Premenstrual syndrome (PMS)
Premenstrual syndrome is the set of physical and emotional changes that turn up in the last week or two of the cycle and clear once a period starts, or within…
On this page
- What it usually looks like
- What matters is not the list of symptoms but their timing
- Why it happens at all
- What looks like PMS but is not
- What helps in everyday life
- Painkillers and supplements
- When to see a doctor and what may be offered
- When it is no longer PMS but premenstrual dysphoric disorder
- Online consultation
Medicines commonly prescribed for Premenstrual syndrome (PMS)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 40 mg/mlActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mgActive substance: ibuprofenManufacturer: Nutra Essential Otc S.L.Prescription not requiredDosage form: TABLET, 30 mgActive substance: citalopramManufacturer: Tarbis Farma S.L.Prescription required
Premenstrual syndrome is the set of physical and emotional changes that turn up in the last week or two of the cycle and clear once a period starts, or within its first days. Most people who menstruate live like this, and on its own that is not an illness. PMS becomes a subject worth raising when those days stop being merely inconvenient: plans collapse, relationships suffer, work gets put off. That is the point at which asking for help makes more sense than putting up with it for another few years.
What it usually looks like
More than a hundred features have been described, and everyone has their own set — steady from month to month, but unlike the next person's. The commonest are:
- mood swings, irritability, flashes of anger, tearfulness;
- anxiety, low mood, a sense that everything is slipping;
- tiredness, trouble falling asleep or, on the contrary, sleepiness;
- absent-mindedness, difficulty holding attention on one task;
- bloating, a dragging ache low in the abdomen and in the lower back;
- breast fullness and tenderness;
- headache and, in some people, a migraine attack;
- cravings for sweet or salty food, a changed appetite;
- fluid retention and a feeling of having gained weight, which passes within days;
- spots on the skin and greasier hair;
- less interest in sex or, less often, more.
Breasts deserve a separate word. Cyclical tenderness and a lumpy feel are ordinary and change with the phase of the cycle. A firm lump that is still there after the period, on the other hand, has nothing to do with PMS and should be examined.
What matters is not the list of symptoms but their timing
None of the symptoms above belongs to PMS alone. What sets it apart is when it appears. The complaints arise in the second half of the cycle, peak in the last days before the period, ease off on the first day of bleeding and vanish completely for a week or ten days. That clear week is the most important part of the picture. If there is no such week and things are roughly as bad all month, this is something else that merely worsens before a period.
So the only reliable way to sort it out is to keep a diary. Not from memory, but day by day: two or three complete cycles, marking the three or four complaints that matter most on a simple scale, along with the days of bleeding. Half an hour of effort in total gives you something no blood test can, and you arrive at the appointment with the answer to the doctor's first question.
Hormone tests are not needed to diagnose PMS and usually show nothing: the levels in the blood are normal. They are ordered not to confirm PMS but to rule other things out.
Why it happens at all
PMS is not about too much or too little of a hormone but about how sensitive a particular brain is to their ordinary swings. After ovulation the progesterone level changes, and its breakdown products act on the very brain systems that govern anxiety, sleep and mood, and on serotonin signalling as well. In some people that shift passes unnoticed; in others it brings on a storm.
The indirect proof is simple: PMS exists only where there is ovulation. It does not occur before puberty, during pregnancy, after the menopause, or in cycles in which ovulation did not happen. One of the treatments rests on exactly that — switching ovulation off for a while.
What makes already difficult days worse: too little sleep, long-running stress, sitting still, smoking, and a lot of alcohol and caffeine. These are not causes, but they are the easiest things to change.
What looks like PMS but is not
Telling them apart matters, because the treatment is different. A diary over a couple of cycles usually settles the question.
- Depression and anxiety disorders. They often worsen before a period, and people take that for PMS. The difference is the clear week: in depression there isn't one, and low mood persists through the first half of the cycle too.
- An underactive thyroid. It causes tiredness, feeling the cold, weight gain, dry skin and low mood, none of it tied to the cycle. A blood test settles it.
- Iron deficiency anaemia. A frequent companion of heavy periods: weakness, breathlessness on exertion, hair fall. Its tiredness builds towards the end of the cycle, which is easy to mistake for PMS.
- Endometriosis and adenomyosis. Here the clue is pain. In PMS it eases as the period starts; in endometriosis those are precisely the worst days, and pain during sex and on opening the bowels is often added.
- Perimenopause. From the mid-forties cycles become irregular, symptoms lose their link to a phase, and hot flushes and night sweats appear.
- Migraine. In some people attacks are tied to the drop in oestrogen before a period. That is a condition in its own right with its own treatment, and it does not stop at painkillers taken when it hurts.
What helps in everyday life
This is where treatment starts, and for many people it is enough. The effect does not show in a single cycle, so judge it after about three months using the same diary.
Movement. Regular aerobic exercise is the best evidenced of the non-drug measures. It is the habit that works, not a one-off effort: half an hour of brisk walking, swimming or cycling several times a week. It tells most on irritability and low mood.
Sleep. Short sleep makes everything worse at once. What helps is less the total number of hours than a constant time of getting up — weekends included, and precisely on the days when getting up is hardest.
Food. Sharp swings in blood sugar make irritability and cravings worse, so it is better to eat smaller amounts more often and not skip meals. It is worth going easy on salt on the days when fluid retention is marked.
Caffeine, alcohol, nicotine. Coffee adds to anxiety and sleeplessness; alcohol spoils sleep and drags the mood down the next day. Smoking is linked to more severe PMS, which is one more argument for stopping.
Handling stress. Breathing exercises, yoga and mindfulness practice help some people. And a practical suggestion: schedule fewer difficult conversations and decisions for those days. That is not surrender, it is sensible use of your strength.
Painkillers and supplements
For cramping low in the abdomen, backache and headache, non-steroidal anti-inflammatory drugs such as ibuprofen and its relatives work well. They work better taken at the start of the pain rather than when it has become unbearable. The usual cautions apply: they irritate the stomach lining, hold on to fluid, and are unsuitable if there is a peptic ulcer, serious kidney disease, or asthma that has ever flared after a painkiller. They are not taken in long courses. If they are not an option, paracetamol remains, though it is weaker against cramps.
With supplements the picture is more modest than the advertising suggests. The most meaningful evidence is for calcium, which slightly softens both the physical and the emotional side, particularly if there is little dairy in the diet. For magnesium, evening primrose oil and agnus castus extract the evidence is weaker and contradictory. Vitamin B6 sometimes helps, but it is exactly the one to be careful with: in large doses and over long periods it damages the peripheral nerves and causes lasting numbness in the hands and feet. Do not exceed the dose stated on the packet, and mention what you take to a doctor, because supplements interact with medicines.
When to see a doctor and what may be offered
The reason to go is straightforward: the symptoms are affecting your life, or home measures have not worked over several cycles. There is no need to endure it for years; treatment exists.
What is usually offered. Combined hormonal contraception removes ovulation and with it the swings that drive the symptoms; it works better taken continuously, without the usual break, because it is during the break that the complaints come back. Antidepressants of the selective serotonin reuptake inhibitor group behave differently here than in depression: a noticeable effect arrives within days, which is why they are sometimes prescribed for the second half of the cycle only, and they help mainly with the emotional symptoms. Cognitive behavioural therapy matches medication for results and has no side effects, but it takes time and regular attendance.
If none of that works, your doctor will refer you on, to a gynaecologist or to mental health services. In severe cases drugs are used that switch the ovaries off temporarily, always together with treatment that gives the hormones back, because otherwise the bones suffer. That is a decision for a narrow set of situations, and always after everything else has been tried.
When it is no longer PMS but premenstrual dysphoric disorder
In a small proportion of people the premenstrual days are incomparably harder. That is recognised as a condition in its own right, premenstrual dysphoric disorder. The word dysphoric is the key one: this is not about being in a bad mood but about marked mental distress.
It is marked by deep low mood and hopelessness, intense anxiety and inner tension, uncontrollable irritability that wrecks relationships, complete loss of interest in ordinary things, and a feeling of having lost control of oneself. All of it, as in PMS, is tied to the second half of the cycle and lets go once the period starts — but during those days the person cannot cope with work or family. It is treated with the same means as severe PMS; the difference is that with this one it is not worth waiting to seek help.
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine, 112) or go to the emergency department if thoughts of suicide or of harming yourself appear. Do not drive yourself — ask someone to take you or call for help. Take any medicines you are on with you. This is not something to sit out until the end of the week.
Online consultation
PMS is a condition that is worked out almost entirely by talking, and an examination is usually not needed for the first step. That makes an online appointment a good fit: the doctor will read the symptom diary with you, see whether it fits the cycle, and separate PMS from depression, a thyroid problem, anaemia or endometriosis.
Have ready a diary covering at least two cycles, the dates of recent periods, a list of the medicines and supplements you take (contraception included) and any recent blood tests. Say what you have already tried and how it went — that saves repeating what did not help.
At the end the doctor will say what is worth checking, suggest a treatment and explain when to judge its effect. If an examination, a scan or a face-to-face gynaecology appointment is needed, you will be told that too.
This material is for information only and does not replace medical advice.
Consult with a doctor about Premenstrual syndrome (PMS)
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Premenstrual syndrome (PMS)
Discuss your symptoms and possible next steps for Premenstrual syndrome (PMS) with a doctor online.
