What Is Premenstrual Syndrome (PMS)?
Published on May 16, 2025
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Premenstrual syndrome (PMS) is a collection of physical and emotional symptoms that occur during the week or two before a menstrual period. Falling levels of the hormones estrogen and progesterone after ovulation are the most likely cause of these symptoms.
The majority of women will experience PMS symptoms at some point in their reproductive years. Symptoms range from mild and annoying to severe enough to interfere with daily life.
PMS is tied to menstrual periods, so symptoms of PMS should end completely when periods stop after menopause or during pregnancy.
Signs and Symptoms of Premenstrual Syndrome (PMS)
PMS causes both physical and emotional symptoms. Every person has a unique experience with PMS, and symptoms can change during different stages of life.
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Emotional symptoms of PMS include:
- Depression
- Irritability and anger
- Crying
- Anxiety
- Trouble concentrating
- Loss of interest in sex
- Sleeping too much or too little
- Food cravings or appetite changes
Physical symptoms include:
Causes and Risk Factors of Premenstrual Syndrome (PMS)
The exact cause of PMS is unknown. It's likely that hormone changes during the menstrual cycle are behind these symptoms. Normally, levels of estrogen and progesterone rise in the early part of the menstrual cycle to prepare a woman's body for pregnancy. If a pregnancy doesn't occur, hormone levels drop and the uterine lining sheds in a period.
Declining estrogen levels cause lower levels of the brain chemical serotonin, which plays a role in mood, sleep, sexual desire, and other body functions. Having less serotonin may contribute to PMS symptoms. Certain lifestyle factors, including eating junk food, drinking coffee, not exercising, and not sleeping well, are associated with PMS. It is difficult to know whether these are causes of PMS symptoms or a result of PMS itself.
A history of postpartum depression, a history of anxiety or depression (in yourself or your family), and high levels of stress can also increase your risk for PMS.
How Is Premenstrual Syndrome (PMS) Diagnosed?
There are no specific tests for PMS, but other tests can rule out conditions with similar symptoms, such as thyroid disease or a mood disorder like depression or anxiety.
Doctors usually diagnose PMS based on symptoms alone. Tracking your PMS symptoms in a calendar or app for two months can help your doctor more accurately diagnose you. Write down when your symptoms start and how long they last each menstrual cycle.
To meet the diagnostic criteria for PMS, symptoms have to:
- Start within five days before a period and happen at least three months in a row
- Stop within four days after the period starts
- Affect at least some daily activities
Treatment and Medication Options for Premenstrual Syndrome (PMS)
Many women can manage PMS with lifestyle changes alone. Medications help with more severe or bothersome symptoms.
Medication Options
PMS treatments include a combination of over-the-counter and prescription medicines that relieve both physical and emotional symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve) help with symptoms like headaches, cramps, and breast soreness. You can take an NSAID at the start of or right before your period to reduce these symptoms. Avoid using these medicines long-term, because they can cause side effects like stomach bleeding and ulcers (sores).
- Hormonal birth control methods like the pill stop ovulation, which may lessen PMS symptoms. You may need to try a few types of birth control to find one that helps.
- Antidepressants improve depression and other mood changes related to PMS, but they don't work for everyone. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft) are the antidepressants most often used for PMS. To prevent PMS-related mood changes, many women only use them in the two weeks before a period, whereas others take them daily.
- Diuretics, also called water pills, remove extra fluid from the body. They can help with symptoms like bloating and breast soreness. Diuretics should not be combined with NSAIDs, as they may cause kidney problems when taken together.
Complementary and Integrative Therapies
Some people take herbal supplements like evening primrose oil, black cohosh, chasteberry, or St. John's wort to relieve their PMS symptoms. While some supplements do seem to help, others either haven't been studied in clinical trials or don't have enough evidence to confirm that they work. Because the Food and Drug Administration (FDA) doesn't regulate supplements like it does medications, talk to your doctor before trying any natural products.
These vitamins and minerals have more evidence to support their use for PMS:
- Calcium may help with symptoms like tiredness, food cravings, and depression.The recommended dose is 1,200 milligrams (mg) a day, which can come from foods like dairy (milk, cheese, yogurt) and fortified products (juice, cereals), or from a supplement.
- Vitamin B6 might be helpful for mood changes, anxiety, irritability, and bloating. This vitamin is found in foods like fish, chicken, potatoes, and fortified cereals, or you can get it from a supplement. The recommended dose for PMS is 50 to 100 mg daily.
- Magnesium is thought to reduce bloating, breast soreness, mood symptoms, and menstrual migraines. This mineral is found in foods like leafy green vegetables (spinach), whole grains, nuts, and fortified cereals.
- Omega-3 fatty acids from fish, flaxseeds, and leafy green vegetables may be helpful for reducing cramps.
Some people find these complementary practices helpful for relieving PMS symptoms:
- Yoga Not only does this series of poses strengthen the body, it also improves PMS symptoms like bloating, sore breasts, and cramps.
- Meditation Focusing and calming the mind with meditation reduces stress, which may be helpful for PMS symptoms.
- Massage Therapy This treatment is used to reduce stress, release muscle tightness, and help you relax.
- Biofeedback In this treatment, you're connected to a device that helps you learn how to control body functions such as heart rate, breathing, and muscle activity. Biofeedback helps to promote a state of relaxation.
- Self-hypnosis With this technique, you put your mind into a deep state of relaxation and then use the power of suggestion to change behaviors and improve symptoms.
Lifestyle Changes for Premenstrual Syndrome (PMS)
Lifestyle changes like exercising, eating a nutritious diet, sleeping well, and not smoking may reduce PMS symptoms or make them more manageable. Sometimes these changes alone are enough to relieve symptoms.
Eat a Well-Balanced Diet
Focus on foods that are rich in nutrition, such as vegetables, fruits, whole grains and legumes (brown rice, beans, whole wheat bread), and dairy products (milk, yogurt). Cut back on fat, sugar, and salt. Eating more complex carbs like leafy green vegetables and whole grains keeps blood sugar levels steady, and may help with moodiness.
Drink more fluids, especially water. Avoid sugary sodas, alcohol, and caffeinated beverages. Some women find that they feel better when they eat smaller meals or snacks throughout the day instead of three large meals. Eating this way keeps blood sugar levels steady, which can help with food cravings and mood.
Stay Active
Aerobic exercises like walking, jogging, bike riding, and swimming are good for the heart, lungs, and the rest of your body. Being active also improves energy levels and mood. Yoga is a mind-body form of exercise that can help with anxiety and stress.
Ideally, try to get at least 30 minutes of exercise on most days of the week. The general recommendation by the American Heart Association for adults is 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week.
Practice Good Sleep Hygiene
A lack of sleep can worsen PMS mood symptoms. The goal is to get eight hours of sleep a night, but that can be hard to do. Hormone changes in the weeks leading up to a period can lead to sleepless nights. "Period insomnia" is the name for sleep issues related to the menstrual cycle.
To sleep longer and more soundly, try these tips:
- Keep your bedroom dark, quiet, comfortable, and cool.
- Try to go to bed and wake up at the same time each day.
- Exercise for 30 minutes early in the day, preferably outside where you're exposed to sunlight.
- Avoid known sleep disrupters like alcohol and caffeine before bedtime.
- Do something calming before bed, like taking a warm bath, reading a book, or meditating.
Stop Smoking
Along with its other harmful health effects, smoking increases the risk of PMS and makes its symptoms worse. Quitting is easier said than done because tobacco is very addictive. A doctor can offer advice on methods to help you stop smoking.
Premenstrual Syndrome (PMS) Prognosis
PMS symptoms can range from mild to severe enough to disrupt your daily life. With treatment, most people get relief from symptoms. PMS should improve on its own once your period starts.
After menopause, when periods stop, you should no longer have to deal with PMS symptoms. Women who have their ovaries removed before menopause, called oophorectomy, will no longer have PMS.
How Many People Have Premenstrual Syndrome (PMS)?
Up to 75 percent of women have at least some PMS symptoms during their reproductive years. Between 3 percent and 8 percent of women have severe PMS symptoms.
Premenstrual dysphoric disorder (PMDD) is a more severe and less common form of PMS. It affects between 5 percent and 10 percent of women during their reproductive years.
Related Conditions to Premenstrual Syndrome (PMS)
Other conditions may worsen during the same time period as PMS, due to the hormonal changes occurring in the body. You might experience worse migraine attacks, asthma, allergies, and seizure disorder at the same time as PMS.
These mental health conditions often occur together with PMS:
- Major depressive disorder is persistent sadness and loss of interest in daily activities.
- Dysthymic disorder is a milder, long-term form of depression.
The Takeaway
- Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that occur a week or two before a menstrual period.
- About 75 percent of women experience PMS at some point during their reproductive years.
- Treatments like NSAIDs, birth control pills, and antidepressants help to relieve PMS symptoms.
- Some women find that lifestyle changes like exercise, a well-balanced diet, and relaxation techniques improve their symptoms.
Common Questions & Answers
What are the symptoms of premenstrual syndrome (PMS)?
PMS includes both physical symptoms, like bloating, headache, and breast soreness, and emotional symptoms such as mood swings, anxiety, and difficulty sleeping.
How many days before your period does PMS start?
PMS typically starts one to two weeks before a period, but the timing can vary from person to person and from month to month.
How is PMS diagnosed?
The diagnosis of PMS is usually based on symptoms. Keeping a symptom diary can help your doctor make an accurate diagnosis.
What is premenstrual dysphoric disorder (PMDD)?
PMDD is a more severe form of PMS that affects a small percentage of women around the time of their period.
Resources We Trust
- Mayo Clinic: Premenstrual Syndrome (PMS)
- Office on Women's Health: Premenstrual Syndrome (PMS)
- The American College of Obstetricians and Gynecologists: Premenstrual Syndrome (PMS)
- Mind: Premenstrual Dysphoric Disorder (PMDD)
- International Association for Premenstrual Disorders (IAPD): Support
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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Meet Our Experts
Kara Smythe, MD
Medical Reviewer
Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.
She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.
Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.
When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.
Stephanie Watson
Author
Stephanie Watson is a freelance health writer who has contributed to WebMD, AARP.org, BabyCenter, Forbes Health, Fortune Well, Time, Self, Arthritis Today, Greatist, Healthgrades, and HealthCentral. Previously, she was the executive editor of Harvard Women’s Health Watch and Mount Sinai’s Focus on Healthy Aging. She has also written more than 30 young adult books on subjects ranging from celebrity biographies to brain injuries in football.