Premenstrual Syndrome (PMS): Symptoms & Treatment

Many women are affected by premenstrual syndrome (PMS): Before their monthly period, they suffer from typical symptoms such as mood swings, breast tenderness, water retention, abdominal pain, and headaches. PMS can severely impair their quality of life.

Find out more about the causes and symptoms of PMS and what measures can be taken to alleviate the symptoms.

PMS at a glance

PMS is the abbreviation for premenstrual syndrome: it describes symptoms that women can experience before their period.
Typical symptoms of PMS include abdominal pain and headaches, mood swings, irritability, fatigue, water retention, and breast tenderness. These symptoms usually subside during or at the start of menstruation.
For severe symptoms, doctors prescribe medication. Many sufferers find relief through lifestyle changes and relaxation techniques, and some try herbal preparations and dietary supplements.
The causes of PMS are not fully understood. Hormonal fluctuations, neurotransmitters, hereditary predisposition, and lifestyle may all influence PMS.

This article primarily refers to women because only people of the female sex can be affected by PMS. There are various groups of people who were assigned female at birth and who, in addition to women, can be affected by PMS. This applies, for example, to trans men, non-binary people, and intersex people.

What is premenstrual syndrome?

Premenstrual syndrome (PMS) is a set of various physical or psychological symptoms that occur a few days before the monthly menstrual period.

Premenstrual symptoms are very common and affect about half of women of childbearing age worldwide ^[1] .

When does PMS occur?

PMS symptoms appear a few days to two weeks before menstruation. In the second half of the menstrual cycle (also called the luteal phase), hormone levels in the body change: After ovulation, the body produces more of the hormone progesterone, while simultaneously the female sex hormone estrogen drops. When menstruation begins and a new cycle begins, PMS symptoms subside. They disappear completely at the latest when menstruation stops and may not reappear until the next ovulation.

What are the symptoms of PMS?

Most women experience only mild PMS symptoms and can cope well with them. However, some women are severely affected by PMS to the point where they are unable to carry out their normal daily activities during this time. Symptoms sometimes vary from cycle to cycle and can change over the years. PMS can cause physical and psychological symptoms.

Physical symptoms of PMS

The physical symptoms of PMS include:

Water retention in the tissue: The breasts become tense and tender. Some sufferers experience swollen hands, feet, or legs. Body weight may increase, causing those affected to feel bloated.
Lower abdominal pain and cramps
Headaches, migraines, and back pain
Tiredness and exhaustion
Cravings for fatty and sweet foods, sometimes loss of appetite
Impure skin, sometimes acne

Many sufferers also struggle with digestive problems, including bloating, flatulence, constipation, and nausea.

Psychological symptoms of PMS

Psychological symptoms of PMS include:

Mood swings
Sadness, dejection, depressive mood, and even depression
Irritability, anger, and aggressiveness
Lack of motivation, difficulty concentrating
Insecurity, anxiety
Sleep problems

In some cases, the psychological symptoms of PMS are extremely severe. This is referred to as premenstrual dysphoric disorder, or PMDD for short. Women with PMDD react particularly strongly to the hormonal fluctuations of their cycle. In the days before menstruation, they are unusually irritable, tearful, extremely depressed, angry, anxious, or tense.

PMDD has been little researched so far, so the disorder often goes undiagnosed. Approximately three to eight percent of all girls and women suffer from it.

What causes PMS?

The causes of PMS are not yet fully understood. Experts suspect several triggers for the symptoms.

Sensitive to hormonal fluctuations: Some women may be sensitive to the changing hormone levels before menstruation. Hormonal fluctuations could, for example, affect fluid and electrolyte balance, thus promoting water retention.

Altered levels of hormones and neurotransmitters: Experts also suspect that altered hormone levels influence the production and activity of other hormones and neurotransmitters, neurotransmitters. This applies, for example, to the neurotransmitter serotonin: The amount of serotonin fluctuates with the hormonal changes of the menstrual cycle. After ovulation, the level of serotonin in the body steadily decreases. Shortly before the onset of menstruation, it then drops to a low point. This could lead to psychological problems.

Lifestyle: Lifestyle habits, especially diet and exercise, may play a role in PMS: Too much sugar, caffeine, alcohol, smoking, and too little exercise could exacerbate symptoms. Genetic predisposition and environmental factors may also influence PMS.

How is PMS diagnosed?

Anyone who regularly suffers from PMS symptoms and is severely impacted by them in everyday life or social relationships should consult a gynecologist. Doctors will ask about the symptoms and when they occur. They will also try to rule out conditions with similar symptoms, such as depression, thyroid disorders, or irritable bowel syndrome.

To record symptoms throughout the cycle, affected women can keep a diary. They should record all symptoms over at least two to three months. These notes can help doctors determine whether the symptoms are related to the affected person’s cycle.

Tip: These cycle diaries are now also available as smartphone apps. Those affected should continue keeping a diary even while undergoing PMS treatment. This will help them better assess whether the treatment is helping.

After the consultation, a gynecological examination follows. Doctors sometimes perform an ultrasound, and a blood test is also possible. This will determine whether the symptoms are due to hormonal causes. Since most women with PMS have normal hormone levels, normal hormone levels do not rule out PMS.

How is PMS treated?

Unfortunately, PMS cannot be cured, but there are various options for treating the symptoms. These include lifestyle changes, dietary changes, nutritional supplements, medications, and hormone replacement therapy.

If you suffer from PMS, a combination of measures may help you relieve the symptoms – try out what works for you during the PMS phase.

Tip: If you experience severe PMS symptoms, consult your gynecologist, especially if you are interested in certain medications, dietary supplements, or herbal preparations.

Medications and hormones for PMS

For women who suffer from severe symptoms, various medications are available. However, some medications are not approved for the treatment of PMS and can have side effects. Consult your doctor regarding these options.

The following medications are frequently prescribed:

Hormonal medications such as birth control pills or hormone patches: They influence hormone levels and relieve PMS and PMDD symptoms.
Antidepressants: So-called SSRIs (selective serotonin reuptake inhibitors) can help with severe psychological symptoms associated with PMS or PMDD.
Painkillers: Painkillers such as ibuprofen can relieve symptoms such as breast tenderness, headaches, back pain, and abdominal pain and are usually well tolerated.
Diuretics: These can be used to treat severe symptoms caused by water retention.

Women who experience severe psychological distress during PMS can try cognitive behavioral therapy. Studies suggest that the therapy may help those affected.

Dietary supplements for PMS

Many women feel that dietary supplements and herbal preparations like chasteberry help with PMS symptoms. Currently, there are few conclusive studies examining what helps with PMS symptoms. Therefore, it is not yet fully understood whether and which dietary supplements can be effective against PMS.

The following nutrients and herbal supplements are commonly used for PMS:

Calcium and Vitamin D: Vitamin D appears to influence calcium metabolism, certain neurotransmitters, and sex hormones. Studies have shown that calcium deficiency may worsen depression and anxiety.
Vitamin B6: Vitamin B6 may help with PMS symptoms such as mood swings, irritability, forgetfulness, bloating, and anxiety. In one study, vitamin B6 combined with magnesium was able to relieve various PMS symptoms.
Chasteberry: Chasteberry reduces the release of the hormone prolactin. Experts suspect that PMS symptoms such as breast tenderness and pain before menstruation are triggered by prolactin. There are very few high-quality medical studies on this to date. Chasteberry has been used for decades to treat PMS symptoms, and many women find it improves their symptoms. Therefore, the European Medicines Agency (EMA) recommends the use of chasteberry for mild PMS symptoms.

Caution: If you are taking the contraceptive pill , consult your gynecologist about whether you can take chasteberry at the same time. Chasteberry may interfere with the pill’s effectiveness.

Lifestyle for PMS

Women with PMS symptoms often find it helpful to rest and avoid stress during this time.

Regular exercise and sport: A review of several studies suggests that regular exercise can relieve PMS symptoms. Try what works for you.
Relaxation techniques (such as yoga, meditation, mindfulness training)
Do not smoke
Sufficient sleep

Nutrition for PMS

When PMS symptoms occur, you may crave foods high in fat and sugar. These cravings can make it easier for sufferers to gain weight. A change in diet could help prevent obesity and alleviate PMS symptoms. Experts recommend, for example: