In short
PMS is a pattern of physical and emotional symptoms in the one to two weeks before a period that ease once bleeding starts. Most women notice some premenstrual changes, and for about 5 to 8 in 100 they are severe. It is caused by sensitivity to normal hormone changes. Exercise, CBT and several medical treatments can help.
On this page
What is PMS?
Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that appear in the one to two weeks before your period, ease within a few days of bleeding starting, and are gone for at least a week afterwards. The timing is what defines it. Symptoms that are there all month are something else.1,2
Most women of reproductive age notice some premenstrual changes. For about 5 to 8 in every 100, symptoms are severe enough to interfere with work, study or relationships.1
PMS symptoms
Emotional symptoms are usually the most distressing:1
- Irritability and a short temper
- Tension or anxiety
- Low mood and tearfulness
- Mood swings
- Trouble concentrating
Physical symptoms include:
- Bloating and fluid retention
- Breast tenderness
- Headaches
- Tiredness and poor sleep
- Food cravings
- Aches and cramps
When the mood symptoms are severe, the diagnosis may be premenstrual dysphoric disorder (PMDD).
Symptoms getting in the way of your day?
Talk it through with an Australian doctor online. No referral needed.
What causes PMS?
PMS isn’t caused by having too much or too little of a hormone. Hormone levels in women with PMS are the same as in women without it. The difference is how the brain responds. In a landmark experiment, researchers switched off the ovaries of women with and without PMS and then gave both groups the same hormones back. Only the women with PMS developed symptoms, which showed that PMS is an abnormal response to normal hormone changes.3
That is why PMS stops during pregnancy and after menopause, when the monthly cycle stops.
How is PMS diagnosed?
There is no blood test. The most reliable method is a daily symptom diary kept for at least two cycles, which shows whether symptoms follow the premenstrual pattern. UK specialist guidance recommends completing the diary before starting treatment, because memory tends to blur the timing.2
A diary also helps separate PMS from conditions that flare before a period but don’t go away afterwards, such as depression, anxiety and migraine.
What helps PMS
- Exercise. A review of 15 randomised trials found exercise may reduce PMS symptoms, though the trials were small4
- Cognitive behavioural therapy (CBT). A meta-analysis found CBT may have important benefits for mood and functioning, with the caveat that the evidence was low quality5
- Calcium. In a trial of 466 women, a daily calcium supplement cut symptom scores by 48 per cent by the third cycle, compared with 30 per cent on placebo6
- Hormonal treatments. Some forms of hormonal contraception, and other treatments that suppress the cycle, reduce symptoms for many women1,2
- Prescription medicines that act on serotonin. These are well established for severe PMS and can be taken all month or only in the second half of the cycle1,2
Many supplements are sold for PMS. Apart from calcium, there is little good evidence for most of them, and it is worth checking with a pharmacist or doctor before starting one.7
Looking after yourself
Regular sleep, cutting back on alcohol and caffeine in the second half of your cycle, and planning demanding tasks around your pattern can make the premenstrual week easier to manage. If period pain is part of the picture, see period pain relief.8,9
When to see a doctor
- Symptoms that affect your work, study or relationships most months
- Symptoms that don’t clear up in the week after your period
- Feeling hopeless, or out of control, before your period
If you are having thoughts of harming yourself, call Lifeline on 13 11 14, or 000 in an emergency.
Next step: talk to a doctor
Answer a few quick questions and you’ll get an email about your eligibility. A consultation doesn’t guarantee any particular treatment.
References
- Yonkers KA, O'Brien PM, Eriksson E. Premenstrual syndrome. Lancet. 2008;371(9619):1200-10.
- . Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG. 2017;124(3):e73-e105.
- Schmidt PJ, Nieman LK, Danaceau MA, et al. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998;338(4):209-16.
- Pearce E, Jolly K, Jones LL, et al. Exercise for premenstrual syndrome: a systematic review and meta-analysis of randomised controlled trials. BJGP Open. 2020;4(3).
- Busse JW, Montori VM, Krasnik C, et al. Psychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials. Psychother Psychosom. 2009;78(1):6-15.
- Thys-Jacobs S, Starkey P, Bernstein D, et al. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 1998;179(2):444-52.
- healthdirect. Premenstrual syndrome (PMS).
- Jean Hailes for Women’s Health. Premenstrual syndrome (PMS).
- Better Health Channel (Victorian Government). Premenstrual syndrome (PMS).
This guide is general information, not medical advice. It doesn’t replace a consultation with a doctor who knows your history. In an emergency, call 000.