Premenstrual syndrome (PMS) refers to physical, emotional and behavioural symptoms that happen before your period and usually improve once your period starts. You may experience mood changes, irritability, anxiety, tiredness, bloating, breast tenderness, headaches or food cravings.
Mild changes before your period are common, but PMS becomes more significant when symptoms repeatedly affect your work, relationships, sleep or daily activities. Keeping a symptom diary can help you and your clinician identify whether your symptoms follow a consistent pattern and decide whether lifestyle changes or treatment may help.
What Exactly Is Premenstrual Syndrome?
PMS refers to recurring physical, emotional and behavioural symptoms that typically occur before your period and improve once menstruation begins. You may experience symptoms such as mood changes, tiredness, bloating, pain or breast tenderness.
The key feature is that your symptoms follow a repeated pattern around your menstrual cycle. You may have mild symptoms in some months and more noticeable symptoms in others, particularly when they begin to affect your normal routine.
What Causes PMS?
The exact cause of PMS is not fully understood. It appears to involve individual sensitivity to the normal hormonal changes that occur after ovulation rather than simply having abnormal hormone levels.
These hormonal changes can also affect brain chemicals involved in mood, sleep and appetite. This is why you may experience PMS differently from someone else, even when your menstrual cycles are similar.
When During Your Cycle Does PMS Occur?
PMS usually develops after ovulation during the luteal phase, which is the time leading up to your next period. You may notice symptoms for a few days or for much of the two weeks before menstruation.
Your symptoms should usually begin to improve when your period starts, with a period of relative symptom relief before the next premenstrual phase. If symptoms continue throughout the month, a symptom diary can help your clinician consider whether another condition may be contributing.
What Are the Emotional Symptoms of PMS?
PMS can cause noticeable changes in your mood before your period. You may feel more irritable, tearful, anxious, sensitive or emotionally overwhelmed than usual.
You may also experience mood swings, lower confidence or difficulty concentrating, which can affect your relationships and daily activities. Recognising a repeated pattern can help you understand your symptoms and find suitable ways to manage them.
What Physical Symptoms Can PMS Cause?
PMS can cause physical symptoms such as bloating, breast tenderness, headaches, abdominal cramps, fluid retention, skin changes and tiredness. You may also notice body aches or feel heavier and less energetic before your period.
PMS symptoms usually begin to improve once menstruation starts and often settle by the end of the period. If you have persistent pelvic pain, severe abdominal swelling or symptoms that continue throughout the month, you should discuss them with your clinician rather than assuming they are caused by PMS.
Can PMS Affect Your Sleep and Energy?
PMS can leave you feeling unusually tired, sleepy or low in energy before your period. You may also find it harder to fall asleep or wake more often during the night, which can make other PMS symptoms feel worse.
Tracking your sleep alongside your other symptoms can help you identify a pattern. If tiredness continues throughout the month rather than mainly before your period, you should speak to your doctor about other possible causes.
Can PMS Change Your Appetite?
PMS can affect your appetite and cause cravings, particularly for sweet, salty or carbohydrate-rich foods. Maintaining a balanced diet and regular eating pattern may be a practical part of general PMS self-care.
You do not need to feel guilty about normal changes in appetite before your period. However, if your eating patterns become extreme, involve bingeing or restriction, or continue throughout the month, you should discuss them with a healthcare professional.
How Is PMS Diagnosed?
Tests may still be appropriate when your symptoms or medical history suggest another condition, but they are used to investigate alternative causes rather than confirm PMS itself. Your diagnosis is usually based on whether your symptoms repeatedly appear before your period and improve once menstruation begins.
You may be asked to record your symptoms each day for at least two menstrual cycles. This helps your clinician identify a clear pattern and decide whether further tests are needed to rule out other possible causes.
Why Is a PMS Symptom Diary Important?
A symptom diary can help you see patterns that may be difficult to remember accurately. You can record symptoms such as mood changes, anxiety, bloating, breast tenderness, headaches, tiredness and appetite changes, along with their timing and severity.
You can also note your period dates and how symptoms affect your work, relationships, exercise or daily activities. Continuing your diary after starting treatment can help you and your clinician see whether your symptoms are genuinely improving over several cycles.
Evidence Note
PMS is diagnosed mainly from the timing and repetition of symptoms rather than from a single blood test or scan. RCOG recommends recording symptoms prospectively for at least two menstrual cycles so your clinician can see whether physical and emotional symptoms consistently occur before your period and improve once menstruation begins.
Continuing the diary for another 2 to 3 months after starting treatment can also help you and your clinician judge whether the intervention is genuinely improving the cyclical symptoms rather than relying on memory alone.
Is PMS the Same as PMDD?
Premenstrual dysphoric disorder (PMDD) is a more severe premenstrual condition where emotional and behavioural symptoms significantly affect your daily life. You may experience severe irritability, anxiety, depression or feelings of hopelessness alongside physical symptoms.
PMDD may require medical or mental health support when symptoms are severe or difficult to manage. If you are feeling suicidal or believe you may be in immediate danger, do not wait for a routine PMS appointment. NHS guidance advises emergency assessment, including calling 999 or going to A&E when PMDD symptoms are accompanied by suicidal feelings.
Can Other Conditions Be Mistaken for PMS?
Yes. Conditions such as depression, anxiety, thyroid problems and perimenopause can cause symptoms that resemble PMS. The timing of your symptoms is important because PMS usually follows a clear pattern before your period.
An existing condition can also become worse before menstruation while still causing symptoms during the rest of the month. This is sometimes described as premenstrual exacerbation and is different from symptoms occurring only as part of a clear premenstrual pattern. You can have PMS alongside another condition, so your clinician may need to consider both rather than attributing every symptom to hormonal changes.
Can Lifestyle Changes Help PMS?
Lifestyle changes may help reduce some physical and emotional PMS symptoms, particularly when they are mild or moderate. You do not need to make extreme changes, as small and sustainable habits are usually easier to maintain throughout your menstrual cycle.
- Stay Physically Active: Regular exercise may help improve your mood, energy levels and overall wellbeing during the premenstrual phase.
- Prioritise Sleep: Maintaining a consistent sleep routine can help you manage tiredness, irritability and difficulty concentrating.
- Eat Regular Balanced Meals: Nutritious meals at regular intervals can support steadier energy levels and may help you manage appetite changes or cravings.
- Manage Stress: Relaxation techniques, mindfulness or yoga may help when anxiety, tension or emotional symptoms become more noticeable.
Lifestyle measures may not be enough when PMS significantly affects your work, relationships or daily activities. If symptoms remain troublesome despite these changes, you can discuss treatments such as CBT, hormonal options or antidepressants with your GP or gynaecologist.
Can Pain Relief Help Physical PMS Symptoms?
Pain relief can help with headaches, cramps and other physical PMS symptoms. Paracetamol or an anti-inflammatory such as ibuprofen may be suitable for some people, but your medical history and other medicines can affect which option is safe for you.
Painkillers mainly manage individual symptoms rather than the wider pattern of PMS. If you need them frequently each month or your symptoms continue to disrupt your daily life, speak to your GP about longer-term treatment options.
Can Cognitive Behavioural Therapy Help?
Cognitive behavioural therapy (CBT) can help you manage emotional and behavioural symptoms of PMS. It is not a suggestion that your symptoms are imaginary; instead, CBT can help you recognise patterns, manage stress and cope with changes in mood or anxiety.
You can use CBT alongside medical treatment when needed. This combined approach may be particularly helpful when PMS affects your relationships, confidence or daily activities.
Can the Combined Contraceptive Pill Treat PMS?
The combined contraceptive pill can help some people manage PMS symptoms. Drospirenone-containing pills may be considered in medically suitable patients, particularly when contraception is also desired.
Your clinician may recommend taking some combined pills continuously, without a break, depending on your symptoms. The combined pill is not suitable for everyone, so your medical history and factors such as migraine with aura or blood-clot risk should be considered first.
Can Antidepressants Be Used for PMS?
Certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can help reduce significant emotional and physical PMS symptoms. Depending on your symptoms, your doctor may recommend taking an SSRI throughout the month or only during the premenstrual phase.
Your doctor can explain the potential benefits and side effects, which may include nausea, sleep changes, tiredness or reduced sexual interest. Do not stop an antidepressant suddenly without medical advice, and speak to your healthcare professional if you are planning a pregnancy or become pregnant.
How Do PMS Treatment Options Compare?
Treatment should be matched to the severity and type of your symptoms, your medical history and whether contraception or pregnancy is relevant to you.
| Treatment | When it may be considered | Important considerations |
| Lifestyle measures | Mild to moderate symptoms or alongside other treatment | Exercise, sleep, balanced diet and stress management may help but may not be enough for severe PMS |
| CBT | Emotional or behavioural symptoms and coping with symptom impact | Can be used alone or alongside medical treatment |
| SSRIs/SNRIs | Moderate or severe PMS, particularly prominent mood symptoms | May be taken continuously or during the premenstrual phase; side effects and withdrawal should be discussed |
| Combined hormonal contraception | When hormonal suppression may help and the method is medically suitable | Drospirenone-containing pills have evidence for PMS; combined pills are not suitable for everyone |
| Oestrogen patches or gel | Selected moderate or severe PMS under medical supervision | If you still have your womb, appropriate progestogen protection is needed; this treatment is not contraception |
| GnRH agonists | Severe PMS when other treatments have failed or are unsuitable | Cause temporary ovarian suppression and menopause-like symptoms; specialist supervision and bone protection are important |
| Supplements/complementary approaches | Sometimes used alongside established care | Evidence is less consistent and supplements can cause side effects or interact with medicines |
RCOG supports CBT, SSRIs/SNRIs, drospirenone-containing combined contraception, transdermal oestrogen and GnRH analogues as potential options depending on severity and previous treatment response.
What Treatments Are Available for Severe PMS?
If standard PMS treatments have not helped enough, your specialist may consider treatments that suppress ovarian hormone activity. In selected cases, oestrogen patches or gel may be used with appropriate progestogen protection if you still have your womb.
For severe symptoms, GnRH analogues can temporarily suppress ovarian function and create a reversible menopause-like state. These treatments can affect bone health and cause menopausal symptoms, so they require careful medical supervision and are generally reserved for specialist care.
Are Supplements and Complementary Treatments Effective?
Supplements such as calcium, vitamin D, magnesium and vitamin B6 are sometimes used to manage PMS, although the evidence for some complementary treatments is less consistent. Herbal products may also be promoted for PMS, but “natural” does not always mean safe or suitable for you.
Some supplements can cause side effects or interact with medicines, particularly when several products are combined. Speak to your GP or pharmacist before taking supplements regularly, especially if you take medicines, have another health condition or could become pregnant.
When Should You See a Gynaecologist for PMS?
You should speak to your GP or gynaecologist when PMS regularly affects your daily life or does not improve with lifestyle changes. Depending on your symptoms, treatment may include hormonal medication, CBT or antidepressants.
Specialist assessment may be helpful when your diagnosis is uncertain or symptoms continue despite treatment. Severe PMS may sometimes benefit from coordinated care between gynaecology and mental health professionals.
Myth vs Fact
| Myth | Fact |
| PMS simply means feeling emotional before a period. | PMS can cause physical, emotional and behavioural symptoms, including bloating, headaches, breast tenderness, fatigue, sleep changes, irritability and anxiety. |
| A blood test can confirm PMS. | There is no single blood test or scan that diagnoses PMS; the cyclical pattern of symptoms is central to diagnosis. |
| One difficult month is enough to diagnose PMS. | RCOG recommends recording symptoms prospectively for at least two menstrual cycles. |
| Symptoms have to disappear the moment your period starts. | They usually begin to improve once menstruation starts and may take until later in the period to disappear. |
| PMDD is just ordinary PMS with slightly worse cramps. | PMDD involves severe cyclical mood and behavioural symptoms that can substantially affect everyday functioning. |
| Antidepressants are only used if you have depression. | SSRIs and SNRIs can also be used specifically to treat moderate or severe premenstrual symptoms. |
| The combined pill always makes PMS worse. | Some combined pills, particularly drospirenone-containing formulations, can improve PMS symptoms in suitable patients. |
| “Natural” PMS supplements are automatically harmless. | Supplements can interact with medicines or cause adverse effects, and evidence for many products remains limited. |
| GnRH treatment permanently switches off your ovaries. | GnRH agonists cause temporary ovarian suppression, although specialist monitoring is needed because of menopause-like and bone-related effects. |
Key Takeaways
- PMS causes recurring physical, emotional or behavioural symptoms before your period that improve once menstruation begins.
- The timing of symptoms is as important as the symptoms themselves.
- There is no single blood test, hormone test or ultrasound that confirms PMS.
- RCOG recommends keeping a daily symptom diary for at least two consecutive menstrual cycles to support diagnosis.
- Lifestyle measures such as exercise, adequate sleep, healthy eating and stress management may help some symptoms.
- CBT can be useful, particularly when mood and behavioural symptoms affect daily life.
- SSRIs and some SNRIs are established medical treatments for more significant PMS and can sometimes be taken only during the premenstrual phase.
- Drospirenone-containing combined hormonal contraception may improve PMS symptoms in medically suitable patients.
- Oestrogen patches or gel and GnRH agonists may be considered in selected severe cases under specialist supervision.
- GnRH treatment can affect bone health and cause menopause-like symptoms, so specialist monitoring and hormone add-back may be required.
- Evidence for supplements is less consistent, and high-dose vitamin B6 can be harmful.
- Severe cyclical depression, self-harm thoughts or inability to keep yourself safe requires urgent mental-health assessment rather than waiting for a routine PMS appointment.
Frequently Asked Questions
1. What is Premenstrual Syndrome (PMS)?
Premenstrual Syndrome (PMS) is a group of physical, emotional and behavioural symptoms that usually occur before your period and improve when menstruation begins. Common symptoms include mood changes, bloating, breast tenderness, headaches and tiredness.
2. How is Premenstrual Syndrome (PMS) diagnosed?
There is no single blood test or scan that confirms PMS. Your clinician usually looks for a repeated pattern of symptoms before your period that improves once menstruation starts, often using a symptom diary for at least two menstrual cycles.
3. Is Premenstrual Dysphoric Disorder (PMDD) the same as PMS?
No. Premenstrual Dysphoric Disorder (PMDD) is a more severe premenstrual condition where emotional and behavioural symptoms significantly affect your daily life.
4. Can lifestyle changes help Premenstrual Syndrome (PMS)?
Yes. Regular exercise, adequate sleep, a balanced diet and relaxation techniques may help you manage some PMS symptoms. Small, sustainable changes can be more practical than making extreme changes to your routine.
5. When should you see a gynaecologist for Premenstrual Syndrome (PMS)?
You should speak to your GP or gynaecologist when your symptoms regularly affect your daily life or do not improve with lifestyle changes. Specialist assessment may be helpful when your diagnosis is uncertain or symptoms continue despite treatment.
Final Thoughts: What Can You Expect from PMS Treatment?
PMS can affect your mood, energy, sleep, appetite and physical comfort in the days before your period. If your symptoms repeatedly interfere with your daily life, keeping a symptom diary and discussing your symptoms with a GP or gynaecologist can help you understand the pattern and identify suitable treatment options.
If you’re thinking about PMS treatment in London, you can contact us at Gynaecology Clinic London to arrange a consultation with one of our specialists.
References:
- Royal College of Obstetricians and Gynaecologists (2018) ‘Managing premenstrual syndrome (PMS)’. RCOG Patient Information. Available at: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/managing-premenstrual-syndrome-pms/
- Royal College of Obstetricians and Gynaecologists (2016) ‘Premenstrual Syndrome, Management’. Green-top Guideline No. 48. Available at: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/premenstrual-syndrome-management-green-top-guideline-no-48/
- NHS (2024) ‘PMS (premenstrual syndrome)’. NHS. Available at: https://www.nhs.uk/conditions/pre-menstrual-syndrome/
- NHS (2020) ‘B vitamins and folic acid – Vitamins and minerals’. NHS. Available at: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/
- NHS (2024) ‘Who can take the combined pill’. NHS. Available at: https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/who-can-take-it/