Premenstrual Syndrome (PMS)

Premenstrual syndrome, or PMS as it is more commonly known, is a condition that affects every three in four menstruating women at some point in their lifetime. Symptoms are generally mild in about 75% of affected women, but may be more severe in others. Symptoms may surface any time between five days to a couple of weeks prior to menstruation, and usually subside at the onset of or three to four days into menstruation.

While PMS could affect menstruating women of any age, it is more commonly reported by women in their thirties. In some cases, symptoms may increase or become more intense as a woman progresses into her late thirties and forties, and subsequently approaches menopause or is in perimenopause. PMS is not experienced by women during pregnancy and after menopause. In the case of pregnant women, post-pregnancy PMS symptoms may be different from those that they experienced pre-pregnancy.


PMS often varies in how it affects every individual, and may also differ in symptoms or their intensity between a given individual’s cycles. Symptoms may include:

Physical SymptomsEmotional / Behavioural Symptoms
. abdominal bloating
. breast tenderness and/or swelling
. constipation or diarrhoea
. cramping
. headache
. muscle/back/abdominal/joint pain
. fluid retention and related weight gain
. dehydration/increased thirst
. fatigue and/or clumsiness
. acne flare-up
. increased prominence of acne scars
. decreased tolerance to touch, noise, light
. increased appetite/cravings
. increased sleepiness/poor sleep
. hot flushes/sweating  
. mood swings
. irritability and/or anger
. anxiety and/or depression
. easily emotional/upset
. difficulty concentrating
. brain fog
. decreased libido
. decreased self-esteem and subsequent social withdrawal


Around 5-8% of women who experience PMS may be affected by a more serious form of PMS called Premenstrual Dysphoric Disorder (PMDD). While symptoms are similar to PMS, they are much more intense and generally negatively impact mental health, quality of life and day-to-day activity.

In some cases, PMS can worsen other existing conditions such as anxiety and depression, irritable bowel syndrome (IBS), bladder pain syndrome and chronic fatigue syndrome.


The exact causes of PMS have not been established for certain. However, PMS is strongly believed to be correlated to the changing hormonal levels during the menstrual cycle – more specifically, the post-ovulation drops in oestrogen and progesterone levels in the luteal phase of the cycle.

Changes in hormone levels during the menstrual cycle
Illustration adapted from UpToDate

Additionally, there are certain factors that are believed to increase the risk of PMS, including:

  • stress
  • poor physical or psychological health
  • being overweight or obese
  • genetics
  • smoking


There is no specific means to test for PMS, and diagnosis depends mostly on observation. Individuals who experience such symptoms as those mentioned above are encouraged to maintain a diary of when they begin to and stop experiencing symptoms and what symptoms they experience for a few consecutive cycles, along with keeping track of their menstrual cycle itself.

If the symptoms experienced are not cyclic, then specific diagnostic tests recommended by your doctor may need to be carried out in order to determine if there are any other underlying causes behind the symptoms experienced.


PMS cannot be completely prevented as such, but there are certain lifestyle changes and measures that can be practised in order to reduce symptoms or at least alleviate their intensity. Such practices can be carried out on those days when one is experiencing PMS, but also otherwise in general. These include:

  • regular workouts – at least half hour each, three times a week – if not everyday
  • getting sufficient sleep – at least 7-8 hours every night
  • maintaining a healthy diet – less carbohydrates, fats, sugars and salty foods, snacking on fruits and vegetables, eating more smaller meals instead of three large meals a day
  • drinking plenty of water
  • reducing alcohol and caffeine intake
  • not smoking
  • taking measures to manage stress levels – such as meditation, yoga, counselling, cognitive behaviour therapy (CBT) or anything that helps you to relax


Following are some forms of treatment that can be administered in order to alleviate some of the symptoms associated with PMS:

  • NSAIDs such as ibuprofen, naproxen, aspirin – to reduce headaches, cramps, muscular pain, back ache, breast tenderness
  • antidepressants such as selective serotonin reuptake inhibitors (SSRIs) – to reduce depression
  • anti-anxiety medicines – to reduce anxiety
  • diuretics such as spironolactone – to reduce bloating, fluid retention, breast tenderness
  • combined oral contraceptive pill – however, the pill is known to cause other side effects and is not recommended to be used long-term
  • supplements such as calcium, vitamin D, vitamin B6, evening primrose – however, effects of these may be limited and it is best to consult your physician prior to use
  • other forms of therapy such as massages, acupuncture – to reduce stress

PMS can be a passive experience for some, while being a rather uncomfortable – and sometimes debilitating – experience for others. Practising the healthy lifestyle habits mentioned above can help to ease some of the discomfort. However, if symptoms are persistently severe, it is best to seek medical advice on how to manage the condition.

Cover illustration from Pinterest

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