Healthy New Jersey

Periods (menstruation)

Premenstrual syndrome (PMS)

Premenstrual syndrome, also known as PMS, refers to a combination of physical and emotional symptoms that many people experience in the days and weeks leading up to their period. Most people who menstruate experience some symptoms of PMS, and the symptoms usually go away after their periods start. PMS is caused by changes in your body's hormone levels. A more severe form of PMS is Premenstrual Dysphoric Disorder (PMDD).

PMS can be overwhelming with symptoms that may range from mild to severe. There are ways to manage most symptoms, however, if your symptoms are severe, contact a health care provider.

PMS can occur at any point thorughout your life but can worsen during menopause.

Symptoms of PMS

Symptoms of PMS differ and could include physical or emotional symptoms, or a combination of both. 

Emotional symptoms could include: 

  • Feeling irritable
  • Mood swings
  • Anxiety
  • Bouts of depression (feeling sad)
  • Difficulty concentrating
  • Changes in sleep patterns
  • Loss of sex drive

Physical symptoms could include:

  • Bloating (stomach sticks out more than normal)
  • Breast swelling and tenderness
  • Acne
  • Fatigue
  • Headaches
  • Muscle and joint pain
  • Backache
  • Changes in appetite
  • Constipation or diarrhea

PMS-related mood changes and symptoms usually improve when your period starts and typically disappear a few days afterward. However, if severe symptoms persist, consult with a health care professional. 

Seek medical advice for a proper evaluation if severe or prolonged mood changes like depression persist.

When seeking medical advice, providing basic information on your period is helpful for the evaluation. Track period dates and symptoms using a calendar, diary, or an app. Basic information should include:

  1. Number of days your period usually lasts
  2. The first day of your period (when it started)
  3. The longest time between periods
  4. The shortest time between periods
  5. Information on your flow
  6. Symptoms you experience before, during and after your period
  7. How strongly you experience those symptoms

How to manage PMS

PMS can be overwhelming, but manageable and no single PMS treatment works for everyone. Less severe symptoms can be managed with: 

  • Over-the-counter pain medication like ibuprofen, aspirin, or naproxen, to help with cramps, headaches, backaches, joint pain, and breast tenderness. Always follow the manufacturer's instructions.
  • Relaxation techniques like taking a warm bath, meditating, doing yoga, or breathing exercises.
  • Eating a healthy, balanced diet.
  • Gentle exercise like walking, riding your bike, or stretching.
  • Getting a full 7 to 8 hours of sleep nightly.

Studies have shown that vitamins, including calcium and B6, may help with some symptoms of PMS. Please consult your provider before taking any vitamins.

If your PMS symptoms are umanageable with over-the-counter medications, your health care provider may suggest prescription medicines, such as:

  • Hormonal birth control. Birth control may help with physical symptoms but sometimes they increase emotional symptoms. You may need to try different types of birth control to find what works for you.
  • Antidepressants, like selective serotonin reuptake inhibitors (SSRIs), may help with emotional symptoms.
  • Diuretics ("water pills") to reduce symptoms of bloating and breast tenderness
  • Anti-anxiety medicine to ease anxiety symptoms

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a severe form of PMS. It's a chronic medical condition that needs attention and treatment. PMDD can cause severe emotional and physical symptoms, or a combination of both. PMDD symptoms are severe enough to affect your quality of life. Occurring monthly during the week or two before your period begins, PMDD is much less common than PMS.

People with a family history of PMS or PMDD, depression, postpartum depression, or other mood disorders are at an increased risk of developing PMDD. If you believe you suffer from PMDD, talk with your health care provider.

Symptoms of PMDD

The most common symptoms of PMDD are:

Emotional symptoms

  • Feeling irritable or angry
  • Mood swings
  • Lack of energy
  • Feeling hopeless
  • Suicidal feelings
  • Difficulty concentrating
  • Severe fatigue
  • Anxiety
  • Forgetfulness
  • Feeling overwhelmed or out of control

Physical symptoms

  • Bloating
  • Breast tenderness or swelling
  • Muscle and joint pain
  • Weight gain
  • Abdominal cramps
  • Headache
  • Insomnia
  • Increased anger or conflict with people around you
  • Dizziness
  • Fainting
  • Nausea
  • Diarrhea
  • Constipation
  • Backache
  • Acne
  • Skin inflammation


If you are experiencing severe PMS and believe it may be PMDD, visit a health care provider. To help with your evaluation, you should:

  • Record your symptoms over the last two months to note changes or patterns over time.
  • Know your medical history, including any family history of severe PMS, PMDD, or other mood disorders, such as depression.
  • Provide accurate information about your lifestyle, such as smoking, alcohol consumption or if you are overweight.


There are treatments for PMDD that have been found to work for some people. Discuss treatment options for PMDD with a health care provider so you can decide your treatment together. Treatment options should be based on your PMDD symptoms, personal preferences, and plans to become pregnant.

Treatment options for trans or non-binary patients may differ if you are undergoing or considering hormone treatments. Talk to a health care provider or specialist to figure out what treatment would work best for you. 

Treatment options include:

  • SSRIs (selective serotonin reuptake inhibitor) or antidepressants
  • Birth control
  • Therapy and counselling
  • Painkillers or anti-inflammatory drugs
  • GnRH analogue injections
  • Surgery

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