Premenstrual Syndrome (PMS)

Aria Health Center for Gynecology & Women's Health

What is premenstrual syndrome?

Most women experience some unpleasant or uncomfortable symptoms during their menstrual cycle. For some women, the symptoms are significant, but of short duration and not disabling. Other women, however, may have one or more of a broad range of symptoms that temporarily disturb normal functioning. These symptoms may last from a few hours to many days. The types and intensity of symptoms vary in individuals. This group of symptoms is referred to as premenstrual syndrome, or PMS. Although the symptoms usually cease with onset of the menstrual period, in some women, symptoms may last through and after their menstrual periods.

Who is affected by PMS?

As many as 85 percent of women, during their reproductive years, experience some of the common symptoms associated with PMS. Further, approximately 30 to 40 percent of these women experience symptoms so severe that they disrupt daily activities. It is estimated that less than 10 percent of women have symptoms so extreme that they are considered disabled by the condition.

In general, women most likely to experience PMS symptoms are between the ages of 20 and 40 - and particularly women from this age group who have one child and have a history of depression in their family.

What are the symptoms of PMS?

The following are the most common symptoms of premenstrual syndrome. However, each individual may experience symptoms differently. Symptoms may include:

psychological symptoms
  • irritability
  • nervousness
  • lack of control
  • agitation
  • anger
  • insomnia
  • difficulty in concentrating
  • lethargy
  • depression
  • severe fatigue
  • anxiety
  • confusion
  • forgetfulness
  • decreased self-image
  • paranoia
  • emotional hypersensitivity
  • crying spells
  • moodiness
  • sleep disturbances

fluid retention

  • edema (swelling of the ankles, hands, and feet)
  • periodic weight gain
  • oliguria (diminished urine formation)
  • breast fullness and pain

respiratory problems

  • allergies
  • infections

eye complaints

  • visual disturbances
  • conjunctivitis
gastrointestinal symptoms
  • abdominal cramps
  • bloating
  • constipation
  • nausea
  • vomiting
  • pelvic heaviness or pressure
  • backache

skin problems

  • acne
  • neurodermatitis (skin inflammation with itching)
  • aggravation of other skin disorders, including cold sores

neurologic and vascular symptoms

  • headache
  • vertigo
  • syncope (fainting)
  • numbness, prickling, tingling, or heightened sensitivity of arms and/or legs
  • easy bruising
  • heart palpitations
  • muscle spasms


  • decreased coordination
  • painful menstruation
  • diminished libido (sex drive)
  • appetite changes
  • food cravings
  • hot flashes

The symptoms of PMS may resemble other conditions or medical problems. Consult a physician for diagnosis.

What causes PMS?

Premenstrual syndrome seems to be related to fluctuations in estrogen and progesterone levels in the body, and does not necessary denote disabled ovarian functioning. The following have been suggested as possible causes of PMS:

  • estrogen-progesterone imbalance
  • hyperprolactinemia (excessive secretion of prolactin, the hormone that stimulates breast development)
  • excessive aldosterone, or ADH (hormone that functions in the regulation of the metabolism of sodium, chloride, and potassium)
  • carbohydrate metabolism changes
  • retention of sodium and water by the kidneys
  • hypoglycemia (low blood sugar)
  • allergy to progesterone
  • psychogenic factors

Preventing premenstrual syndrome symptoms:

For some women, making simple lifestyle changes helps to reduce the occurrence of PMS symptoms. These changes may include:

  • regular exercise (3 to 5 times each week)
  • a well-balanced diet
    It is generally recommended that women with PMS increase their intake of whole grains, vegetables, and fruit, while decreasing their intake of salt, sugar, caffeine, and alcohol.
  • adequate sleep and rest

How to diagnose premenstrual syndrome:

Aside from a complete medical history and physical and pelvic examination, diagnostic procedures for PMS are currently very limited. Your physician may consider recommending a psychiatric evaluation to, more or less, provide a differential diagnosis (to rule out other possible conditions). In addition, he/she may ask that you keep a journal or diary of your symptoms for several months, to better assess the timing, severity, onset, and duration of symptoms.

Treatment for PMS:

Specific treatment for PMS will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the condition
  • current symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Counseling with your physician regarding symptoms can often increase understanding and lead to activities for stress management. Other possible treatments for managing premenstrual syndrome symptoms may include:

  • diuretic use prior to the time symptoms are usually noted (to reduce fluid retention)
  • prostaglandin inhibitors (i.e., nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin, ibuprofen) - to reduce pain
  • oral contraceptives (ovulation inhibitors)
  • progesterone (hormone treatment)
  • tranquilizers
  • changing the diet (to increase protein and decrease sugar and caffeine intake)
  • vitamin supplements (i.e., vitamin B6, calcium, and magnesium)
  • regular exercise
  • antidepressants (or other medications)