Most people who own vaginas (up to 90%) and who are still menstruating feel mild to moderate physical, emotional, and/or psychological symptoms before their period starts.

You've probably experienced the discomfort.

Abdominal pain. Bloating. Mood changes. Headaches. Fatigue. And the list goes on.

But when these symptoms occur in a predictable fashion, month after month, and have a more serious impact on life, it’s called PMS (premenstrual syndrome).

PMS is a common, misunderstood condition that affects nearly 50% of women around the world and includes an array of symptoms that begin during the luteal phase of the menstrual cycle (after ovulating, before starting your period) and end by the fourth day of your period.

The cause(s) of PMS is anyone’s scientific guess at this point, although changes in hormone levels during the menstrual cycle (and their impact on chemical messengers in the brain, like serotonin) seems to be a leading theory. Genetic and dietary factors might also play a role.

Even if we don’t know the exact cause(s) of PMS, we do know there are several strategies that can help relieve symptoms. For most people, PMS can be managed with modest lifestyle changes: getting more exercise, eating a healthier diet, reducing stress, getting better sleep.

There is a place for medication too, especially for a small number of women who are diagnosed with PMDD (premenstrual dysmorphic disorder), a severe form of PMS that can impact work and relationships and includes serious emotional and psychological symptoms like anxiety, depression, difficulty concentrating, and extreme mood swings.

Common Symptoms of PMS

PMS is personal, and no two people will experience the same symptoms in the same way. Your version of PMS won’t look or feel like hers. Also, symptoms are subjective, and just because someone else might not be overly bothered by occasional bloating or breast tenderness, for example, this doesn’t mean those same symptoms can’t affect you in a much different way. Third, even if the list of potential symptoms is long, most people only experience a few of them.

Physical Symptoms of PMS

• Abdominal pain
• Back pain
• Generalized joint and muscle pain
• Breast tenderness
• Bloating
• Weight gain
• GI issues, like constipation, diarrhea, and/or nausea
• Headaches
• Skin issues, like acne
• Fatigue
• Food cravings, especially for sweet or salty foods
• Swelling in hands and feet

Behavioral/Emotional Symptoms of PMS

• Anxiety
• Depression
• Crying
• Brain fog
• Anger/Irritability
• Mood swings
• Restlessness
• Decreased libido/desire
• Insomnia
• Social withdrawal
• Poor focus and concentration

Diagnosing PMS

There aren’t any unique physical findings or lab tests that point to a positive diagnosis of PMS. Instead, your provider will look for a pattern of symptoms and lean on three elements to help confirm the diagnosis:

• The symptoms should be consistent with PMS.
• The symptoms should occur during the luteal phase of the menstrual cycle, beginning at least five days before your period starts and ending within four days after it starts for three or more consecutive cycles.
• The symptoms should have a negative impact on your normal activities, functioning, and lifestyle.

Once a physician suspects PMS, your provider will usually recommend keeping a diary of PMS symptoms for consecutive months to assess for cycle-to-cycle variability. So, if you experience predictable PMS symptoms that follow a pattern, start keeping a record.

A good diary of symptoms should include: when your symptoms started and ended, what they felt like (rate them from 1-10 and describe them), what made them feel better or worse, how your symptoms impacted your life (missed work, stayed up all night), and when your period started and stopped.

Treatment for PMS

There isn’t a one-size-fits-all treatment plan for PMS, but many women find relief through a combination of lifestyle changes, dietary adjustments, medication, and alternative therapies.

Lifestyle Changes:

• Get moving: 30 minutes of brisk walking or another aerobic activity can help improve overall health and alleviate certain symptoms, such as fatigue and mood.
• Prioritize sleep: Improving your sleep hygiene and getting more restful sleep makes everything better, including PMS symptoms.
• Reduce stress: Whatever works. Yoga. Meditation. Massage. Being alone in nature. Progressive muscle relaxation. Deep-breathing exercises. They all can help.
• Consider counseling: Therapy can be beneficial, particularly if PMS symptoms include depression or mood swings. There are support groups that can provide additional coping strategies.

Dietary Changes:

• Eat smaller, more-frequent meals rich in fruits, vegetables, and whole grains to reduce bloating and fullness and improve GI discomfort.
• Limit sugary and salty foods to fight fluid retention and weight gain.
• Avoid caffeine and alcohol.
• Add calcium-rich foods, like yogurt and leafy-greens, to your diet.

Medication:

• Hormonal birth control: These hormonal birth control stops ovulation and regulate the hormones most responsible for PMS symptoms, which may bring relief.
• Antidepressants: SSRIs (Prozac, Lexapro) are the first-line treatment for PMDD, but for people with less severe PMS symptoms, these meds can also be taken two weeks before your period begins and stopped until the following month.
• NSAIDS: Taking non-steroidal anti-inflammatory drugs (Advil, Aleve, Motrin) before the onset of your period can greatly reduce cramping and breast tenderness.
• Diuretics: When exercise and limiting salt intake aren’t enough to reduce bloating, swelling, and weight gain, diuretics (aka water pills) can help your body shed excess fluid through your kidneys.

Alternative Medicine:

Alternative medicine can be amazing for some people, but since there is a lack of scientific evidence about their efficacy and safety, always consult with your provider before trying out a complementary therapy.

• Supplements: Reports indicate that calcium, magnesium, vitamin E, and vitamin B6 can be beneficial for soothing PMS symptoms.
• Herbal remedies: Some people hold herbs in high regard, including ginko, ginger, evening primrose, and St. John’s wort.
• Acupuncture: Many people swear by the relief they get from this traditional Eastern medicine practice.

PMS is a global burden that impacts half of the female population in the world. While its array of unwanted symptoms can be a challenge, there are many common strategies that can be used to help reduce PMS. Understanding personal triggers and experimenting with different treatment approaches can help people lead more comfortable and productive lives during their menstrual cycles.

Thankfully, most PMS symptoms can be self-managed. But if nothing seems to be helping or if your symptoms take on a more serious tone, it’s important to contact your provider for medical support. Educate yourself and advocate for yourself. Too many women have been conditioned to suffer in silence with PMS symptoms; too many physicians have been conditioned to believe PMS symptoms are simply acceptable.