begin menstruating, but it tends to get worse in your late 30s and 40s when you're in perimenopause, the transition to menopause.

How do you deal with PMS?

Exercise helps, as does a balanced diet. Get 7-8 hours of sleep nightly and try to ease stress with techniques such as yoga or meditation. Limit or avoid alcohol and smoking.