What is premenstrual syndrome (PMS)?

Premenstrual syndrome (PMS) includes physical and emotional symptoms that happen before a period and go away after it starts.

Common symptoms include mood swings, irritability, bloating and sore breasts. For some people, these symptoms can affect daily life.

A severe form of PMS is called premenstrual dysphoric disorder (PMDD). It leads to stronger emotional symptoms, such as anger and anxiety.

What are the symptoms of PMS?

PMS includes several physical, emotional and behavioural symptoms. These usually happen during the second half of the menstrual cycle and stop shortly after the period begins. They are consistent each cycle.

Common emotional symptoms include:

• mood swings
• irritability
• anxiety
• feeling sad or depressed
• loss of interest in usual activities

Common physical symptoms include:

• feeling bloated
• breast tenderness
• headaches
• fatigue
• hot flushes

For some, these symptoms may affect daily life or work.

PMDD can lead to more intense mood-related symptoms.

What causes PMS?

PMS happens because of changes in hormones during the second half of your menstrual cycle. These changes can affect brain chemicals, such as serotonin, which controls your mood. Some people are more sensitive to these hormone changes, which can lead to symptoms.

Genetics, stress, inflammation and past mental health issues may also play a role in, or worsen PMS.

When should I see my doctor?

You should see your doctor if your PMS:

• symptoms are severe
• affects your daily life
• makes it hard to work or get along with others

Seek help immediately if you ever feel like hurting yourself or have thoughts of suicide.

Your doctor can help find treatments to manage your symptoms.

How is PMS diagnosed?

PMS is diagnosed based on your symptoms and their timing in relation to your menstrual cycle. Your doctor may ask about your symptoms during the second half of your cycle and when they disappear.

To confirm the diagnosis, your doctor may ask you to keep a record of your symptoms for at least 2 menstrual cycles. This helps find patterns and rule out other conditions that may cause similar symptoms.

There are no specific tests for PMS. Your doctor may suggest tests to rule out other possible causes of your symptoms. For example, thyroid disorders or other mood conditions.

How is PMS treated?

Treatment for PMS depends on the severity of your symptoms.

Treatment for mild symptoms

For mild symptoms, recommended treatments may include:

• regular exercise — to help reduce stress, tension, anxiety and depression
• relaxation therapy — to ease stress and anxiety, including relaxation techniques, yoga or meditation
• eating a healthy diet
• vitamin and dietary supplements, such as magnesium and calcium
• over-the-counter pain-relief medicines

Ask your doctor or pharmacist for advice before using any medicines, vitamins or dietary supplements.

Treatment for moderate or severe symptoms

If your symptoms are moderate or severe, your doctor may prescribe medicines. Antidepressant medicines may help improve your mood. Hormonal treatments, such as the pill, may help regulate hormone changes.

If these treatments don't work, your doctor may recommend:

• specialised hormone therapies
• cognitive behavioural therapy (CBT)
• surgery (surgical menopause), as a last resort if you have severe symptoms and other treatments do not help you

Living with PMS

Living with PMS can be challenging, but small changes can make a big difference. Regular exercise, managing stress and eating a healthy diet may help reduce your symptoms. Over-the-counter pain-relief medicines may ease headaches or cramps.

If symptoms are severe, talk to your doctor about treatment options, such as medicines or therapy. Support from friends, family or a counsellor can also help you cope and improve your quality of life.

You have healthcare rights. Seek a second opinion if you feel like something isn't right and your doctor isn't listening.

What are the complications of PMS?

Sometimes, PMS can be more severe and may seriously impact your ability to function at work and in daily life. Severe PMS is known as premenstrual dysphoric disorder (PMDD).

Premenstrual dysphoric disorder (PMDD)

Living with PMDD may impact your quality of life and lead to severe physical and mental changes. Severe PMDD may increase your risk of mental health issues, such as:

• anxiety
• depression
• thoughts of self-harm or suicidal thoughts

These conditions can also lead to missed work, higher stress and more visits to the doctor. Seeking help early may prevent PMS from becoming severe.

PMDD often needs treatment with prescription medicines and lifestyle changes. These may include an antidepressant or hormonal medicines (such as oral contraceptives).

Can PMS be prevented?

Exercise, stress management, dietary changes and medicines can all be used to try and prevent some of the symptoms of PMS.

Speak to your doctor, who can help you build a health management plan. This can help prevent PMS symptoms from affecting your daily life.

Resources and support

The Royal Women's Hospital provides overviews on premenstrual conditions including:

• Sleep, sunshine and vitamin D
• Contraceptive pills
• Exercise, diet and periods
• Complementary and alternative therapies

Jean Hailes for Women's Health offers information on:

• Premenstrual syndrome (PMS)
• Premenstrual dysphoric disorder (PMDD)
• PMS, PMDD and you

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Other languages

Jean Hailes offers resources including fact sheets and videos about periods, fertility and infertility in many community languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

Jean Hailes also provides a booklet on periods, including information on symptoms before your period for Aboriginal and/or Torres Strait Islander people.