PMS 101

Like a predictable monthly occurrence, many women experience a peculiar set of symptoms. They might feel unusually irritable, lashing out at loved ones over minor issues. They could struggle with forgetfulness, misplacing items like car keys, or find it hard to focus during work meetings. Intense cravings for chocolate or late-night snacks like pizza might take over, or they might feel dissatisfied with their appearance due to bloating and greasy, dull hair.

These symptoms are often labeled as premenstrual syndrome, or PMS. While some dismiss it as merely "that time of the month"—a convenient excuse for indulging in chocolate or acting moody—it is far more than that.

Medical professionals acknowledge PMS as a genuine condition, characterized by both physical and emotional symptoms. For countless women, these symptoms are severe enough to significantly impact their daily lives.

What is PMS?

Premenstrual Syndrome (PMS) refers to a series of hormonal fluctuations that lead to various physical and emotional symptoms in women. These symptoms may include mood swings, irritability, abdominal pain, breast sensitivity, and intense food cravings. Typically, PMS manifests 7 to 14 days before menstruation (a woman's monthly period) and subsides once menstruation starts. It is exclusive to a woman's reproductive years and ceases after menopause.

Approximately 40 percent of women who menstruate experience PMS symptoms [ref]. For most, these symptoms are mild and manageable, but around 5 percent of women face severe symptoms that disrupt their daily routines.

In this article, we will explore how medical professionals diagnose PMS, uncover the root causes of this condition, and discuss effective strategies for managing and alleviating its symptoms. 

PMS Symptoms

With over 150 potential symptoms linked to PMS, diagnosing the condition can be challenging. While no specific test exists for PMS, doctors typically conduct tests to eliminate other conditions with similar symptoms. If a woman's symptoms align with her menstrual cycle and other conditions are ruled out, PMS is usually identified as the cause. Maintaining a monthly symptom diary can aid in confirming the diagnosis.

When diagnosing PMS, certain conditions must be ruled out:

PMS encompasses more than 150 physical and emotional symptoms, which can range from mild to severe and vary between individuals and menstrual cycles.

Common symptoms of PMS include:

Psychological symptoms

Physical symptoms

In the following section, we'll explore potential factors that may contribute to the development of PMS.

What Causes PMS?

The exact reasons behind PMS and its varying severity among women remain unclear to scientists. However, they attribute it to a mix of hormonal fluctuations, genetic predisposition, nutrition, and psychological influences.

The Menstrual Cycle

Hormonal changes are a key focus in understanding PMS. PMS typically arises in the latter phase of a woman's menstrual cycle, about seven to 14 days before menstruation begins. This cycle, lasting around 28 days, involves the maturation and release of an egg from the ovaries for potential fertilization. The hormones estrogen and progesterone are central to this process.

Approximately five days after the start of the menstrual cycle, the ovaries begin to secrete estrogen, a key female hormone. This hormone plays a crucial role in thickening the uterine lining, creating a nurturing environment for a potential embryo should fertilization take place. Around the 14-day mark, the process of ovulation occurs, where an egg is released. Following ovulation, the luteal phase commences, often bringing with it the onset of PMS symptoms. During this phase, the ovaries boost estrogen production and start generating progesterone to ready the uterus for pregnancy. If fertilization does not occur, the levels of estrogen and progesterone decline sharply. This decrease triggers the shedding of the uterine lining, resulting in menstruation. PMS symptoms typically dissipate within a day or two after menstruation begins. (For a deeper understanding, refer to How Menstruation Works for more details on the menstrual cycle.)

Scientists theorize that the hormones estrogen and progesterone influence specific brain chemicals, known as neurotransmitters, potentially altering mood and contributing to various PMS symptoms. Below, we explore some of the key neurotransmitters thought to play a role in PMS.

The Role of Hormones and Neurotransmitters

Research indicates that the following neurotransmitters are influenced by estrogen and/or progesterone throughout the menstrual cycle, potentially triggering some PMS symptoms:

The impact of estrogen and progesterone levels on PMS symptoms remains a topic of debate, with studies often yielding contradictory findings. Some experts suggest that the interplay between these two hormones during the menstrual cycle is crucial in determining the severity of PMS symptoms.

Diet and PMS

The exact relationship between diet and PMS is not fully understood, but some studies suggest that consuming more complex carbohydrates before menstruation can boost serotonin levels, a neurotransmitter whose deficiency is linked to PMS-related depression. While complex carbohydrates, such as those in whole grains and vegetables, are beneficial during PMS, simple carbohydrates, like those in sugary snacks and white bread, may worsen water retention, irritability, and other PMS symptoms.

Health professionals often recommend that menstruating women take vitamins, particularly a daily multivitamin containing folic acid, which is vital for fetal development in case of pregnancy, and a calcium supplement with vitamin D to support bone health and potentially alleviate PMS symptoms. While Vitamin B6 is thought to help with symptoms like depression, its efficacy lacks clinical proof, and excessive doses (500 mg to 2,000 mg daily) can lead to nerve damage.

Nutritionists often advise women dealing with PMS to opt for smaller, more frequent meals instead of three large ones. Consuming large quantities of food in one sitting can lead to fluctuations in blood sugar levels, which some believe may worsen PMS symptoms.

Health professionals recommend avoiding specific foods during PMS:

Women are also advised to steer clear of nicotine, as it not only poses general health risks but can also exacerbate PMS symptoms similarly to caffeine.

A 2005 study revealed that women who consumed diets high in vitamin D and calcium were less likely to develop PMS compared to those who didn't. Participants needed to intake at least 1,200 milligrams of calcium and 400 IU of vitamin D daily to see benefits. While the exact mechanism is unclear, researchers suggest that calcium's influence on estrogen during the menstrual cycle may play a role in reducing PMS symptoms.

Treatments for PMS

Alongside dietary adjustments, mild PMS symptoms can often be managed through simple lifestyle changes, such as incorporating regular exercise and minimizing stress.

Exercise Physical activity increases the production of beta-endorphins, chemicals that enhance mood and behavior. Health professionals recommend exercising at least three times a week to help reduce feelings of anger, depression, and stress associated with PMS.

Stress Reduction While stress doesn't directly cause PMS, it can exacerbate its symptoms. Practices like meditation and yoga are often effective in alleviating stress and improving overall well-being.

Medications When lifestyle changes like diet, exercise, and stress management fail to ease symptoms, medications may become necessary. Over-the-counter options, such as those with acetaminophen (Tylenol) or ibuprofen (Motrin), can help alleviate cramps and minor pains. Certain products, like Midol and Pamprin, are specifically designed for PMS and typically combine aspirin or acetaminophen with diuretics to reduce bloating. For women with PMDD (see below), antidepressants like sertraline hydrochloride (Zoloft) and fluoxetine (Prozac, Sarafem) can help manage depression. In extreme cases, birth control pills may be prescribed to halt ovulation entirely.