An Overview of Premenstrual Syndrome (PMS)

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You most likely experience typical symptoms that come at the same time every month signaling to you that your period will start soon. For most, these symptoms are just a little annoying reminder to stock up on tampons or pads or find your menstrual cup. But for some, these symptoms can really interfere with day-to-day functioning. If you feel like your world is turned on its side, or worse, in the week or so before your period, you probably have PMS, or premenstrual syndrome.

What Is Premenstrual Syndrome?

Premenstrual syndrome or PMS is a condition that causes typical physical and psychological symptoms that occur monthly in the week or so before your period. These typical symptoms cause some degree of distress or disruption in your life and then rather abruptly go away by the end of your period. The type of symptoms and the intensity of the symptoms you feel are unique to your body.

Unfortunately, there is some controversy in the medical community on how the condition is actually defined, and this can lead to some confusion. Here are the basic principles that define the diagnosis of PMS:

  • You have recurrent and distressing physical and/or psychological or mood symptoms every month during the week or so before your period
  • Your symptoms may vary, but typical symptoms are present
  • Any number of symptoms can be present
  • These symptoms disappear during or at the end of your period
  • You always have at least one symptom-free week between your period and ovulation (aka you feel "like yourself")

Wondering why there are typical symptoms and why these symptoms only occur in the week or so before your period? That is because PMS is caused by the hormonal changes that happen during your normal menstrual cycle.

Simply put, your menstrual cycle is divided into two phases separated by ovulation. Each phase has a dominant hormone produced. The follicular phase or the first part of your cycle starts with the first day of your period and ends with ovulation. Estrogen is the dominant hormone during this part of your cycle.

When you ovulate there is a big hormonal switch. The second half of your menstrual cycle from ovulation until the first day of your period is called the luteal phase. During the luteal phase, progesterone is the dominant hormone. Progesterone and probably other changes caused by the big hormonal fluctuations of ovulation are responsible for the distressing and disruptive symptoms of premenstrual syndrome.

Because every woman has a unique reaction to her own hormonal changes, the type of symptoms, the number of symptoms and the severity of symptoms will be different for every woman diagnosed with PMS.

That being said, there are typical symptoms that are associated with the diagnosis of PMS. These symptoms can be divided into two groups: physical and psychological/behavioral. Your symptoms may be mostly physical or mostly psychological, or a mixture of both. Again, how you experience PMS is unique to you. The symptoms of PMS include but are not limited to:

  • abdominal swelling or bloating
  • breast tenderness or painful breasts
  • weight gain
  • acne
  • headaches
  • swelling of your hands or feet
  • generalized muscle aches and/or joint pain
  • low back pain
  • food cravings 
  • increased appetite
  • mood swings
  • difficulty sleeping or sleeping too much
  • lack of energy
  • anger
  • anxiety
  • depressed mood
  • hopelessness
  • poor concentration
  • irritability
  • loneliness
  • lack of interest in your usual activities

It is important to pay attention to how you feel at different times during your menstrual cycle. PMS is real and getting the proper diagnosis can help you manage your symptoms and "feel like yourself" all month long.

3 Things to Know About Premenstrual Syndrome

There Is No Test to Diagnose PMS

There are no blood tests or imaging tests that can diagnose PMS. Unlike most conditions, the diagnosis of PMS is based completely on your symptoms and how those symptoms make you feel. It really is a personal diagnosis. Some diagnostic criteria require a certain number of symptoms to be present in order to make the diagnosis of PMS. But most experts and newer guidelines have introduced criteria to diagnose PMS that focus more on the timing, the type, and severity of your symptoms rather than the actual number of symptoms.

In order to properly diagnose PMS, you need to prospectively rate your symptoms. This means that you actually have to keep track of how you feel every day for two cycles. It is important that you record this information and then bring it along with you to your doctor's visit. You can use a blank calendar, but you may find it helpful to use a specific symptom tracker or app. Take this step seriously. It is the only way for you to get the correct diagnosis and treatment.

Misdiagnosis Can Occur

Many of the psychological symptoms of PMS are also common in women with mood and/or anxiety disorders. If your symptoms are mostly psychological you are at risk of misdiagnosis. If you have severe cyclic mood disturbances you are most at risk of being diagnosed incorrectly. Too often you may be misdiagnosed with bipolar disorder and treated with mood-stabilizing drugs. The key to getting the right diagnosis is determining if your symptoms occur in the week or so before your period and go away completely by the end of your period. You also must have a symptom-free week after your period finishes. Properly recording your daily symptoms for two menstrual cycles will help you and your doctor decide if your symptoms are caused by PMS or an underlying psychiatric disorder.

Some Birth Control May Cause PMS Symptoms

We know that the hormonal changes of ovulation trigger the symptoms of PMS. So, it makes sense that the treatment of PMS focuses on suppressing ovulation. This is why your doctor will likely recommend the oral contraceptive pill that contains both estrogen and progesterone to treat your PMS symptoms. Hopefully, this will give you good relief of your symptoms. But sometimes it doesn't, or it might even make your symptoms worse.

It is possible that you may be "progesterone sensitive." For some women, exposure to the progesterones found in hormonal contraceptives can worsen or even cause PMS-like symptoms. If you have started an OCP to treat PMS and you are feeling worse, discuss this with your doctor. Most likely your doctor will suggest trying a different type of pill that contains a different progesterone.

If you are "progesterone sensitive," using any hormonal birth control can worsen pre-existing PMS or even cause new PMS-like symptoms. However, using a progesterone-only hormonal birth control puts you at the greatest risk. The progesterone-only hormonal contraceptive options include:

If you are using any of these birth control options and have developed new onset or a significant worsening of your PMS symptoms, you need to discuss this with your doctor.

Living With PMS

Take Good Care of Yourself 

Maintaining a healthy lifestyle is important for everyone, but it really can help improve PMS symptoms. The challenge is that when you suffer from PMS you can easily be thrown off track and slip into bad habits. Regular aerobic exercise is perhaps the most important lifestyle change, especially during the second half of your cycle. Aerobic exercise increases endorphins, which help your mood. Regular exercise can also help decrease the food cravings of PMS that further aggravate symptoms like bloating, swelling, and weight gain.

Don't Be Afraid to Talk About Your Condition

PMS is a real medical condition just like diabetes or hypertension. Unfortunately, popular culture has belittled the condition into a label that is judgemental and degrading. Don't be afraid to talk to your friends and family about how you are feeling. If your loved ones understand how you are feeling and why, they can help you get through the difficult days of your cycle. 

Maybe you would benefit from seeing a licensed mental health professional to talk about your feelings, especially during the second half of your menstrual cycle. This could be especially helpful if you experience significant PMS mood changes. 

Make Sure You Are Getting the Right Treatment

This can't be stressed enough. You do not have to suffer silently with PMS. If you feel that the treatment your doctor has prescribed is not working for you, please discuss other treatment options with your doctor. If your doctor doesn't feel comfortable treating PMS or you feel like your doctor isn't taking your symptoms seriously, you should consider consulting another physician. You may consider seeing a gynecologist if you do not have one already.

A Word From Verywell

Getting the diagnosis of PMS is the first step in taking control of your symptoms. Don't be ashamed of the diagnosis. Learning more about how your brain and body reacts to your changing hormones will help you feel better every day. Making lifestyle changes and talking with your doctor about treatment options will help you live well with PMS. 

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Article Sources

  • Brien S, Rapkin A, Dennerstein L. Diagnosis and management of premenstrual disorders. BMJ. 2011;11(342)1297-1303