What is premenstrual syndrome (PMS)?

Premenstrual syndrome (PMS) involves physical and emotional changes that happen before your period starts each month.

PMS is the same as premenstrual tension (PMT).

There is a severe form of PMS is called premenstrual dysphoric disorder (PMDD). It leads to stronger emotional symptoms, such as anger and anxiety. About 8 in every 100 women get PMDD.

What are the symptoms of PMS?

There are many symptoms of PMS.

Common physical symptoms are:

• feeling bloated
• breast tenderness
• headaches
• fatigue (tiredness)

Common emotional symptoms are:

• mood swings
• irritability
• anxiety
• feeling sad or depressed

These usually happen during the second half of the menstrual cycle and stop shortly after your period begins. Symptoms are the same each month.

These symptoms may affect your daily life.

Premenstrual dysphoric disorder (PMDD)

PMDD is a severe form of PMS. It causes more intense mood-related symptoms, such as:

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

Try the International Association for Premenstrual Disorders (IAPMD) self-screening tool.

What causes PMS?

The exact cause of PMS is not known. It’s thought that people who get PMS or PMDD may be more sensitive to the menstrual cycle hormonal changes.

PMS is also linked to brain chemicals, such as serotonin and gamma-aminobutyric acid (GABA).

When should I see my doctor?

You should see your doctor if your PMS symptoms affect your daily life and lifestyle changes have not helped. Your doctor can find treatments to help ease your symptoms.

When to seek urgent care

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

Get a second opinion if you feel like your doctor isn't listening. Learn more about your healthcare rights.

How is PMS diagnosed?

Your doctor will ask you about symptoms and your menstrual cycle.

Show your doctor a record of your symptoms for at least 2 menstrual cycles. This helps them find patterns and rule out other conditions.

There are no specific tests for PMS. Your doctor may suggest blood tests to check your thyroid function.

If you have irregular periods, your doctor may refer you to a gynaecologist (specialist in the female reproductive system).

How is PMS treated?

Treatment for PMS depends on the type and severity of your symptoms.

Self-care at home

There are things that you can do at home that may help your PMS, such as:

• regular exercise
• eating a healthy diet
• managing stress with relaxation techniques, such as yoga, meditation or mindfulness

Placing a heat pack on the area where the cramps are or having a warm bath may help with reducing the impact of cramps.

Many women find taking dietary supplements helpful, but there is little scientific evidence to support this. Some people use products, such as:

• calcium
• evening primrose oil — for breast tenderness
• Ginkgo biloba
• magnesium
• vitamin B6
• vitamin D
• Vitex agnus-castus (chasteberry)

Always ask your doctor or pharmacist for advice before taking vitamins or dietary supplements.

Medicines for PMS

Some antidepressant medicines may help improve your mood, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin–noradrenaline reuptake inhibitors (SNRIs).

Hormonal medicines can also treat PMS. Taking the combined oral contraceptive pill may help improve your symptoms. Oestrogen hormone patches and gel can improve your PMS symptoms.

Other treatment options

Cognitive behavioural therapy (CBT) can be helpful. This lets you talk about your symptoms with a psychologist. It can help reduce the impact of your symptoms on your life.

If you have severe symptoms and other treatments do not help, your doctor may suggest surgery. Removing your uterus, ovaries and fallopian tubes is called a surgical menopause.

Living with PMS

Living with PMS can be challenging, but small changes can make a difference.

Try to:

• get regular exercise — about 30 minutes every day
• eat a healthy diet
• manage your stress — using yoga, meditation or mindfulness
• get good quality sleep
• quit smoking or vaping, if you smoke

What are the complications of PMS?

People with PMS are at greater risk of suicidal thoughts. Those with PMDD are more likely to attempt suicide.

A history of PMS or PMDD is also linked to a greater chance of getting postnatal depression.

Can PMS be prevented?

There are no specific strategies to prevent PMS. However, lifestyle changes may help, such as:

• aerobic exercise
• yoga
• a carbohydrate rich diet
• vitamin supplements

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

Resources and support

The Royal Women's Hospital provides overviews on premenstrual conditions.

Languages other than English

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

Information for Aboriginal and/or Torres Strait Islander peoples

Jean Hailes has a booklet on periods for Aboriginal and/or Torres Strait Islander people.

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