Quick version
PMS (premenstrual syndrome) involves both physical and psychological problems that occur in women in the days before menstruation. Common symptoms include mood swings, irritability, depression, breast tenderness, headaches and fatigue. Approximately 75% of all women of childbearing age experience some form of PMS, and up to 30% have symptoms that affect everyday life. A smaller proportion (3–5%) have a more severe form called PMDS, with severe mood problems and depression.
The cause is believed to be a sensitivity to the body's natural hormonal changes during the menstrual cycle, especially the impact on neurotransmitters such as serotonin. Genetics, stress, nutritional deficiencies and mental illness can also play a role.
What is PMS?
PMS (premenstrual syndrome) is a collection of physical and psychological symptoms that occur in the luteal phase of the menstrual cycle – that is, after ovulation and until the start of menstruation. Once menstruation has started, the symptoms usually begin to subside.
PMS is very common – around 75% of all menstruating people experience some form of premenstrual discomfort, while up to 30% have moderate to significant physical and/or psychological symptoms that affect their daily lives. A smaller subgroup, around 3–5%, suffer from a more severe form called PMDS (premenstrual dysphoric syndrome). PMDS is characterized by severe mood swings, significant irritability, anxiety and depression in the days before menstruation. In Sweden, it is estimated that approximately 10% of women of childbearing age desire some kind of treatment for their problems.
Common symptoms of PMS
For some, PMS causes a mild feeling of discomfort, while others are affected so severely that it affects their everyday life and quality of life. PMS can cause a combination of physical and psychological symptoms. Symptoms usually appear about 1–2 weeks before menstruation and disappear when bleeding starts.
Physical symptoms:
- Swelling and tenderness of the breasts
- Headaches or migraines
- Joint and muscle pain
- Swollen stomach or altered bowel function
- Increased appetite or cravings for sweets/carbohydrates
- Fatigue or difficulty sleeping
- Skin problems, such as acne
- Increased sensitivity to sound or light
Mental and emotional symptoms:
- Depression
- Anxiety and worry
- Irritability or anger
- Rapid mood swings
- Difficulty concentrating
- Reduced sex drive
- Feeling of not being able to to reach or to lose control
Causes of PMS
The exact cause of PMS is not fully understood, but researchers believe that it is a combination of hormonal, neurochemical and individual factors.
- Hormonal changes: After ovulation, levels of estrogen and progesterone change. This natural hormonal fluctuation affects the brain's neurotransmitters - primarily serotonin, which regulates mood and emotions.
- Increased sensitivity to hormonal changes: People with PMS or PMDS do not have abnormal hormone levels, but an increased biological sensitivity to the normal hormonal changes that occur during the menstrual cycle. This sensitivity affects the serotonin system in the brain.
- Other contributing factors:
Genetic predisposition
- Stress
- Underlying mental conditions (which can worsen during the luteal phase)
What can be done to relieve PMS?
There are several ways to relieve PMS symptoms, depending on the type and severity of symptoms. For many, lifestyle changes help, while others need medical treatment.
- Exercise and diet: Regular physical activity has a positive effect on both mood and physical symptoms. A varied diet and reduced intake of caffeine, alcohol and fast sugars can help stabilize mood and reduce fluid retention.
- Stress management: Mindfulness, yoga, relaxation exercises and sufficient recovery can relieve psychological symptoms.
- Medication for mild symptoms: Over-the-counter painkillers (such as ibuprofen, naproxen or paracetamol) can relieve period-related pain and headaches.
- Hormonal contraceptives: Some combined birth control pills can help by inhibiting ovulation and providing more even hormone levels over the cycle.
- Medication for severe PMS and PMDS: For more severe symptoms or PMDS, the first choice is often SSRIs (selective serotonin reuptake inhibitors). These can be taken either continuously or only during the period from ovulation to menstruation.
If the symptoms affect your quality of life or relationships, you should seek help through your health center or a gynecologist for investigation and customized treatment.
