Premenstrual Syndrome (PMS)

Last Updated: August 16, 2022

PMS stands for premenstrual syndrome. PMS involves physical symptoms such as pain, bloating, and acne along with mood changes that occur prior to menstruation.

Premenstrual Syndrome (PMS) falls under theWomen’s HealthandMental Healthcategories.

What is PMS?

Premenstrual syndrome, or PMS, is a group of symptoms that start one to two weeks before menstruation. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. For some women, the symptoms are severe enough to interfere with their lives, which is a type of PMS called premenstrual dysphoric disorder (PMDD).[1]

What are the main signs and symptoms of PMS?

Common PMS symptoms are as follows:[1]

How is PMS diagnosed?

PMS is usually diagnosed if at least one of the symptoms listed above occurs during the five days before the start of menses for at least three cycles, two of which must be consecutive cycles. Additionally, these symptoms stop at least four days after the onset of menses and do not recur until the next cycle.[2]

What are some of the main medical treatments for PMS?

Over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen may help ease mild PMS symptoms (e.g., cramps, headaches, breast tenderness). When symptoms of PMS are severe, selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft) can be tried. Oral contraceptives have also shown some benefit for reducing PMS symptoms. Theoretically, these work by regulating fluctuations of estrogen and progesterone throughout a cycle.[2]

Have any supplements been studied for PMS?

Daily calcium supplements (calcium carbonate) have been shown to reduce symptoms of PMS. Vitamin D and vitamin B6 have also been assessed for PMS symptoms, but there is insufficient evidence to support their use.[2] Many herbs have also been studied, with chasteberry having the greatest volume of evidence behind it.[3]

How could diet affect PMS?

Specific diets have not been studied for PMS. Some observational evidence has found that consuming foods high in calcium, vitamin D, thiamine, and riboflavin has been associated with a lower risk of PMS.[4][5] Common dietary recommendations for PMS include small and frequent meals as well as reducing consumption of salt, caffeine, and refined sugars. These modifications are intended to reduce irritability, insomnia, fluid retention, bloating, and weight gain during PMS.[6]

Are there any other treatments for PMS?

Exercise is often recommended for PMS because it can promote endorphin release which can improve mood and increase energy.[6] Psychological modalities such as cognitive-behavioral therapy (CBT) and other modalities such as acupuncture with and without herbal medicine have been studied for relieving PMS symptoms. However, more research is needed to determine their benefits. [2]

What causes PMS?

No one knows what causes PMS. It is likely that changes to the levels of estrogen and progesterone and individual sensitivity to these changes trigger PMS symptoms. These hormones affect levels of neurotransmitters such as gamma-aminobutyric acid, dopamine, and serotonin which in turn can affect mood. Some evidence suggests that suppressing estrogen can improve PMS symptoms,[2] and a deficiency of progesterone may worsen symptoms, but more research is needed.[7]

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  1. ^MedlinePlus (Internet) Bethesda (MD): National Library of Medicine (US); (updated June 20 2016; cited April 28 2022)
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  3. ^Csupor D, Lantos T, Hegyi P, Benkő R, Viola R, Gyöngyi Z, Csécsei P, Tóth B, Vasas A, Márta K, Rostás I, Szentesi A, Matuz MVitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials.Complement Ther Med.(2019-Dec)
  4. ^Chocano-Bedoya PO, Manson JE, Hankinson SE, Willett WC, Johnson SR, Chasan-Taber L, Ronnenberg AG, Bigelow C, Bertone-Johnson ERDietary B vitamin intake and incident premenstrual syndrome.Am J Clin Nutr.(2011-May)
  5. ^Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JECalcium and vitamin D intake and risk of incident premenstrual syndrome.Arch Intern Med.(2005-Jun-13)
  6. ^Jarvis CI, Lynch AM, Morin AKManagement strategies for premenstrual syndrome/premenstrual dysphoric disorder.Ann Pharmacother.(2008-Jul)
  7. ^Gudipally PR, Sharma GKPremenstrual SyndromeStatPearls.(2022-07)
  8. ^Tiranini L, Nappi RERecent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome.Fac Rev.(2022)
  9. ^Arab A, Rafie N, Askari G, Taghiabadi MBeneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature.Int J Prev Med.(2020)
Examine Database References
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  7. PMS Symptoms - Berger D, Schaffner W, Schrader E, Meier B, Brattström AEfficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS)Arch Gynecol Obstet.(2000 Nov)
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  21. Anxiety Symptoms - Fukui H, Toyoshima K, Komaki RPsychological and neuroendocrinological effects of odor of saffron (Crocus sativus)Phytomedicine.(2011 Jun 15)
  22. Depression Symptoms - Ebrahimi E, Khayati Motlagh S, Nemati S, Tavakoli ZEffects of magnesium and vitamin b6 on the severity of premenstrual syndrome symptomsJ Caring Sci.(2012 Nov 22)
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