Premenstrual Syndrome (PMS): Symptoms and Causes

• Researched and written by: Dr. Akshara C H, MBBS

• Edited by: Vaibhavi Kodnani

• Medical inputs by: Dr Poonguzhali Liston, MBBS, MS OBG, FMAS, DRM, FRM, CIMP

• Medically reviewed by: Dr Yash Bahuguna, MBBS, MS, DNB, ISGE Certified Practitioner for PCOS

TL;DR

• Women with premenstrual syndrome (PMS) experience a pattern of emotional, physical symptoms, and sometimes sexual changes a few days before their period.[1,2]

• Symptoms of premenstrual syndrome can include mood swings, breast tenderness, bloating, fatigue, and sleep changes, and they usually improve once bleeding begins.[1,3]

• PMS happens in the luteal phase of the menstrual cycle due to hormonal shifts and related brain chemical changes.[1,4]

• Management of premenstrual syndrome includes exercise, sleep, stress reduction, and dietary support, along with tracking symptoms over at least two cycles.[2,5]

• Treatment of premenstrual syndrome may involve selective serotonin reuptake inhibitors SSRIs, which are used as the first line treatment for moderate to severe symptoms and for PMDD.[1,2]

What Is Premenstrual Syndrome (PMS)?

Premenstrual syndrome, or PMS, is a group of recurring symptoms that appear during the luteal phase, which is the second half of the menstrual cycle. These emotional and physical symptoms often worsen in the premenstrual phase, a few days before menstruation and improve once bleeding begins.[1,2]

PMS is very common. Research suggests that up to 80% of women experience some type of premenstrual symptoms. Around 30–40% have symptoms strong enough to be classified as premenstrual syndrome (PMS), while about 3% to 8% develop premenstrual dysphoric disorder (PMDD), the most severe form.[1,6] 

Indian studies also show a high prevalence, with many reporting that more than half of women experience PMS, though severity varies and only a smaller percentage have severe symptoms.[7]

What Are the Signs and Symptoms of PMS?

PMS can affect both your body and your emotions. For some women, symptoms are mild and manageable. For others, they are severe enough to interfere with work, relationships, or daily routines.[1]

Emotional symptoms of PMS

Emotional symptoms of PMS are often linked to changes in serotonin and other brain chemicals influenced by hormones.[1,4]

Emotional symptoms include:

• Mood swings

• Anxiety or tension

• Irritability

• Anger

• Sadness or depression

• Crying 

• Difficulty concentrating

• Sleep disturbances or insomnia

Physical symptoms of PMS

Physical symptoms are driven largely by hormonal fluctuations in the luteal phase. They usually peak in the days just before your period and ease once bleeding begins.[1,3,4]

Physical symptoms include:

• Breast tenderness

• Bloating 

• Swelling of the hands and feet

• Nausea, diarrhea, or constipation

• Abdominal pain 

• Temporary weight gain

• Headache

• Fatigue

• Joint or muscle pain

• Acne

• Changes in appetite

• Food cravings 

Sexual symptoms of PMS

Hormonal shifts can also influence sexual well-being. Research suggests that sexual desire and satisfaction can fluctuate across the menstrual cycle, especially in the luteal phase.[9,10]

Sexual symptoms include:

• Reduced libido or sex drive

• Difficulty in arousal or satisfaction

• Vaginal dryness

• Pain during sex

• Anxiety related to sexual feelings or experiences

In some women, there may be a temporary increase in sexual desire before periods. 

What Are the Causes of PMS?

Premenstrual syndrome (PMS) is mainly caused by hormonal fluctuations and brain chemical changes during the luteal and premenstrual phase. 

Hormonal fluctuations

Estrogen and progesterone are the key female hormones responsible for sexual and reproductive health. However, they also influence other key processes in the body. 

• Estrogen influences: Bone health, muscle mass, brain function (mood and cognition), skin health

• Progesterone influences: Nervous system (has calming effects), fluid balance, body temperature, sleep regulation

During the luteal phase of the menstrual cycle, levels of estrogen and progesterone rise. If pregnancy does not occur, these hormone levels begin to fall in the days before menstruation. This drop in hormones is closely linked to the timing of PMS symptoms.[1,4]

As estrogen and progesterone affect several body systems, drop in their levels can affect the body in various ways. It can contribute to symptoms such as breast tenderness, bloating, headaches, joint or muscle pain, fatigue, and skin changes.

Chemical changes in the brain

Hormonal changes during the menstrual cycle also affect neurotransmitters or brain chemicals such as serotonin. Serotonin plays a key role in regulating mood, sleep, appetite, and emotional stability.[1]

During the luteal phase, hormonal fluctuations may alter serotonin activity in some women. These changes are associated with common PMS symptoms such as mood swings, irritability, anxiety, fatigue, food cravings, brain fog, and sleep disturbances.[1,8] 

Quick insight: Premenstrual symptoms vary widely from person to person. One of the reasons for this is individual hormonal sensitivity. In simpler words, it means that some women are more sensitive to the normal hormonal changes that happen during the menstrual cycle.[1]

What Are the Common Risk Factors and Triggers of PMS?

While PMS can affect any woman of reproductive age, some factors may increase the likelihood of experiencing symptoms or make them more severe.[1] These factors do not directly cause PMS but may influence how strongly the body reacts to hormonal changes.

Age

PMS is most commonly reported in women in their mid-20s through their 40s. Symptoms may become more noticeable with age, particularly as women approach perimenopause. During this stage, hormonal fluctuations can become more unpredictable, which may worsen premenstrual symptoms in some women.[2]

Family history

Women who have close female relatives, such as a mother or sister with PMS, may be more likely to experience similar symptoms. This suggests that genetic factors may play a role in how the body responds to hormonal changes during the menstrual cycle.[1]

Reproductive history

Hormonal sensitivity can vary across different stages of life. Some women notice changes in their PMS symptoms after pregnancy or childbirth. Others may experience differences when using or stopping hormonal contraceptives. These shifts may alter hormone patterns or the body’s response to them, which can influence PMS symptoms.[2]

Underlying mental health conditions

Women who live with depression, anxiety, or other mood disorders may be more likely to report severe PMS symptoms. In some cases, emotional conditions can worsen during the premenstrual phase, a pattern sometimes referred to as premenstrual exacerbation of existing mental health conditions [1,11].

Lifestyle factors

Daily habits and lifestyle choices can also influence PMS severity. High stress levels may intensify symptoms by affecting hormone balance and the body’s stress response. Poor sleep can worsen fatigue, irritability, and difficulty concentrating. Smoking, excessive caffeine intake, and limited physical activity have also been associated with more severe PMS symptoms in some studies.[2,5]

Understanding the Spectrum of Premenstrual Disorders

Premenstrual symptoms exist on a spectrum. Some women experience only mild physical or emotional changes before their period, while others have symptoms that are intense enough to interfere with daily activities and quality of life.[1]

Conditions such as premenstrual syndrome (PMS), premenstrual exacerbation (PME), and premenstrual dysphoric disorder (PMDD) fall along this spectrum. They are linked to the same hormonal cycle but differ in severity and impact.

Premenstrual Exacerbation (PME)

Premenstrual exacerbation (PME) refers to the worsening of an existing mental health condition during the luteal phase of the menstrual cycle.[11] 

In this situation, the symptoms are present throughout the month, but they noticeably worsen in the days leading up to menstruation. For instance, if someone has depression, they may notice worsening anxiety, increased irritability, extreme low mood, or deep hopelessness before their period. 

When menstrual bleeding begins and and hormone levels reset, the symptoms often return to their usual baseline level.[11]

Recognizing this pattern is important because treatment may need to address both the underlying mental health condition and premenstrual exacerbation.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder, or PMDD, is considered the most severe form of premenstrual syndrome. It affects a smaller proportion of women in their reproductive age, usually estimated at around 3–8%.[1,8]

PMDD symptoms are similar to PMS but are significantly more intense and disruptive. They often appear during the luteal phase and improve shortly after menstruation begins.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria, PMDD diagnosis criteria include: 

At least 5 out of 11 specified symptoms should occur in the luteal and premenstrual phase in most cycles over the past year. The symptoms should improve a few days after the period begins. 

At least one of the five symptoms should be a severe psychological symptom:

1. Mood swings, feeling sudden sadness or crying spells, or increased sensitivity to rejection

2. Irritability, anger, having conflicts with others 

3. Depressed mood, hopelessness, or self-critical thoughts

4. Anxiety, tension, or a persistent feeling of being on the edge

One or more of the following symptoms should be additionally present that adds up to five symptoms: 

5. Decreased interest in usual activities

6. Difficulty concentrating

7. Lethargy, fatigue, or lack of energy

8. Change in appetite such as overeating or specific food cravings

9. Sleep problems such as excessive sleepiness or difficulty falling asleep

10. Feeling overwhelmed or out of control

11. Physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain, bloating or temporary weight gain

Remember: PMDD is not simply a worsening of another mental health condition. The timing of symptoms is important for an accurate diagnosis. In PMDD, symptoms appear during the luteal phase of the menstrual cycle and improve once menstruation begins. To confirm the diagnosis, symptoms should be tracked for at least two consecutive menstrual cycles.

PMDD symptoms are severe enough to interfere with daily functioning. They may affect work performance, school activities, relationships, and overall quality of life.[1,2] Because of this impact, PMDD is recognized as a medical condition that often requires professional evaluation and treatment.

Berry's Insights: Does a PMS and PMDD Severity Scale Exist?

There is no single test that can confirm premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Doctors usually make the diagnosis by looking at symptom patterns over at least two menstrual cycles.[1,8]

The key feature doctors look for is timing. Symptoms must appear during the luteal phase, and then improve or disappear once the period begins. Tracking this pattern helps doctors distinguish PMS from other health conditions that may cause similar symptoms.[1]

Premenstrual Symptoms Screening Tool (PSST)

The Premenstrual Symptoms Screening Tool (PSST) is a questionnaire used to screen for moderate to severe PMS and PMDD. It asks women to rate common physical and emotional symptoms. It also measures the impact of these symptoms on daily life, such as work, school, relationships, and social activities.[8]

The PSST is mainly used as a screening tool. It helps doctors identify women who may have significant premenstrual symptoms and who may benefit from further evaluation or treatment.

Daily Record of Severity of Problems (DRSP)

The Daily Record of Severity of Problems (DRSP) is a diagnostic tool. It involves a symptom diary that women complete every day for at least two menstrual cycles. It records emotional symptoms, physical symptoms, and their severity throughout the cycle.

This daily tracking is considered one of the most reliable ways to confirm PMDD because it clearly shows whether symptoms appear in the luteal phase and improve after menstruation begins. It also helps determine whether the symptoms are severe enough to meet diagnostic criteria.[1,8]

Track your symptoms across menstrual cycles so you can identify patterns and notice when symptoms usually begin and improve. This information can also help your doctor confirm PMS.

Could It Be Something Else?

Several health conditions can cause symptoms that feel similar to PMS. Because of this overlap, doctors often look carefully at symptom timing and patterns before confirming a PMS or PMDD diagnosis.

Conditions that may overlap with PMS include irritable bowel syndrome, chronic fatigue syndrome, thyroid disorders, and primary mood disorders such as depression or anxiety.[1,2]

Signs that symptoms may be caused by something other than PMS include:

• Symptoms do not form a consistent, predictable pattern in relation to the menstrual cycle

• They occur at any time during the month or stay persistent throughout the month

• They do not improve once menstruation begins

Symptoms could include:

• Ongoing low mood or emotional distress without symptom-free intervals

• Persistent severe fatigue that is not linked to cycle timing

• Continuing digestive symptoms such as frequent abdominal pain, bloating, diarrhea, or constipation

If symptoms do not clearly follow the menstrual cycle, it is important to consult a doctor for proper evaluation and diagnosis.[1]

A Quick Guide: How to Relieve PMS Symptoms

For many women, both physical and emotional PMS symptoms may improve with simple lifestyle changes.[2,5] 

Helpful steps include:

• Eat regular, balanced meals that include whole grains, fruits, vegetables, and protein to help maintain steady energy levels and reduce cravings.

• Limit caffeine and excess salt, especially in the week before your period, as these may worsen bloating, breast tenderness, and irritability.

• Engage in regular aerobic exercise, such as brisk walking, cycling, swimming, or light jogging, for about 30 minutes most days of the week. Physical activity may help improve mood and reduce fatigue.

• Practice relaxation techniques, such as deep breathing, gentle yoga, or mindfulness, to help lower stress and support better sleep during the premenstrual phase.

• Avoid smoking and alcohol as these habits can worsen PMS symptoms by affecting hormone balance, sleep quality, and mood. They may also increase inflammation and irritability during the premenstrual phase, which can make symptoms such as fatigue, headaches, and mood changes feel more intense. Limiting or avoiding them may help reduce symptom severity.[1,2]

Lifestyle strategies may not completely eliminate symptoms, but they often help the body cope better with hormonal changes during the luteal and premenstrual phase.

When to See a Doctor?

Premenstrual symptoms are common. But if your symptoms are intense and significantly disrupt your daily life, a healthcare provider can help confirm whether it’s PMS, PMDD, or another condition.

Seek medical care if:

• Your symptoms begin to interfere with your work, school responsibilities, daily activities, or relationships

• Self-care strategies such as lifestyle changes, exercise, or stress management do not improve symptoms

• Your symptoms are severe, distressing, or continue to worsen over time

• Your symptoms are not clearly linked to the menstrual cycle and are present throughout the month

Note: If you feel persistently depressed or have thoughts of self-harm, seek immediate medical care. 

When symptoms are moderate to severe, medical treatment may be recommended. Selective serotonin reuptake inhibitors (SSRIs) are commonly used as the first line treatment, particularly for mood related PMS symptoms and PMDD. These medicines help regulate serotonin activity in the brain, which can improve mood stability and reduce emotional symptoms.[1,2]

In some cases, doctors may also consider hormonal therapies that help regulate or suppress ovulation, depending on symptom severity and individual health factors.[2,5]

Early evaluation and treatment can make a significant difference. With the right support and management plan, many women can reduce symptoms and improve their quality of life.[1,2]

The Bottom Line

Premenstrual syndrome (PMS) is a common condition linked to normal changes in hormones and brain chemicals. PMS symptoms appear during the luteal and premenstrual phase of the menstrual cycle, around 1–2 weeks before menstruation. Many women have mild physical or emotional symptoms that improve with lifestyle interventions. Some may experience premenstrual dysphoric disorder (PMDD), wherein symptoms disrupt daily functioning. Severe PMS and PMDD need proper diagnosis and medical treatment. 

Tracking your symptoms and seeking medical advice when needed can help you manage PMS more effectively and feel more in control of your health. 

FAQs on PMS

How many days does PMS last?

Premenstrual syndrome (PMS) usually starts 1–2 weeks before your period. Symptoms usually improve or disappear once your period starts.

What are the signs your period is coming?

Common signs your period is coming include bloating, breast tenderness, mood swings, acne, fatigue, food cravings, and mild cramps. 

What foods make PMS worse?

Certain foods and drinks may make PMS symptoms worse, especially those high in salt, sugar, and caffeine. Salty foods can increase water retention and bloating, sugary foods may trigger energy crashes and mood swings, and caffeine can worsen anxiety, irritability, and breast tenderness.

What vitamins help with PMS?

Some vitamins and minerals may help reduce PMS symptoms naturally, including calcium, vitamin B6, magnesium, and vitamin D. These nutrients may support mood balance, reduce bloating, and improve fatigue during the days before your period.

What not to do during PMS?

During premenstrual syndrome (PMS), it helps to avoid habits that can worsen symptoms. Try not to skip sleep, rely on sugary or salty foods, consume excessive caffeinated drinks, or avoid exercise completely. Healthy sleep, balanced meals, and light physical activity can help manage PMS symptoms.

References

1. Gudipally PR, Sharma GK. Premenstrual syndrome.

2. American College of Obstetricians and Gynecologists. Premenstrual Syndrome (PMS). Accessed February 26, 2026 

3. Office on Women’s Health. Premenstrual syndrome (PMS). Accessed February 26 2026 

4. NHS. PMS (premenstrual syndrome). Accessed February 26 2026 

5. Royal College of Obstetricians and Gynaecologists. Managing premenstrual syndrome (PMS). Accessed February 26 2026

6. Maity S, Gadad BS, Rodrigo H, Noorani S, Usman A, Lark C, Attarpour M, Mageto I, Schwartz L, Trachuk AM, Yaareb D. Prevalence of premenstrual syndrome, premenstrual dysphoric disorder, and dysmenorrhea in nursing students: a systematic review, meta-analysis, and evidence-based recommendations. Frontiers in Global Women's Health. 2026 Feb 12;6:1701704.

7. Raval CM, Panchal BN, Tiwari DS, Vala AU, Bhatt RB. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar, Gujarat. Indian Journal of psychiatry. 2016 Apr 1;58(2):164-70.

8. Borenstein JE, Dean BB, Leifke E, Korner P, Yonkers KA. Differences in symptom scores and health outcomes in premenstrual syndrome. Journal of Women's Health. 2007 Oct;16(8):1139-44.

9. Clayton AH, Dennerstein L, Fisher WA, Kingsberg SA, Perelman MA, Pyke RE. Standards for clinical trials in sexual dysfunction in women: research designs and outcomes assessment. The Journal of Sexual Medicine. 2010 Jan;7(1_Part_2):541-60.

10. Caruso S, Agnello C, Malandrino C, Lo Presti L, Cicero C, Cianci S. Do hormones influence women's sex? Sexual activity over the menstrual cycle. The journal of sexual medicine. 2014 Jan;11(1):211-21.

11. Nolan LN, Hughes L. Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies. Archives of Women's Mental Health. 2022 Oct;25(5):831-52.