What is Premenstrual Syndrome (PMS)?

Medically reviewed by May 30, 2024| Written by

What is Premenstrual Syndrome (PMS)?

Premenstrual syndrome (PMS) is when a woman experiences noticeable physical and emotional changes in the days leading up to her period. These changes happen after ovulation and before the start of the menstrual period. 

PMS can cause considerable discomfort and may affect a woman’s daily activities. Suddenly she feels two sizes bigger, her boobs hurt, and she may be in an irritable mood.

About 47.8% of women of reproductive ageexperience PMS worldwide. Of these, 20% suffer severe symptoms disrupting their daily activities; while the remaining 80% experience mild to moderate symptoms.

PMS symptoms usually go away within a few days after the onset of a woman’s period. Meanwhile, periods come to a halt after menopause and during pregnancy.

Severe PMS symptoms may be a sign ofPremenstrual Dysphoric Disorder (PMDD) -  a condition that affects less than 5% of women. PMDD is classified as a mental disorder.

What are the Symptoms of PMS?

PMS is miserable. So much so, that sometimes you don't know what's worse PMS or the period. 

PMS has a wide range of physical and emotional symptoms. They are different for every woman and they can change throughout your menstruating years. Here is a long list of physical and emotional symptoms that can plague a woman before her period: 

Common Physical Symptoms 

  • Swollen or tender breasts
  • Bloating 
  • Headache or backache
  • Weight gain because of fluid retention
  • Clumsiness
  • Acne breakouts
  • Feeling tired
  • Constipation or diarrhea
  • Cramping

Emotional or Mental Symptoms 

  • Irritability
  • Unreasonableness 
  • Mood swings like crying spells
  • Trouble concentrating 
  • Forgetfulness
  • Tension or anxiety
  • General feelings of depression or sadness 

Behavioral Symptoms

  • Lower tolerance for noise or light
  • Food and coffee cravings
  • Craving for sweet foods
  • Leaning toward junk food
  • Disrupted sleep patterns
  • No or little interest in sex (or the opposite!)

What Hormone Causes PMS?

PMS is poorly understood, but the syndrome seems to involvea mix of factors. On the one hand, progesterone might affect certain brain chemicals like GABA, opioids, serotonin, and catecholamine that contribute to PMS symptoms. On the other hand, factors like changes in prolactin levels, glucose metabolism, and stress can also contribute to PMS symptoms by affecting things like uterine contractions.


There is no test for the diagnosis of PMS. Rather, for PMS to be diagnosed, you must have physical symptoms, such as tender breasts or a bloated stomach, as well as emotional symptoms like moodiness or unexplained sadness. You experience these symptoms before your period starts and they disappear as soon as your period starts.

If you plan to see your healthcare provider about your PMS, it will be helpful to keep a diary of your periods, the start and end dates, and any mood swings or physical symptoms you experience. This information can help the doctor with a diagnosis.  

Depending on the information you provide, your doctor may order tests to rule out other health issues that might also affect how you feel. For example, if you are very bloated and uncomfortable, the doctor might want to have you tested forIBS or Irritable Bowel Syndrome.

Does PMS Affect Other Health Problems?

Certain health conditions tend to worsen before a menstrual period. When the symptoms of a preexisting chronic disease or mood disorder get worse before a period, it is called Premenstrual Exacerbation (PME). 

For example, a person who hasirritable bowel syndrome (IBS) may notice that symptoms, like cramping, bloating, and gas worsen before their periods.This could be due to PME.

Or, a woman who is on treatment for depression might find that before her period starts, her depression gets worse, and if she is taking medication for it, it is not as effective.

PME may also worsen the symptoms of:

  • Bipolar Disorder
  • Depression OCD
  • Post-traumatic stress disorder 
  • Borderline personality disorder
  • Eating disorders
  • Schizophrenia
  • Migraine
  • Asthma
  • Eczema
  • Epilepsy
  • Chronic fatigue syndrome
  • Irritable bowel syndrome (IBS)
  • Bladder pain syndrome 

How Do You Know that You Have PME?

You will know that you havePMEif the symptoms of your chronic illness worsen a few days before your period starts or if your condition doesn't respond in the same way to medication. But you get better as soon as you start menstruating.

PME is poorly understood, and very little research has been done on the issue. The condition is not recognized as an official diagnostic specifier in the Diagnostic & Statistical Manual of Mental Disorders (DSM-5).

Doctors don't usually treat PME as such, preferring to treat the underlying condition rather than adding additional treatments for a few days of the month.  

Can Lifestyle Changes and Diet help with PMS?

There are a few things you can try to make life easier for yourself when you feel those blue days that announce the arrival of your period. I know you want (and you're going) to reach for something sweet for comfort.

Go ahead; a lady’s gotta do what a lady’s gotta do!

Apart from this, you can make your PMS experience more bearable by increasing your calcium intake, managing your stress, and getting enough exercise and sleep.  Also, make sure you have abalanced diet, and limit your intake of coffee, alcohol, salt, and sugar.

Try focusing on the following strategies for optimum experience: 

1. Eliminate Stress as far as Possible

Women who feel stressed in the weeks before menstruation could experience worse PMS and menstrual symptoms. One study showed that women who reported feeling stressed two weeks before they started menstruating, weretwo to four times more likely to report moderate to severe symptoms than women who did not feel stressed.

Healthy ways to cope with stress include spending time with friends, doing yoga, taking a massage, meditating, going for a walk, or keeping a diary. Find what works for you and manage your stress levels.

Additionally, you can check out our guide onStress to understand what’s causing you stress and various techniques to get rid of it.  

2. Get Aerobic Exercise

It is common knowledge that aerobic exercise benefits people both physically and psychologically. Exercise keeps the body in shape, and improves mood and sleep. 

A study from Iran showed that8 weeks of regular aerobic exercise had a positive impact on physical and psychological symptoms of PMS among female non-athletes. The findings of this study are aligned with other studies that indicate that aerobic activity reduces PMS symptoms.

3. Get a Full Eight Hours of Sleep

Women who experience PMS every month are twice as likely to struggle with sleep during PMS. Getting at least eight hours of sleep these days requires self-discipline. You have to make up your mind to go to bed early and then take the usual precautions to ensure a good sleep, such as avoiding coffee, alcohol, and heavy meals at night.

If you tend to feel depressed, lack of sleep will make you feel worse. So, ensure you get enough sleep during PMS.

Natural Remedies for the Relief of PMS

Though PMS lasts only for a few days a month; it can put a damper on life. Sudden mood swings and irritability can be difficult to deal with and so, PMS can affect interpersonal relationships at home, work, or school. So, finding a treatment that helps you feel better is crucial.

Sometimes doctors prescribe selective serotonin reuptake inhibitors (SSRIs) and other medications to treat the symptoms of PMS. Apart from these, scientists are also studying the following six natural remedies for PMS: 

1. Saffron

In addition to being the most expensive spice in the world, saffron has also been studied as a supplement for treating several conditions, including depression, anxiety, blood pressure, weight loss, appetite, and PMS.

A trial conducted in 2008 found that saffron waseffective in relieving symptoms of PMS, but the researchers said that more studies are needed.

A systematic review that looked at the effectiveness and safety of Iranian herbal medicines for the treatment of PMS, lists saffron as aneffective and safe herbal medicine for the relief of PMS symptoms.

2. Ginkgo Biloba

Ginkgo biloba is native to China where it has been used in traditional Chinese medicine for centuries. Gingko Biloba extract EGb 761 has been studied as a possible treatment for several conditions, including PMS, chronic schizophrenia, dementia, and ischemia.

In another trial research participants experienced a significantdecrease in the overall severity of physical and psychologic PMS symptoms after treatment with 40mg Ginkgo biloba leaf extract three times a day.

3. Vitex agnus castus

The Vitex agnus-castus supplement is made from the plant’s berries. Multiple scientific studies have shown that Vitex agnus castus canalleviate PMS symptoms. Studies have shown that the supplement is effective at reducing hot flashes, bloating, irritability, sleep disturbances, depression, various mood disorders, and cramping associated with PMS.

In another study, scientists found that40 drops of Vitex agnus extract taken for 6 days before menstruation and continued for 6 consecutive cycles significantly reduced PMS symptoms compared to placebo.

3. Valeriana officinalis

Valeriana officinalis (also known as Valerian) is widely used in tea for its sedative properties. Valerian can be of assistance during PMS and menstruation. 

In one study, scientists found the Valerian treatment more effective than a placebo inreducing abdominal pain during menstruation. The pain also lasted for a shorter time. The scientists attributed the effect to the antispasmodic qualities of the plant. 

A meta-analysis of 16 randomized, controlled trials found the use of valerianalmost doubled the chance of sleeping better compared with a placebo for 6 of the 16 studies.

Extract of the valerian root has been used to treat sleeping disorders in Europe for decades and it's becoming popular in the States as well. A survey conducted in 2002 found that about 2 million adults were using valerian.

4. Krill oil

Krill oil comes from krill, a shrimp-like planktonic crustacean that lives in the ocean. Krill is the main source of food for whales and other sea creatures. Like other marine life, krill oil is rich in omega-3 fatty acids which are known to decrease inflammation and relieve pain. 

Research shows that krill oil can help to decrease physical and emotional symptoms of PMS. 

Duringa clinical trial, women with PMS were treated over three months with either krill oil or omega-3 fish oil. There was a statistically significant improvement in all PMS symptoms, including emotional symptoms and menstrual cramps. In addition, the women who took the krill oil also took much less pain medication.

5. Calcium Supplements

Calcium is an important mineral that the human body can't manufacture – we must obtain it from our food or obtain it from breaking down our bones, which is not desirable. Several studies have shown a positive effect of calcium supplementation on PMS symptoms. 

In a large placebo-controlled study, calcium supplementation of up to 1,200 mg per daysignificantly reduced premenstrual depression, fatigue, edema, and pain in women with PMS. This study found that500mg was sufficient to obtain similar results. 

The researchers also observed that prolonged intake of calcium leads to increased relief over time and helps reduce mood symptoms experienced during PMS. Also, calcium supplementation is a cost-effective and effective treatment for reducing symptoms of PMS.

What Foods to Eat to Ease PMS?

Very few scientific studies have been done on the effect of nutrition on PMS symptoms. Scientists have established that a diet of fast foods, processed meat, and soft drinks is associated withmore severe PMS symptoms while a healthy, balanced diet is associated with mild PMS. 

It's best to eat as varied a diet as possible while avoiding processed food as far as possible. 

Dietary Suggestions to Help You Cope with PMS Symptoms

1. Eat Iron-rich foods

Women can develop an iron deficiency because they lose blood during menstruation. Focus on increasing your iron intake before and during your period.

Red meat is a good source of iron. But if you are Vegan or only rarely eat meat, you can get your iron from other food sources, including

  • Tofu
  • Dark leafy green vegetables — such as spinach, silver beet and broccoli
  • Nuts and seeds
  • Dried fruit
  • Bread and pasta made from whole meal 
  • Legumes like black beans, lentils and chickpeas

Fortifying yourself with iron-rich food may protect you against fatigue during PMS and your period. 

2. Eat a Variety of Vegetables

Enjoy all vegetables, but focus on nutrient-dense vegetables like broccoli, cabbage, kale, Brussels sprouts, chard, spinach, and cauliflower. These vegetables are high in fiber, minerals, including calcium, and vitamins K, and B9.

Enjoy lots of green salads and experiment with some green smoothies.

3. Eat Plenty of Fruit

Fruit is high in fiber, bioactive phytochemicals, and antioxidants. Researchers have found that eating fruit seems to protect against psychological, physical, and other PMS symptoms. 

Several studies have shown that fruit, as part of a healthy Mediterranean diet, reduced the occurrence and severity of premenstrual pain and PMS symptoms. 

Scientists think the antioxidant content of various fruits may be the reason fruit protects against PMS symptoms. 

In one study, low rates of severe PMS symptoms were reported, which researchers attributed to the daily consumption offruit and non-starchy vegetables by participants. These plant foods provide anti-oxidant and anti-inflammatory agents, which may play a role in protecting against PMS symptoms.

4. Eat Food Rich in Calcium

As previously mentioned, calcium is effective in reducing PMS symptoms. Fortunately, there are many sources of calcium to choose from. Milk and milk products have plenty of calcium as do nuts leafy green vegetables, oatmeal, and dried fruit. 

Sardines are also a great source of calcium as well as protein and omega-3 fatty acids.

5. Eat Complex Carbohydrates

Complex carbs are found in whole grain foods, sweet potatoes, lentils, and other legumes, and starchy vegetables like pumpkin and potatoes. 

These foods are rich in fiber, which slows down the digestive process, preventing a sudden spike in insulin levels. Fiber also keeps you full for longer, so you don't start craving sweet treats soon after a meal. 

6. Eat Whole Grains

Eating whole grains benefits your general health, providing loads of nutrients that would otherwise go lost in the milling process. Eating whole grains has been shown tosignificantly decrease the emotional, physical, and behavioral symptoms of PMS.

Swap white bread for whole wheat bread and white rice for unpolished rice.  

7. Be Mindful About Your Snacks

We all love to reach for a bag of salted chips or crackers with a dip when we feel sluggish. But there are healthier choices that are just as tasty. Try fruit, nuts, unflavored popcorn, olives, and whole-grain crackers to snack on. 

Make your own high-fiber dips using cooked vegetables, beans, and cream cheese. Delicious!

Nuts are great to snack on, but they are calorie-dense. You only need a few to get the benefits; more would tax your digestive system and cause you to gain weight.

8. Reduce Salt Intake

Eating less salt will help with symptoms like bloating, breast tenderness, and swollen hands or feet. If you get most of your food outside your home, cooking for yourself will immediately reduce your salt intake. After all, processed and ready-made foods are often brimming with salt.

Of course, this will only work if you don't add too much salt to your cooking!

9. Stay Hydrated

It is recommended for adults to drink eight glasses of water a day, but this recommendation is not based on scientific evidence. Some people need more, and others need less. Also, you don't need to get all your liquid from water; you can get a lot from fruit, vegetables, and soups. 

If you enjoy plenty of these foods, you don't need to drink so much water. 

10. Go slow on the alcohol

For women who suffer from PMS symptoms like mood swings, irritability, bloating, and fatigue; alcohol can make all these things worse.

Multiple research results suggest that alcohol consumption increases the chances of falling victim to PMS, with heavy drinking increasing the chances even more.

While we drink alcohol to relax; alcohol disrupts sleep - resulting in poor-quality sleep and restlessness.

11. Go Slow on the Caffeinated Drinks

Caffeine is another substance that disrupts sleep, contributing to fatigue that can worsen PMS symptoms or make them feel worse simply because you're tired. Try not to have coffee too late in the day.

Final thoughts

Premenstrual syndrome is a common disorder in women of reproductive age worldwide. The condition is characterized by physical, emotional, or behavioral symptoms, which appear a few days before the onset of menstruation and end shortly after the onset of menstruation. 

The symptoms include breast tenderness, bloating, headache, mood swings, depression, anxiety, and irritability. These symptoms can disrupt a woman's life for a few days every month, affecting home, school, and work life.

Women can take steps to make this time of the month less challenging by eating sensibly, getting enough sleep, limiting caffeine and alcohol intake, and getting enough exercise. Some natural remedies may also be worth investigating.