Premenstrual syndrome (PMS): When it starts, symptoms & treatment

What is PMS?

PMS is short for premenstrual syndrome, referring to the collection of symptoms experienced during the luteal phase of the menstrual cycle, in the weeks before your period starts. PMS can affect anyone who has periods and includes physical, behavioral, and psychological symptoms [1, 2]. But not everyone experiences PMS, and symptoms and severity vary from person to person, and often from cycle to cycle.

Why do I get PMS?

Unfortunately, scientists are still unsure as to why we experience PMS. One leading theory is that PMS symptoms are related to hormonal fluctuations during the luteal phase [3]. After ovulation, at the end of the follicular phase, estrogen levels drop slightly, and progesterone levels begin to rise. Around the middle of the luteal phase, estrogen levels rise again, in parallel with progesterone. If pregnancy does not occur, progesterone levels fall, triggering our periods [4]. These fluctuating hormone levels in the luteal phase may be the cause of our PMS symptoms. There is also a potential genetic component in the individual's likelihood of having PMS, though more research is needed in this area [5]. 

When does PMS start? 

Since PMS is related to menstruation, you may experience PMS from the beginning of your periods. Periods can begin anytime between ages 8 and 17, with an average age of 12 [6]. Each cycle, PMS can start anytime during the luteal phase, but symptoms often begin just before or at the start of your period, and last for three to four days [7, 8]. As your period ends, symptoms should subside. PMS can also feel different from cycle to cycle. Sometimes you might barely notice symptoms, and in other cycles, they may be more intense. 

What are the symptoms of PMS?

Symptoms of PMS can be physical, behavioral, and psychological. Everyone experiences PMS differently, and while some people may only experience one or two symptoms, others may experience several.

[1, 2, 8]

PMS is very common, with around three-quarters of women reporting symptoms at some point in their lives [8]. For most, the symptoms are mild or manageable. However, up to 5% of women experience a much more extreme form of PMS called premenstrual dysphoric disorder (PMDD) [7]. PMDD symptoms are similar to PMS, but psychological symptoms are much more severe and can disrupt daily life, work, and relationships [8].

“PMDD is a severe, hormonally driven mood disorder that occurs in the luteal phase of the menstrual cycle and significantly disrupts emotional and cognitive functioning. Unlike typical premenstrual symptoms (PMS), PMDD involves extreme mood swings, depression, anxiety, irritability, and cognitive difficulties that can interfere with work, relationships, and daily life. Think you are getting into fights, feel ragey and out of control in the 2 weeks before your period!” - Dr. Sarah Oreck

How to manage PMS

For most people who experience PMS, they can manage symptoms with a combination of lifestyle changes and home remedies, such as:

Tracking your cycle and symptoms

Knowing how to manage PMS depends on what symptoms you experience and, crucially, when you experience them. Keep a note of what symptoms you experience, whether they are physical, psychological, or behavioral, and how close to your period they happen. Natural Cycles lets you log symptoms straight into the app while simultaneously tracking your cycle, so you have a clearer picture of how these changes affect you. You’ll also be able to look ahead and know when your period is likely to start, helping you plan ahead.

Gentle exercise

Exercise releases endorphins, which can help balance hormone production and stimulate the body’s natural anti-inflammatory processes. Ultimately, this can provide some relief from physical PMS symptoms, like pain, and improve psychological symptoms, such as stress or anxiety [9]. Whether you enjoy an afternoon at the gym or a gentle stretching session at home, it can be useful to experiment and find an exercise that is supportive for you and your symptoms. Research has shown that yoga, resistance training, and aerobic exercises (such as swimming) can be particularly helpful [9]. 

Eat a balanced diet

Research has shown that maintaining a balanced diet can help to lessen the severity of symptoms, such as period cramps. Try to reduce your intake of salty and fatty foods, as well as simple carbohydrates and alcohol, and increase the amount of fresh, unprocessed foods you are eating. Ensuring you get adequate amounts of vitamin D, zinc, calcium, omega-3 fatty acids, and B vitamins can also help manage PMS [10]. Always speak to your doctor if you are making changes to your diet or considering taking supplements. 

Heat and cooling therapies

Many of us reach for a hot water bottle when we experience period cramps, and for good reason. A systematic review of existing studies concluded that heat therapy can decrease menstrual pain [11]. There are several types of heat therapy you can try, such as a hot water bottle or a heat wrap, depending on what is most comfortable and accessible to you. 

On the other hand, you may find cold water treatments comforting. One study of 1114 women found that cold water swimming helped reduce PMS symptoms, especially psychological symptoms including anxiety, mood swings, and irritability [12]. Though more research is needed, some studies suggest cooling therapies may help with pain symptoms, too. One small study found a decrease in headache pain with cooling caps, and another found the same effect on migraine pain with a cooling neck wrap, though neither study specifically focused on PMS-related pain [13, 14]. Always practice caution when using cold or hot therapies to avoid burns or discomfort.

Sex 

Yes, sex may help PMS! More research looking at the relationship between sexual pleasure, pain relief, and PMS is needed, but we do know that sexual pleasure releases “feel-good” chemicals, including oxytocin, which is linked to improved mood and reduced stress and anxiety [15, 16]. 

Not everyone will want to have sex during their period, and that is perfectly okay. Only do what feels comfortable and right for you. You don’t have to involve a partner, either - masturbating during your period has the same effects! 

Birth control and other medications

If you find your PMS symptoms are not subsiding with at-home remedies, there is medication that may help. Over-the-counter painkillers, such as ibuprofen or paracetamol, can help ease pain. If you are struggling with psychological symptoms, your doctor may prescribe antidepressants or recommend cognitive behavior therapy (CBT) [1]. 

Sometimes doctors recommend using hormonal birth control, like the pill, to help relieve the symptoms of PMS. Hormonal birth control reduces the fluctuations of hormones you experience, often to prevent ovulation from occurring. For some people, this will reduce the severity of PMS symptoms, as your body does not have a natural period [1]. However, as with all medications, this option may not be well-suited to everyone and some people may experience side effects [17]. In that case, a non-hormonal birth control method might be a better fit and can still help manage the symptoms of PMS. It’s always best to discuss treatment plans with a trusted healthcare professional to find the support that suits you best. 

When to see a doctor

If you find your PMS symptoms don’t improve after trying at-home treatments and lifestyle changes, or you find your PMS is having an impact on your mental health and think you could have PMDD, speak to your doctor or healthcare provider [1]. Your doctor may be able to prescribe medication to help with symptoms and investigate other potential conditions, such as endometriosis, which may contribute to your symptoms. 

Debilitating pain with periods is NEVER normal…severe pain or heavy bleeding or associated severe diarrhea, constipation, vomiting, or other symptoms should never be ignored. Please see your gynecologist for evaluation. - Dr. Sarah Oreck