PMS Syndrome – Causes, Symptoms, & Treatment

Premenstrual symptoms are common in women of childbearing age and usually present a few days before menstruation. From mood shifts and breast tenderness to headaches to headaches and bloating, premenstrual symptoms have the potential to interfere with daily living. You can take control of your hormonal health by recognising the causes of PMS and understanding the available treatments.

This article reviews the causes of premenstrual syndrome (PMS), its diagnosis, treatments of PMS, and when you need professional advice.

What is PMS (Premenstrual Syndrome)?

Premenstrual syndrome (PMS) consists of a collection of physical, behavioural, and emotional symptoms that develop at the luteal phase of the menstrual cycle, the days following ovulation until the days preceding bleeding. PMS symptoms tend to develop one or two weeks before bleeding onset and disappear after bleeding starts.

According to Thomas J Reilly from the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK, et al., premenstrual syndrome occurs in 20–30% of women. It is defined by symptoms in the luteal phase. A minority also qualify for PMDD, a related but more serious disorder of prevalence 1–6%. Doctors diagnose the condition based on a variety of symptoms, primarily mood-related changes that limit your ability to function.

Symptoms range from several days to two weeks in duration, depending on the woman. The NHS and world medical organisations acknowledge PMS as an actual illness affecting quality of life.

Early identification of PMS allows women to prepare and manage cycle-related symptoms. The diagnosis is typically based on a recurrent pattern of symptoms that occurs with the menstrual cycle, rather than an isolated acute episode.

What Causes PMS Symptoms?

Premenstrual syndrome (PMS) arises from an interaction of hormonal shifts, lifestyle contributions, and medical issues that occur differently among women. PMS usually develops during the luteal phase of the menstrual cycle, at a stage when hormonal shifts impact your mood, physical comfort, and energy levels.

Several factors contribute to these symptoms:

• Hormonal changes: Fluctuations of oestrogen and progesterone before menstruation have an impact on neurotransmitters such as serotonin that regulate mood.
• Genetic predisposition: A history of PMS or a related hormonal disorder may increase susceptibility.
• Lifestyle factors: Stress at high levels, smoking, poor sleeping, and low exercise activity are likely to worsen PMS.
• Deficiencies of nutrients: Lowered concentrations of vitamin B6, magnesium, and calcium have been related to more serious symptoms.
• Medical illness: Thyroid disease, depression, and endometriosis can present with or worsen PMS.

According to the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany, normal hormonal changes trigger PMS. This happens because some women are sensitive to metabolites (substances produced when the body breaks down progesterone). Genes and environment also play a part in the tendency to develop PMS because progesterone may also affect neurotransmitters of the brain.

Delineation of such causes provides guidance on treatment strategies, including lifestyle interventions, nutritional therapy, and pharmaceutical therapy.

What are the 7 Most Common PMS Symptoms?

PMS symptoms follow a specific pattern during the luteal phase (the time between ovulation and your period) of the cycle, occurring every month and resolving around the onset of menstruation. Physical discomforts often occur alongside behavioural symptoms, such as increased hunger or emotional changes like irritability.

Recognising these common PMS symptoms helps with early management and treatment.

Breast Tenderness

Premenstrual hormonal changes can increase breast tenderness by stimulating hormone receptors, causing the breasts to feel heavy, swollen, or sore. Symptoms normally subside after bleeding commences. Though harmless, they may interfere with comfort at work. Supportive bras, heating pads or warm compresses, and reducing excessive caffeine intake may help alleviate symptoms. Tracking these patterns helps your doctor differentiate typical PMS symptoms from other breast conditions.

Bloating or Feeling Gassy

Water retention and delayed digestion from hormonal shifts frequently bring on bloating, stomach upset, or a “puffy” sensation leading up to menstruation. Though temporary, PMS symptoms of this nature can deflate self-esteem and energy. Drinking water, restricting salt intake, and engaging in regular exercise are simple remedies that promote digestive harmony and prevent water retention.

Constipation or Diarrhoea

Pre-menstrual prostaglandins (lipids that aid in recovery at tissue damage sites) also affect bowel activity and may give rise to constipation or diarrhoea. Gastrointestinal PMS symptoms are common but often overlooked. Short-lived for most women, they can sometimes disrupt their routine. Premenstrual gastrointestinal discomfort is often alleviated by a high-fibre diet, adequate hydration, and gentle exercise that helps maintain gut control.

Clumsiness

A few women experience clumsiness or coordination inadequacy days before their cycle. This overlooked PMS symptom may be connected to fatigue, momentary lapses of concentration, or fluid imbalances that cause the body to become unbalanced. While temporary, it is frustrating. Rest, hydration, and gentle exercise improve stability and decrease its impact on daily activities.

Headache

Decreases in oestrogen levels at the premenstrual stage may provoke headaches or migraines. These headaches from PMS sometimes have an association with fatigue, irritability, or photophobia (extreme sensitivity to light). According to Kjersti Grøtta Vetvik from the Akershus University Hospital, Norway, et al., there is a strong link between migraines and PMS. A study of 237 women highlighted the comparison of self-rated symptoms between those with migraines and those without.

Food Cravings

Hormonal changes that affect serotonin and blood sugar can also usher in hunger for sweets or salt snacks. Although natural, overindulging will only worsen bloating and sluggishness. Energy-stabilising snacks that contain protein and grains control hunger. Recognising cravings as a normal PMS symptom allows more constructive decisions that reduce discomfort while maintaining emotional and physical wellness.

Light/Noise Sensitivity and Cognitive Shifts

During the premenstrual period, many women experience heightened sensitivity to sound or light, which is frequently linked to menstrual migraines or intense headaches. Beyond these physical sensations, PMS often manifests through behavioural and psychological shifts, such as marked irritability and an inability to concentrate. These symptoms can lead to withdrawal from work, social engagements, and family life, as noisy or high-pressure environments become overwhelming.

Recognising this combination of physical discomfort and emotional change is vital for an accurate diagnosis. It allows clinicians to distinguish PMS from other underlying conditions and helps in designing support strategies that address not only the physical pain but also the impact on the patient’s professional and personal relationships.

How is PMS Diagnosed?

PMS is typically diagnosed based on the recurrence of symptoms with the menstrual cycle. The physician typically requests that the woman maintain a symptom diary for at least two to three months, including details on the timing and severity of her symptoms.

There are no diagnostic blood tests for PMS per se, but tests can be carried out to rule out thyroid disease, anaemia, or psychiatric illness that will masquerade as cycle-dependent symptoms. Clinicians diagnose the condition by looking for patterns rather than isolated symptoms.

Gynaecologists and specialists who treat menopause recommend differentiating PMS from PMDD and exclusion of other conditions before diagnosis. According to Irene Petersen from the Department of Clinical Epidemiology, Aarhus University, Denmark, et al., the prevalence of premenstrual syndrome symptoms (PMS among reproductive-age women is high at 50% to 90%, with reports of symptoms. Severe cases range from 10% to 30%, while those who qualify for the DSM-5 PMDD criteria are from 1% to 8%.

Thus, monitoring mood, body changes, and lifestyle variables enables individualised treatment by the clinician.

How to Treat PMS

PMS symptom treatment varies from mild lifestyle adjustments to physician-prescribed pharmacologic therapies. Optimal treatment balances safety, efficacy, and individual needs accordingly. Determining what is best often requires professional consultation with a healthcare professional.

The following are the main treatment groups commonly applied to premenstrual syndrome.

Medical Treatments

Doctors can prescribe oral contraceptives, which regulate hormones and reduce the severity of PMS. Antidepressants such as SSRIs are also utilised in cases with primary mood symptoms, particularly PMDD.

In their study, “Treatment of severe pre-menstrual syndrome with oestradiol patches and cyclical oral norethisterone,” Watson and Studd demonstrated that suppressing the ovarian cycle effectively alleviates PMS. By using transdermal oestrogen patches to prevent hormonal fluctuations, their research moved away from “deficiency” theories and established the clinical foundation for hormonal suppression as a primary specialist treatment for the syndrome.

Pain relief medications, such as ibuprofen, help alleviate cramps and headaches. In resistant cases, hormonal therapies that suppress ovulation may be considered. Regular follow-up ensures safety and effectiveness.

Lifestyle And Home Management

Lifestyle changes are typically the first step to alleviate PMS symptoms. Exercise regularly helps stabilise hormones and relieve strain, and getting enough sleep stabilises mood and energy levels. Relaxation measures, such as yoga, mindfulness, or deep breathing, help reduce irritability and stress.

Reducing alcohol and caffeine intake can alleviate sleep disturbances and reduce bloating. A healthful diet high in whole grains, fruits, vegetables, and lean protein offers stable energy and reduced craving. Keeping a symptom journal reveals personal patterns and precipitants so women can make practical, informed choices to reduce the impact of PMS on everyday function and health. For further guidance and peer support, the National Association for Premenstrual Syndromes (NAPS) is an excellent resource.

Compounded Medicines

In women who do not tolerate typical treatments, compounded products may offer individualised options. Some possible options include specific hormonal mixes or individualised preparations to treat unique PMS complaints.

Nevertheless, most British organisations, such as the British Menopause Society, insist that first-line licensed treatments must always take precedence. Specialists should only use compounded preparations when there is no adequate licensed alternative, but with rigorous clinical monitoring in all instances. Proper governance, informed consent, and monitoring follow-through are required to meet the safety, efficacy, and individualised needs of women with complex or refractory PMS.

Complementary And Natural Therapies

Complementary therapies are frequent in PMS, but there is inconclusive evidence. Vitamins such as vitamin B6, magnesium, and calcium have been shown to reduce bloating, mood swings, or somnolence (drowsiness) in selected patients. Other herbs, such as evening primrose oil, have been explored with modest benefit.

Non-pharmacological therapies, such as acupuncture, yoga, and relaxation modalities, increase stress resilience and general well-being. Although these alternatives offer relief, they should ideally be administered under the guidance of a healthcare professional, rather than as sole treatments.

Seeking the advice of a healthcare professional guarantees the safe incorporation of alternative remedies with a general plan of managing PMS.

Do PMS Symptoms Get Worse With Age?

Symptoms of PMS can shift with age. Some women feel bad in their 30s and 40s, particularly around perimenopause, when their body’s hormone production is unpredictable. Stress, lifestyle factors, and other diseases, such as thyroid disease, also come into play.

According to Shivani Rangaswamy from Johns Hopkins University School of Medicine, Baltimore, USA, et al., PMS could peak at the end of reproductive life, followed by an improvement after menopause. Symptom prevalence increased with age for absentmindedness, low libido, sleep disturbances, gastrointestinal symptoms, weight gain, headaches, sweating or hot flashes, fatigue, hair loss, and swelling. In contrast, the frequency of abdominal spasms lowered with age.

Adopting good living habits, such as exercise and a balanced diet, will offset age-related deterioration.

When Should You See A Healthcare Provider For PMS Symptoms?

PMS is common, but expert advice is necessary when it is severe, persistent, or significantly disrupts one’s life. Symptoms should never be ignored when they affect work, relationships, or psychiatric health. Emergency consultation is especially required when there are drastic changes in mood, suicidal thoughts, or significant physical issues such as heavy menstruation and sharp pelvic pain.

Successful management of PMS relies on an understanding of hormonal changes and individualised treatment. Expert advice from hormone specialists provides evidence-based recommendations, from advice on lifestyle and coping with the pressure of work or examinations through drug therapies and, as required, compounded medicines. Keeping a symptom diary with cycle analysis of fluctuations of mood, energy, and physiological changes allows accurate diagnoses to be established and the best therapies to be recommended.

Treatment of PMS early in life not only relieves symptoms but also improves interpersonal relationships, overall health, and self-confidence. Monthly suffering is never an absolute requirement because effective and safe treatments are plentiful to restore things to order and harmony. Contact us at Hormone Health to get help.