PMS
- Recurring physical or emotional symptoms before a period that can interfere with daily life.
Is Premenstrual Syndrome (PMS) Normal?
Yes. Most women get some symptoms in the week or two before a period, and for many they're mild. When symptoms disrupt work, relationships or sleep every month, they're worth treating, and several treatments have been shown to help.
When PMS happens.
PeriodDays 1 to 5
First half of the cycleDays 6 to 13
PMS window: symptoms in the 1 to 2 weeks before a periodSymptoms ease within a few days of the period starting
A typical 28-day cycle has a period on days 1 to 5, then the first half of the cycle, ovulation around day 14, and a PMS window over the last 7 to 14 days. Symptoms ease within a few days of the period starting.
Six things worth knowing.
- More than 90% of women get some premenstrual symptoms.
- PMS symptoms come in the 1 to 2 weeks before a period and ease within a few days of it starting.
- PMS can reflect sensitivity to normal hormonal changes during the menstrual cycle and does not necessarily mean high estrogen or low progesterone.
- PMDD is a less common premenstrual disorder with prominent mood symptoms that disrupt daily life. It is treatable.
- Regular exercise, calcium and a type of talk therapy called CBT can ease symptoms.
- SSRIs are among the best-supported treatments for moderate to severe PMS and PMDD.
PMS definition
PMS is a group of physical and emotional symptoms that come in the 1 to 2 weeks before a period and ease within a few days of it starting.
According to the Office on Women’s Health, more than 90% of women report some premenstrual symptoms. Having occasional symptoms does not necessarily mean you have PMS.
PMS is diagnosed from recurring symptoms that affect daily life, appear before a period and improve shortly after it starts, with a relatively symptom-free interval afterward. Tracking symptoms daily for two to three cycles helps your clinician identify the pattern and consider other causes.
What are PMS symptoms?
Emotional
irritabilityanxietylow moodmood swingstrouble concentrating
Physical
bloatingbreast tendernessheadachesfatiguefood cravingscrampswaking up in the night
Food cravings and changes in appetite are common premenstrual symptoms.
What causes PMS?
PMS symptoms can reflect sensitivity to normal hormonal changes during the menstrual cycle and do not necessarily indicate high estrogen or low progesterone.
Changes in estrogen and progesterone seem to affect brain chemicals such as serotonin. That may be one reason SSRIs (a type of antidepressant) help many women with PMS.
Is it PMS or PMDD?
PMDD (premenstrual dysphoric disorder)
- A less common premenstrual disorder with prominent mood symptoms that cause significant distress or disrupt work, relationships or daily activities. It affects up to about 1 in 20 women of reproductive age. Treatment often includes SSRIs.
Get help now
If you have thoughts of harming yourself, at any point in your cycle, call or text 988 (the 988 Suicide & Crisis Lifeline) any time, day or night. If you are in immediate danger, call 911.
PMS in your 40s
PMS can feel different in perimenopause. Cycles become irregular and hormone levels swing more, so symptoms can come at unexpected times or feel stronger.
New mood symptoms, sleep changes or irregular periods in your 40s may reflect perimenopause, PMS or another condition. A clinician can help distinguish them. Our guide to perimenopause vs menopause explains the difference.
How to deal with PMS
Start with the steps that have the most evidence. Many women need only these.
Everyday steps
- 1
Exercise regularly.
Aerobic activity, such as brisk walking for about 30 minutes most days, may ease physical and mood symptoms.
- 2
Calcium.
About 1,200 mg a day in total, from food and supplements combined, may reduce PMS symptoms. Use supplements only to make up a dietary shortfall.
- 3
Vitamin B6 and magnesium.
Vitamin B6 and magnesium have limited evidence for relieving some PMS symptoms. Check with a clinician or pharmacist before taking supplements. Vitamin B6 can cause nerve damage, particularly with prolonged use or when several products containing B6 are combined.
- 4
Sleep, salt, caffeine and alcohol.
Regular sleep and cutting back on salt, caffeine and alcohol in the second half of the cycle may help some women.
- 5
Pain relief.
Anti-inflammatory medicines such as ibuprofen or naproxen can ease cramps, headaches and breast tenderness. Take them as directed when symptoms begin. Ask a pharmacist or clinician first if you have stomach ulcers, kidney disease or take blood thinners.
Treatments a clinician can recommend or prescribe
- 6
Cognitive behavioral therapy (CBT).
A type of talk therapy that guidelines recommend for PMS and PMDD, on its own or with other treatment.
- 7
SSRIs.
SSRIs are among the best-supported treatments for moderate to severe PMS and PMDD. Depending on your symptoms and the medicine prescribed, they may be taken daily or only during the second half of the menstrual cycle.
- 8
Hormonal birth control.
Some combined birth control pills can reduce premenstrual symptoms by suppressing ovulation. A low-dose estrogen pill containing drospirenone has evidence for treating PMDD, although benefits and side effects vary. Combined pills are generally unsuitable if you have migraine with aura or smoke and are 35 or older. Your clinician will review other risk factors too.
DIM and calcium D-glucarate are studied for their potential roles in estrogen metabolism and elimination, though evidence that they relieve PMS or perimenopausal symptoms remains limited. Vitex and other herbal and adaptogen products have limited evidence. Some chemicals in certain plastics and personal care products can interfere with hormones, including estrogen. Their health effects depend on the chemical, amount and timing of exposure, and research is ongoing.
Our supplements guide covers doses and cautions.
Hormone testing
Blood tests can be helpful in certain situations, such as checking for thyroid disease when symptoms suggest it. No blood test diagnoses PMS. A clinician assesses your symptoms, their timing and their effect on daily life, often using a daily symptom diary.
Your doctor decides at the first visit whether lab testing is needed. Lab prices depend on what is tested.
When to get help
If PMS disrupts work, relationships or sleep every month, or is getting worse as you approach your 40s, talk with a provider.
Talk.
A one-on-one video visit about your symptoms, your history and what you want to feel like again. Your first visit is $99, refunded if you cancel at least 24 hours ahead.
Test.
If your provider thinks it will help, a hormone blood panel adds lab results to what you’ve told them. Not everyone needs this step.
Treat.
If treatment is right for you, your plan can include hormone prescriptions, non-hormonal options, lifestyle changes and optional supplements. Then two to three follow-up visits with a doctor and text check-ins through HIPAA-compliant messaging, included in membership at $49 a month, which begins one month after your first visit. Prescriptions and labs are priced separately.
FAQ
Is PMS normal?
Premenstrual symptoms are common, but symptoms that disrupt daily life deserve attention and treatment.
What is the difference between PMS and PMDD?
Both involve recurring symptoms before a period. PMDD has specific diagnostic criteria, including prominent mood symptoms that cause significant distress or interfere with daily life. Treatment often includes SSRIs.
Does PMS mean my hormones are out of balance?
Not necessarily. PMS can reflect sensitivity to normal hormonal changes rather than unusually high estrogen or low progesterone.
Does PMS get worse in perimenopause?
It can. Hormonal fluctuations and less predictable cycles may change the timing or severity of symptoms. PMS and perimenopause can occur together.
What helps PMS without medication?
Options include cognitive behavioral therapy (CBT), regular exercise, consistent sleep and adequate calcium intake. Evidence for vitamin B6 and magnesium supplements is limited, and supplements can have side effects.
PMS that disrupts your month is worth treating.
A video visit with a clinician who treats perimenopause and menopause, in 33 states.
