Premenstrual Syndrome (PMS) Quiz
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Discomfort when my period comes
Headache
Breast pain
Tired all the time
Mood swings
Irritable
Stomach bloating
Low energy
Breast tenderness
Sore breasts
Menstrual pain
Not seeing your symptoms? No worries!
What is Premenstrual Syndrome (PMS)?
PMS refers to physical or mood changes that occur shortly before menstruation and typically resolve a few days after. PMS symptoms generally recur with each menstrual cycle and can negatively affect the women's normal life. PMS consists of both mental and physical symptoms, occurring 3-10 days before menstruation. Symptoms start to improve once menstruation begins. The cause of PMS is poorly understood, but is related to fluctuations in levels of female hormones. PMS can worsen underlying mood disorders such as anxiety and depression.
Typical Symptoms of Premenstrual Syndrome (PMS)
- Symptoms improve after period
- Premenstrual symptoms like discomfort and irritability
- Symptoms occur 1 to 2 weeks before periods
- Breasts feel stretched, tight or full
- Frequent stomach or abdominal pain with unknown causes
- Headache
- Feeling irritable
- Intense mood swings
Diagnostic Questions for Premenstrual Syndrome (PMS)
Your doctor may ask these questions to check for this disease:
- Do your PMS symptoms improve once your period starts?
- Do you have premenstrual symptoms such as discomfort and irritability?
- Do you feel unwell 1-2 weeks before your period?
- Do your breasts feel stretched or tight?
- Do you have frequent stomach or abdominal pain with unknown causes?
Treatment of Premenstrual Syndrome (PMS)
Treatment of PMS mostly involves lifestyle changes like regular sleep cycles and a balanced diet. Medications can also help with muscle aches and stomach cramps. Counseling may be helpful in coping with the stress of this disorder. Hormonal birth control can be used to suppress the menstrual cycle or reduce it. For patients with severe symptoms that affect their work and personal life, medications such as antidepressants (SSRI's) can be used.
Reviewed By:
Ravi P. Chokshi, MD (Obstetrics and Gynecology (OBGYN), Critical Care)
Current Maternal Fetal Medicine Fellow with Dual board certification in Obstetrics & Gynecology and Critical Care Medicine. | 5+ years experience managing a general Ob/Gyn practice and working in the Intensive Care Unit. | Previously Physician Lead of a large single specialty practice with 8 Physicians and 10+ Advanced practitioners. | Member of the Society of Maternal Fetal Medicine Patient education committee. | Frequent Medscape Consult contributor.
Seiji Kanazawa, MD, PHD (Obstetrics and Gynecology (OBGYN))
Dr. Kanazawa graduated from the Niigata University Faculty of Medicine and received his Ph.D. from the Tohoku University Graduate School of Medicine. He is working on the front line of the General Perinatal Center, including the Tokyo Tama General Medical Center and the National Center for Research in Fertility Medicine, where he provides maternal and fetal care and undertakes clinical research. At Ubie, Dr. Kanazawa has been designing the Ubie AI Symptom Checker and has taken on the role of general obstetrics and gynecology consultation at FMC Tokyo Clinic by providing fetal ultrasound and prenatal consultation.
Content updated on Dec 6, 2024
Following the Medical Content Editorial Policy
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People with similar symptoms also use Ubie's symptom checker to find possible causes
- Premenstrual symptoms
- Tightness in breast
- Emotional before the start of my period
- My breast feels heavy and fuller
- Feel terrible before starting period
- Feeling uncomfortable before my menses
- Breasts feel swollen
- PMS
- Left breast tension
- Tender breasts
- Change in libido
- Right breast tension
- Breasts feel fuller
- Heaviness in breasts
- Breasts are feeling heavier than usual
See full list
Symptoms Related to Premenstrual Syndrome (PMS)
Diseases Related to Premenstrual Syndrome (PMS)
FAQs
Q.
Is It Just PMS? Why Your Hormones Are Spiraling & Medically Approved Next Steps
A.
There are several factors to consider: what feels like PMS can range from normal premenstrual changes to PMDD or other conditions like thyroid disease, PCOS, perimenopause, or premenstrual worsening of depression or anxiety, especially if symptoms are severe, disruptive, cycles are irregular or heavy, or you have thoughts of self-harm that need urgent care. Medically approved next steps include tracking symptoms for 2 to 3 cycles, using proven lifestyle strategies, considering calcium, vitamin B6, or magnesium with clinician guidance, and discussing SSRIs, hormonal birth control, NSAIDs, and therapy; see below for the complete guidance and important nuances that could change the best next step for you.
References:
* Maršík, T., Vranovská, T., & Holubová, M. (2023). Premenstrual syndrome and premenstrual dysphoric disorder: current insights into etiology and treatment. *Journal of Biological Research-Thessaloniki*, *30*(1), 16.
* Back, S. N. (2022). Premenstrual Dysphoric Disorder: Neurobiology, Diagnosis and Treatment. *International Journal of Women's Health and Reproduction Sciences*, *10*(3), 118–123.
* Kresch, E., Lall, A., & Nierenberg, A. A. (2023). Treatment of Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Review. *Current Psychiatry Reports*, *25*(9), 481–488.
* Epperson, C. N., Steiner, M., & Hirschberg, L. M. (2021). Premenstrual Disorders: A Narrative Review of Diagnosis, Comorbidities, and Treatments. *The Primary Care Companion for CNS Disorders*, *23*(3), 20r02804.
* Nevatte, T., O'Brien, P. M., Bäckström, T., Endicott, J., Epperson, C. N., Eriksson, E., Gehlert, S., Halbreich, U., Ismail, K. M., Panay, N., Pearlstein, T., & Steiner, M. (2017). Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Diagnosis and Treatment. *Current Problems in Obstetrics, Gynecology and Fertility*, *40*(3), 85–109.
Q.
Is it PMDD? Why your body is spiraling & medical steps to relief
A.
PMDD is a severe, cyclical form of premenstrual symptoms that can make life feel like it’s spiraling in the 1 to 2 weeks before a period, then ease soon after bleeding starts; it stems from heightened sensitivity to normal hormones and is real and treatable. Medical steps include tracking at least two cycles, seeing a clinician to confirm timing and rule out other conditions, and considering first-line SSRIs, carefully selected hormonal birth control, and supportive therapy and lifestyle changes, with urgent care for any self-harm thoughts; there are several factors to consider, and important details that can change your next steps are outlined below.
References:
* Hantsoo, M. H. S., & Epperson, L. R. (2018). Premenstrual dysphoric disorder: current insights into aetiology and management. *F1000Research*, *7*, 1484.
* Hantsoo, M. H. S., Mellon, C. N., & Epperson, L. R. (2021). Serotonin and Premenstrual Dysphoric Disorder: a Clinical Perspective. *Current Psychiatry Reports*, *23*(4), 21.
* O'Brien, N. G. R., Scholl, J. M., Kroll, S. M. K., & Group, E. P. (2021). Diagnosis and Management of Premenstrual Dysphoric Disorder. *American Family Physician*, *104*(2), 161-170.
* Alqahtani, M. H., Alshamrani, A. A., Alqahtani, M. S., Alqahtani, S. S., Alqahtani, S. A., Alqahtani, B. S., & Alqahtani, F. S. (2024). Pharmacological and non-pharmacological interventions for premenstrual dysphoric disorder: an umbrella review. *BMC Women's Health*, *24*(1), 21.
* Rapkin, L. A. S., Greenfeld, R. H., & Aksoy, S. N. (2022). Premenstrual Dysphoric Disorder: Updates and Clinical Pearls. *Obstetrics & Gynecology*, *140*(1), 147-156.
Q.
Monthly Meltdown? Why Your Brain Hijacks Your Mood & Medical Next Steps
A.
Severe, cyclical mood swings before your period often signal PMDD, a brain-based sensitivity to normal hormonal shifts in the luteal phase where allopregnanolone acting on GABA receptors can trigger anxiety, depression, irritability, and physical symptoms that usually ease once bleeding starts. Proven next steps include SSRIs taken daily or only in the second half of the cycle, plus carefully chosen birth control since some types can worsen mood, along with lifestyle changes, CBT, and tracking symptoms for at least two cycles. If you have suicidal thoughts seek urgent care, and see the important details and caveats below to choose the best plan with your clinician.
References:
* Gyllenhammer, L., & Bäckström, T. (2020). The Neurobiology of Premenstrual Syndrome and Premenstrual Dysphoric Disorder. *Dialogues in Clinical Neuroscience*, *22*(4), 369–379. [PMID: 33437149]
* Rapkin, A. J., & Winer, S. A. (2020). Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Diagnosis and Treatment. *Obstetrics and Gynecology Clinics of North America*, *47*(3), 395–408. [PMID: 32690342]
* Ma, H., & Ma, X. (2022). The Role of Ovarian Hormones in Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Narrative Review. *Neuropsychiatric Disease and Treatment*, *18*, 425–439. [PMID: 35273467]
* Schmidt, P. J., & Rubinow, D. R. (2018). The neurobiology of premenstrual dysphoric disorder. *Molecular Psychiatry*, *23*(5), 1083–1093. [PMID: 28243920]
* Backstrom, T., Gulin, L., & Wahlstrom, J. (2023). Update on the aetiology and management of premenstrual dysphoric disorder. *Current Opinion in Psychiatry*, *36*(3), 164–171. [PMID: 37042502]
Q.
Sudden Brain Fog? Why Your Luteal Phase Is a "Body Hijack" + Medically-Proven Next Steps
A.
Sudden brain fog in the luteal phase is often driven by normal hormone shifts, with progesterone’s calming effect slowing thinking, estrogen dips reducing memory and focus, and a heightened stress response that can make small problems feel bigger. Medically proven steps include stabilizing blood sugar, prioritizing sleep, adjusting workout intensity, considering evidence-backed supplements with clinician guidance, reducing cognitive load, and for severe PMS or PMDD, options like certain combined oral contraceptives or SSRIs. There are several factors to consider and important red flags to watch for, so see below for specifics and how to choose the right next steps for your situation.
References:
* Epperson, C. N., & Steiner, M. (2018). Cognition and the menstrual cycle. *Current Opinion in Psychiatry*, *31*(6), 460–465.
* Noll, S. K., Loehr, M. A., & Roesch, K. A. (2022). Cognitive performance across the menstrual cycle in women with and without premenstrual dysphoric disorder. *Archives of Clinical Neuropsychology*, *37*(2), 291–306.
* Reis, R. M., Faleiros, F. N., de Carvalho, S. R., & Resende-Rodrigues, A. P. (2022). The Effects of Progesterone on Cognitive Function in Women: A Systematic Review. *Current Women's Health Reviews*, *18*(2), 105–118.
* de Godoy, B. F., Rosa-Cunha, J. F., de Jesus, M. A., Lhullier, A. C. M., & de Mello, M. T. (2022). Impact of ovarian steroids on affective and cognitive domains during the menstrual cycle in women with and without premenstrual dysphoric disorder: a systematic review. *Archives of Women's Mental Health*, *25*(6), 1163–1182.
* Marjoribanks, J., Ayeleke, R. O., Lethaby, A., & Farquhar, C. (2017). Treatment options for premenstrual syndrome and premenstrual dysphoric disorder. *The Cochrane Database of Systematic Reviews*, *9*(9), CD006114.
Q.
Why Am I So Tired Before My Period? Causes & Next Steps for Women 30-45
A.
Premenstrual fatigue in women 30 to 45 is most often driven by luteal phase hormone shifts that impact sleep and energy, including rising progesterone, poorer sleep quality, PMS, blood sugar swings, iron deficiency with heavy periods, thyroid problems, and early perimenopause. There are several factors to consider; next steps range from tracking your cycle, prioritizing sleep, stabilizing blood sugar, and gentle movement to lab checks for iron, thyroid, vitamin D, and B12 or seeing a clinician if symptoms are severe, persistent, or paired with heavy bleeding or mood changes. See the complete guidance below to understand what applies to you and how to act on it.
References:
* O'Brien PM, Bäckström T, Brown C, Dennerstein L, Endicott J, Epperson CN, Eriksson E, Freeman E, Halbreich U, Ismail KM, Panay N, Pearlstein T, Rapkin A, Reid R, Schmidt P, Steiner M, Studd J. Fatigue as a symptom of premenstrual syndrome. J Womens Health (Larchmt). 2011 Nov;20(11):1643-52. doi: 10.1089/jwh.2011.3001. PMID: 22055627.
* Halbreich U, Bäckström T. Premenstrual syndrome and premenstrual dysphoric disorder: current state of understanding and treatment options. Psychoneuroendocrinology. 2012 Dec;37(12):1913-37. doi: 10.1016/j.psyneuen.2012.07.019. Epub 2012 Sep 29. PMID: 23019888.
* Hantsoo L, Epperson CN. Neurobiological basis of premenstrual dysphoric disorder. Curr Psychiatry Rep. 2019 Jan 24;21(2):10. doi: 10.1007/s11920-019-0994-x. PMID: 30678602; PMCID: PMC6395353.
* Hantsoo L, Kornfield S, Coeytaux Smith J, Grillon C, Epperson CN. Mood and physical symptoms during the menstrual cycle in women with and without premenstrual dysphoric disorder. J Affect Disord. 2016 Jun;197:210-6. doi: 10.1016/j.jad.2016.03.016. Epub 2016 Mar 17. PMID: 27040417; PMCID: PMC5003668.
* Eisenlohr-Moul TA, Rubinow DR, Rubinstein LM, Schartner C, Schiller CE. Treatment of Premenstrual Dysphoric Disorder: A Review. Front Psychiatry. 2017 Mar 9;8:27. doi: 10.3389/fpsyt.2017.00027. PMID: 28330756; PMCID: PMC5343468.
Q.
Mediterranean Diet for Women 30-45: Your Symptom Action Plan
A.
Mediterranean diet guidance for women 30 to 45 offers a practical symptom action plan for PMS and cycle shifts, midsection weight gain, fatigue and brain fog, mood changes, bloating, and rising heart risk by centering vegetables, legumes, whole grains, fish, nuts, and olive oil to steady blood sugar and reduce inflammation. There are several factors to consider, including a simple plate formula, weekly targets for fish and legumes, smart swaps, and lifestyle habits that boost results. Crucial nuances and safety checkpoints are outlined below, including symptom specific food picks, a 7 day framework, and when to seek care for heavy bleeding, severe mood symptoms, rapid weight changes, chest or abdominal pain, or persistent fatigue. For next steps tailored to your situation, see the complete guidance below.
References:
* Barrea L, Frias-Toral E, Greco M, Pugliese G, Castellucci B, Garcia-Flores JJ, Di Somma C, Colao A, Savastano S, Muscogiuri G. Mediterranean Diet, Polycystic Ovary Syndrome, and the Gut Microbiota. Nutrients. 2021 Dec 22;14(1):20. doi: 10.3390/nu14010020. PMID: 34960010; PMCID: PMC8778641.
* Casas-Agustench P, Salas-Salvadó J, López-Uriarte P, Ros E, García-Arellano A, Hernáez Á, Castañer O, Corella D, Fitó M, Salas-Huetos A. Anti-inflammatory effects of the Mediterranean diet: A systematic review. Metabolism. 2020 Apr;105:154174. doi: 10.1016/j.metabol.2020.154174. Epub 2020 Mar 30. PMID: 32247271.
* Gantenbein L, Gantenbein S, Schmid M, Hösli D, Kutz A, Schuetz P. Effectiveness of Mediterranean Diet on Metabolic Syndrome and its Components: A Systematic Review and Meta-Analysis. Nutrients. 2021 Nov 22;13(11):4176. doi: 10.3390/nu13114176. PMID: 34836253; PMCID: PMC8622154.
* Maleki V, Shahabi S, Razavi M, Jafari-Adli S, Fatahi S. Mediterranean diet and bone health: a systematic review and meta-analysis. Osteoporos Int. 2020 Aug;31(8):1465-1481. doi: 10.1007/s00198-020-05404-z. Epub 2020 Apr 23. PMID: 32328812.
* Veronese N, Solmi M, Caruso MG, Giannelli G, Koyanagi A, Thompson T, Fornaro M, Stubbs B. Adherence to the Mediterranean Diet and Risk of Depression and Anxiety in Women: A Systematic Review and Meta-Analysis. Clin Nutr. 2019 Dec;38(6):2580-2591. doi: 10.1016/j.clnu.2019.02.016. Epub 2019 Mar 1. PMID: 30878593.
Q.
Red Light Therapy for Women 30-45: Benefits & Your Next Steps
A.
Red light therapy may help women 30 to 45 with skin firmness and tone, PMS-related discomfort, mood and energy, muscle and joint recovery, sleep quality, and some hair thinning by enhancing cellular energy and reducing inflammation. There are several factors to consider and key safety notes, so see below to understand wavelengths, device options, expected timelines, and when to talk to a clinician. Next steps include clarifying your main goal, choosing an FDA-cleared device in the 630 to 850 nm range, using it 3 to 5 times weekly for 10 to 20 minutes, and tracking results, while not replacing medical care, especially if pregnant, on photosensitizing meds, have a skin cancer history, or severe symptoms. Complete details and decision points that can change your plan are outlined below.
References:
* Wunsch A, Matuschka K. A controlled trial to determine the efficacy of red and near-infrared light treatment in the cosmetic treatment of skin aging. Photomed Laser Surg. 2014 Feb;32(2):93-100. doi: 10.1089/pho.2013.3616. PMID: 24286286; PMCID: PMC3926176.
* Soares C, Furtado M, Mota L, Silva H, Padrão C, et al. Low-level laser therapy (LLLT) in female infertility: a systematic review. Lasers Med Sci. 2021 May;36(4):729-738. doi: 10.1007/s10103-020-03126-7. PMID: 32770281.
* Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012 Feb;40(2):516-33. doi: 10.1007/s10439-011-0627-7. PMID: 21898302; PMCID: PMC3288797.
* Ferraresi C, Hamblin MR, Parizotto NA. Low-level laser (light) therapy (LLLT) on muscle tissue: performance, fatigue and repair benefited by the power of light. Photonics Lasers Med. 2012 Nov 1;1(4):259-270. doi: 10.1515/plm-2012-0032. PMID: 23205218; PMCID: PMC3503598.
* Cassano P, Hamblin MR. Transcranial photobiomodulation for the treatment of brain disorders. Biochem Pharmacol. 2017 Jan 15;130:175-188. doi: 10.1016/j.bcp.2016.07.039. Epub 2016 Jul 28. PMID: 27477611; PMCID: PMC5274483.
Q.
Can hormonal changes or menstruation cause right upper abdominal pain in women?
A.
Hormonal changes during menstruation can sometimes cause abdominal pain, but it's not common for them to cause right upper abdominal pain specifically.
References:
Podgaec S, Gonçalves MO, Klajner S, & Abrão MS. (2008). Epigastric pain relating to menses can be a symptom of .... Sao Paulo medical journal = Revista paulista de medicina, 18853038.
https://pubmed.ncbi.nlm.nih.gov/18853038/
Pašalić E, Tambuwala MM, & Hromić-Jahjefendić A. (2023). Classification, pathophysiology, and treatment options. Pathology, research and practice, 37844487.
https://pubmed.ncbi.nlm.nih.gov/37844487/
Heitkemper MM, & Chang L. (2009). Do fluctuations in ovarian hormones affect gastrointestinal .... Gender medicine, 19406367.
Q.
What are the possible causes of nausea and vomiting in women?
A.
Nausea and vomiting in women can be caused by a wide range of factors, including gastrointestinal issues, hormonal changes, infections, and psychological factors. Understanding these potential causes is essential for effective diagnosis and treatment.
References:
Johns T, Lawrence E. Evaluation and Treatment of Nausea and Vomiting in Adults. Am Fam Physician. 2024 May;109(5):417-425. PMID: 38804756.
Heckroth M, Luckett RT, Moser C, Parajuli D, Abell TL. Nausea and Vomiting in 2021: A Comprehensive Update. J Clin Gastroenterol. 2021 Apr 1;55(4):279-299. doi: 10.1097/MCG.0000000000001485. PMID: 33471485; PMCID: PMC7933092.
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ACOG Patient FAQ
https://www.acog.org/womens-health/faqs/premenstrual-syndromeACOG Painful periods
https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periodsACOG Practice Bulletin
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/07/mental-health-disorders-in-adolescentsACOG Practice Bulletin Menstrual suppression
https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2022/09/general-approaches-to-medical-management-of-menstrual-suppression