PMS is a combination of physical and emotional symptoms that many women get after ovulation and before the start of their menstrual period. Researchers think that PMS happens in the days after ovulation because estrogen and progesterone levels begin falling dramatically if you are not pregnant. PMS symptoms go away within a few days after a woman’s period starts as hormone levels begin rising again.

Some women get their periods without any signs of PMS or only very mild symptoms. For others, PMS symptoms may be so severe that it makes it hard to do everyday activities like go to work or school. Severe PMS symptoms may be a sign of premenstrual dysphoric disorder (PMDD). PMS goes away when you no longer get a period, such as after menopause. After pregnancy, PMS might come back, but you might have different PMS symptoms.

PMS is a group of symptoms that are linked to the menstrual cycle. Symptoms usually begin before menstrual bleeding starts and then stop once menstrual bleeding begins. For some women, PMS symptoms include mild cramps or some bloating. For other women, PMS symptoms include severe pelvic pain, headaches, and fatigue.

What is premenstrual syndrome (PMS)?

Premenstrual syndrome, or PMS, is a group of physical and emotional symptoms that start one to two weeks before your period. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. The symptoms may range from mild to severe.

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a severe type of PMS. With PMDD, the symptoms are severe enough to interfere with your life. PMDD much less common than PMS.

What causes premenstrual syndrome (PMS)?

Researchers don't know exactly what causes PMS. Changes in hormone levels during the menstrual cycle may play a role. These changing hormone levels may affect some women more than others.

What are the symptoms of premenstrual syndrome (PMS)?

PMS symptoms are different for everyone. You may get physical symptoms, emotional symptoms, or both. Your symptoms may also change throughout your life.

Physical symptoms may include:

• Breast swelling and tenderness
• Acne
• Bloating and weight gain
• Headache
• Joint pain
• Backache
• Constipation or diarrhea
• Food cravings

Emotional symptoms may include:

• Irritability
• Mood swings
• Crying spells
• Depression
• Anxiety
• Sleeping too much or too little
• Trouble with concentration and memory
• Less interest in sex

How is premenstrual syndrome (PMS) diagnosed?

You may wish to see your health care provider if your symptoms bother you or affect your daily life.

There is no single test for PMS. Your provider will talk with you about your symptoms, including when they happen and how much they affect your life. To be diagnosed with PMS, your symptoms must:

• Happen in the five days before your period for at least three menstrual cycles in a row
• End within four days after your period starts
• Keep you from enjoying or doing some of your normal activities

Your provider may wish to do tests to rule out other conditions which may cause similar symptoms.

What are the treatments for premenstrual syndrome (PMS)?

No single PMS treatment works for everyone. If your symptoms are not severe, you may be able to manage them with:

• Over-the-counter pain relievers such as ibuprofen, aspirin, or naproxen, to help ease cramps, headaches, backaches, and breast tenderness
• Getting regular exercise
• Getting enough sleep
• Eating healthy foods
• Avoiding salt, caffeine, sugar, and alcohol in the two weeks before your period

Some studies have shown that certain vitamins may help with some symptoms of PMS. They include calcium and vitamin B6.

Some women take certain herbal supplements for PMS symptoms. But there is not enough evidence to prove that supplements are effective for PMS. Check with your provider before taking any vitamins or supplements.

If you are not able to manage your PMS symptoms, your provider may suggest prescription medicines. These medicines may also be used to treat PMDD. They include:

• Hormonal birth control, which may help with the physical symptoms of PMS. But sometimes they may make the emotional symptoms worse. You may need to try several different types of birth control before you find the right one.
• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), which may help with emotional symptoms.
• Diuretics ("water pills") to reduce symptoms of bloating and breast tenderness.
• Anti-anxiety medicine to ease symptoms of anxiety.

As many as three in four women say they get PMS symptoms at some point in their lifetime. For most women, PMS symptoms are mild.

Less than 5% of women of childbearing age get a more severe form of PMS, called premenstrual dysphoric disorder (PMDD).

PMS may happen more often in women who:

• Have high levels of stress
• Have a family history of depression
• Have a personal history of either postpartum depression or depression

Researchers do not know exactly what causes PMS. Changes in hormone levels during the menstrual cycle may play a role. These changing hormone levels may affect some women more than others.

PMS symptoms are different for every woman. You may get physical symptoms, such as bloating or gassiness, or emotional symptoms, such as sadness, or both. Your symptoms may also change throughout your life.

Physical symptoms of PMS can include:

• Swollen or tender breasts
• Constipation or diarrhea
• Bloating or a gassy feeling
• Cramping
• Headache or backache
• Clumsiness
• Lower tolerance for noise or light

Emotional or mental symptoms of PMS include:

• Irritability or hostile behavior
• Feeling tired
• Sleep problems (sleeping too much or too little)
• Appetite changes or food cravings
• Trouble with concentration or memory
• Tension or anxiety
• Depression, feelings of sadness, or crying spells
• Mood swings
• Less interest in sex

Talk to your doctor or nurse if your symptoms bother you or affect your daily life.

Yes. PMS symptoms may get worse as you reach your late 30s or 40s and approach menopause and are in the transition to menopause, called perimenopause.

This is especially true for women whose moods are sensitive to changing hormone levels during the menstrual cycle. In the years leading up to menopause, your hormone levels also go up and down in an unpredictable way as your body slowly transitions to menopause. You may get the same mood changes, or they may get worse.

PMS stops after menopause when you no longer get a period.

About half of women who need relief from PMS also have another health problem, which may get worse in the time before their menstrual period. These health problems share many symptoms with PMS and include:

• Depression and anxiety disorders.These are the most common conditions that overlap with PMS. Depression and anxiety symptoms are similar to PMS and may get worse before or during your period.
• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Some women report that their symptoms often get worse right before their period. Research shows that women with ME/CFS may also be more likely to have heavy menstrual bleeding and early or premature menopause.
• Irritable bowel syndrome (IBS). IBS causes cramping, bloating, and gas. Your IBS symptoms may get worse right before your period.
• Bladder pain syndrome. Women with bladder pain syndrome are more likely to have painful cramps during PMS.

PMS may also worsen some health problems, such as asthma, allergies, and migraines.

There is no single test for PMS. Your doctor will talk with you about your symptoms, including when they happen and how much they affect your life.

You probably have PMS if you have symptoms that:

• Happen in the five days before your period for at least three menstrual cycles in a row
• End within four days after your period starts
• Keep you from enjoying or doing some of your normal activities

Keep track of which PMS symptoms you have and how severe they are for a few months. Write down your symptoms each day on a calendar or with an app on your phone. Take this information with you when you see your doctor.

These tips will help you be healthier in general, and may relieve some of your PMS symptoms.

• Get regular aerobic physical activity throughout the month. Exercise can help with symptoms such as depression, difficulty concentrating, and fatigue.
• Choose healthy foods most of the time. Avoiding foods and drinks with caffeine, salt, and sugar in the two weeks before your period may lessen many PMS symptoms.
• Get enough sleep. Try to get about eight hours of sleep each night. Lack of sleep is linked to depression and anxiety and can make PMS symptoms such as moodiness worse.
• Find healthy ways to cope with stress. Talk to your friends or write in a journal. Some women also find yoga, massage, or meditation helpful.
• Don’t smoke. In one large study, women who smoked reported more PMS symptoms and worse PMS symptoms than women who did not smoke.

Over-the-counter and prescription medicines can help treat some PMS symptoms.

Over-the-counter pain relievers you can buy in most stores may help lessen physical symptoms, such as cramps, headaches, backaches, and breast tenderness. These include:

• Ibuprofen
• Naproxen
• Aspirin

Some women find that taking an over-the-counter pain reliever right before their period starts lessens the amount of pain and bleeding they have during their period.

Prescription medicines may help if over-the-counter pain medicines don’t work:

• Hormonal birth control may help with the physical symptoms of PMS, but it may make other symptoms worse. You may need to try several different types of birth control before you find one that helps your symptoms.
• Antidepressants can help relieve emotional symptoms of PMS for some women when other medicines don’t help. Selective serotonin reuptake inhibitors, or SSRIs, are the most common type of antidepressant used to treat PMS.
• Diuretics (“water pills”) may reduce symptoms of bloating and breast tenderness.
• Anti-anxiety medicine may help reduce feelings of anxiousness.

All medicines have risks. Talk to your doctor or nurse about the benefits and risks.

Maybe. Studies show that certain vitamins and minerals may help relieve some PMS symptoms. The Food and Drug Administration (FDA) does not regulate vitamins or mineral and herbal supplements in the same way they regulate medicines. Talk to your doctor before taking any supplement.

Studies have found benefits for:

• Calcium. Studies show that calcium can help reduce some PMS symptoms, such as fatigue, cravings, and depression. Calcium is found in foods such as milk, cheese, and yogurt. Some foods, such as orange juice, cereal, and bread, have calcium added (fortified). You can also take a calcium supplement.
• Vitamin B6. Vitamin B6 may help with PMS symptoms, including moodiness, irritability, forgetfulness, bloating, and anxiety. Vitamin B6 can be found in foods such as fish, poultry, potatoes, fruit (except for citrus fruits), and fortified cereals. You can also take it as a dietary supplement.

Studies have found mixed results for:

• Magnesium. Magnesium may help relieve some PMS symptoms, including migraines. If you get menstrual migraines, talk to your doctor about whether you need more magnesium. Magnesium is found in green, leafy vegetables such as spinach, as well as in nuts, whole grains, and fortified cereals. You can also take a supplement.
• Polyunsaturated fatty acids (omega-3 and omega-6). Studies show that taking a supplement with 1 to 2 grams of polyunsaturated fatty acids may help reduce cramps and other PMS symptoms. Good sources of polyunsaturated fatty acids include flaxseed, nuts, fish, and green leafy vegetables.

Some women report relief from their PMS symptoms with yoga or meditation. Others say herbal supplements help relieve symptoms. Talk with your doctor or nurse before taking any of these supplements. They may interact with other medicines you take, making your other medicine not work or cause dangerous side effects. The Food and Drug Administration (FDA) does not regulate herbal supplements at the same level that it regulates medicines.

Some research studies show relief from PMS symptoms with these herbal supplements, but other studies do not. Many herbal supplements should not be used with other medicines. Some herbal supplements women use to ease PMS symptoms include:

• Black cohosh.The underground stems and root of black cohosh are used fresh or dried to make tea, capsules, pills, or liquid extracts. Black cohosh is most often used to help treat menopausal symptoms, and some women use it to help relieve PMS symptoms.
• Chasteberry. Dried ripe chasteberry is used to prepare liquid extracts or pills that some women take to relieve PMS symptoms. Women taking hormonal birth control or hormone therapy for menopause symptoms should not take chasteberry.
• Evening primrose oil. The oil is taken from the plant’s seeds and put into capsules. Some women report that the pill helps relieve PMS symptoms, but the research results are mixed.

Researchers continue to search for new ways to treat PMS. Learn more about current PMS treatment studies at clinicaltrials.gov.