PMS Symptoms, Treatment and When to See a Doctor

Premenstrual syndrome symptoms treatment and when to see a doctor means PMS.

PMS includes body, mood, and behavior changes before a period ^2,8. These changes often follow a clear cycle.

This guide explains common signs, diagnosis, treatment, and levels of care. It also compares PMS vs PMDD and reviews other possible causes.

PMS describes a group of symptoms that appear before menstruation ⁸. The symptoms may affect the body, mood, behavior, or several areas at once ^2,8.

PMS occurs during the luteal phase of the menstrual cycle. PMS symptoms occur in this phase and resolve during menstruation or within the following week ⁶.

Symptoms may begin several days or two weeks before a period ^2,8. They often fade within a few days after menstruation starts. Some symptoms may take up to one week to resolve ⁶.

A symptom-free week should follow symptoms in core premenstrual disorders. The same pattern then returns during later cycles.

Many people notice at least one physical or mood change before a period ⁶. However, PMS involves meaningful distress or problems with daily function.

The symptoms may disrupt work, school, relationships, or usual activities. Their effects can range from mild to severe ^7,8.

Timing and daily impact matter more than any one symptom. One person may have mainly physical signs. Another may have mood changes or a mix of both.

PMS symptoms can differ from person to person ^7,8. Their type and strength may also change over time ^7,8.

Most people with PMS experience only some possible symptoms. A diary can help show which signs cause the most trouble ^3,4.

Common physical PMS symptoms may include the following:

Cramps and breast soreness can range from mild to disruptive ^3,5. The symptoms should improve soon after the period starts.

Common mood and behavior changes may include the following:

These signs can also occur with other health problems. A clear monthly pattern helps a clinician assess whether PMS is likely.

The exact cause of PMS remains unknown ⁸. Hormone levels change around ovulation and menstruation ⁸.

Some people may be more sensitive to these hormone shifts ⁸. This difference may help explain why symptoms vary between people ⁸.

Serotonin changes may also affect mood, sleep, fatigue, and food cravings. Serotonin is a brain chemical linked with mood.

High stress levels may increase the chance of having PMS ⁸. A personal or family history of anxiety or depression is another reported risk factor ⁸.

Premenstrual dysphoric disorder is also called PMDD. It is a more severe premenstrual condition.

PMDD causes major distress or serious problems with daily function ⁶. It may affect work, school, social activities, or close relationships ⁶.

Strong mood symptoms are common with PMDD ^6,7. They may include severe anger, anxiety, sadness, or sudden mood changes ^6,7.

The symptoms may also involve poor focus and loss of interest ⁶. Some people feel tense, overwhelmed, or out of control ^6,7.

Both PMS and PMDD follow a cycle-related pattern ⁶. Symptoms improve during menstruation or within the following week ⁶.

A clinician may consider other causes during an evaluation. Conditions that can resemble or worsen PMS include the following:

Symptoms lasting throughout the month may suggest another cause ⁶. They may also warrant reassessment for another underlying cause ⁶.

A clear symptom-free interval supports a premenstrual pattern. Tell your clinician if symptoms do not follow that pattern.

No physical finding or laboratory test confirms PMS by itself ^3,5. Diagnosis depends on timing, recurrence, and effects on daily life ^1,8.

A clinician will ask when symptoms start and stop ^5,8. The clinician may also ask how they affect work, relationships, and daily tasks ⁸.

PMS symptoms should occur before menstruation and improve after bleeding starts. This pattern should return during later menstrual cycles.

Prospective tracking means recording symptoms each day as they happen. Experts recommend daily tracking for at least two menstrual cycles ^1,5,6.

Daily records are more dependable than memories of past symptoms. When possible, complete the diary before starting treatment.

A useful symptom diary can include these details:

The Daily Record of Severity of Problems is a validated diary ^1,6. It can help show whether symptoms follow a monthly cycle ⁶.

An evaluation may include a health history and physical examination ^2,3. A pelvic examination may also form part of the assessment ³.

The clinician may review medicines, supplements, and other health conditions ^5,8. Mood screening may help identify depression, anxiety, or another mood disorder.

Testing depends on the symptoms and possible alternative causes. Thyroid testing may help when a thyroid disorder is possible.

A clinician may consider other conditions if treatment does not help ⁶. Further review is also important when symptoms continue throughout the month ⁶.

PMS treatment aims to reduce symptoms and their effect on daily life. The best approach depends on symptom type and severity.

Some people need to try more than one option ⁴. Continued tracking can help show whether a treatment is working ^4,5.

Lifestyle changes are often the first step for mild symptoms. Practical self-care options include the following:

Exercise may reduce physical and emotional PMS symptoms ⁶. It may also ease fatigue and low mood.

Cognitive behavioral therapy is often called CBT. It teaches ways to change unhelpful thoughts and actions.

CBT also helps people build coping skills for daily challenges. It may improve some physical and emotional PMS symptoms ⁶.

CBT may be useful alongside other treatments for severe PMS. A trained mental health professional can provide this therapy.

Nonsteroidal anti-inflammatory drugs are called NSAIDs. Ibuprofen and naproxen are common examples.

NSAIDs may ease cramps and breast discomfort. They may also help with headaches and back pain ⁴.

These medicines may work best near the start of symptoms or menstruation. If you use them most days, tell your clinician ⁴.

Ask about possible side effects before using these medicines. Report suspected side effects to a healthcare professional ^4,5.

A provider may recommend calcium, magnesium, or vitamin B6 for PMS ^4,5. Evidence for many supplements remains limited or unclear.

Herbal products may cause side effects or interact with medicines. St. John’s wort can reduce the effect of birth control pills.

Discuss vitamins and herbs with a clinician before using them. Include every supplement on the medicine list for your appointment.

Selective serotonin reuptake inhibitors are called SSRIs. These antidepressants are first-line medicines for severe PMS or PMDD ^1,5,6.

SSRIs can reduce mood symptoms. A clinician may prescribe them daily or only during the luteal phase.

Possible side effects include nausea, fatigue, sleep changes, and reduced sexual interest. Continuous SSRI treatment should be reduced slowly when stopping.

Hormonal birth control can stop ovulation and may relieve some PMS symptoms. However, the response can vary between people.

Combined pills containing drospirenone may improve PMS or PMDD symptoms. Ask a clinician whether this choice fits your needs.

Spironolactone is a diuretic, also called a water pill. It may ease bloating, swelling, and fluid-related weight gain.

Gonadotropin-releasing hormone analogues are called GnRH analogues. Specialists generally reserve them for diagnosis or especially severe cases.

These medicines are not recommended for routine PMS treatment. Specialist care is appropriate when symptoms remain severe despite simpler measures.

Make an appointment if self-care does not improve the symptoms ^3,7. Medical care is also useful when symptoms limit normal function ³.

The following situations support a routine medical visit:

Bring your symptom diary when possible. Also bring a list of medicines, vitamins, herbs, and supplements.

Some changes should not be assumed to come from PMS. Contact a clinician in these situations:

These signs do not confirm a specific condition. A clinician can review the pattern and decide whether more tests are needed.

Do not delay care during a mental health crisis ³. The 988 Suicide and Crisis Lifeline provides free, private support at all times ³.

A gynecology referral may help when first-line treatments have failed. Referral may also help when severe symptoms need specialist care.

Severe PMS may benefit from a team approach. The team may include primary care, gynecology, mental health, and nutrition experts.

The timing and daily impact of PMS symptoms are central to diagnosis. Symptoms should occur before menstruation and improve after bleeding starts.

Track symptoms each day for at least two cycles ^1,5,6. Lifestyle changes may help, while severe symptoms may need prescription treatment.

Track persistent or disruptive symptoms in a diary to help you and your healthcare provider find the best treatment ^3,7. An evaluation can help distinguish PMS vs PMDD or another condition.