Premenstrual Syndrome (PMS)

12 min read
Premenstrual syndrome symptoms and ways to manage PMS

Premenstrual syndrome (PMS) describes physical and emotional symptoms that appear in the week or two before a period and usually improve once bleeding begins.

Common symptoms include bloating, breast tenderness, tiredness, irritability, food cravings and mood changes.

PMS is sometimes called premenstrual tension, or PMT. It's common, but experiences vary considerably. You don't have to accept symptoms that regularly interfere with work, study, relationships or everyday life.

Key takeaways

  • PMS symptoms occur before a period and usually improve shortly after menstruation begins.
  • Physical symptoms can include bloating, cramps, breast tenderness, headaches, fatigue and bowel changes.
  • Emotional symptoms can include irritability, anxiety, sadness, mood changes and difficulty concentrating.
  • The exact cause isn't fully understood, but sensitivity to normal hormonal changes appears to be involved.
  • Regular movement, sleep, a balanced diet, stress management and symptom-specific treatments may help.
  • Calcium has some supportive research, while evidence for most other supplements is limited or inconsistent.
  • PMDD is different from PMS and involves severe recurring mood symptoms that substantially interfere with daily life.

On this page

What is PMS and when does it start?

PMS is a recurring pattern of physical or emotional symptoms associated with the menstrual cycle.

Symptoms usually occur during the luteal phase, which is the part of the menstrual cycle after ovulation and before menstruation.

For many people, symptoms appear during the final week or two before a period and improve within the first few days after bleeding begins.

There is usually a time during the cycle when symptoms are minimal or absent.

Premenstrual symptoms are extremely common. Many people experience one or two symptoms before a period, while a smaller proportion experience a combination of symptoms significant enough to interfere with daily life.

Having an occasional headache, craving or mood change before your period doesn't automatically mean you have PMS. The repeating timing and impact of symptoms are more useful when identifying a premenstrual pattern.

For more cycle context, read our guide to the menstrual cycle.

What are the symptoms of PMS?

PMS can affect your body, your mood or both. Symptoms may also change from one cycle to another.

Physical symptoms

  • bloating or abdominal fullness
  • pelvic cramping
  • breast tenderness or swelling
  • fluid retention, such as swollen fingers or ankles
  • headaches
  • general aches
  • changes in appetite or food cravings
  • tiredness
  • changes in sleep
  • acne or other skin changes
  • constipation or diarrhoea

Emotional and thinking-related symptoms

  • irritability
  • mood changes
  • feeling more anxious or tense
  • feeling sad or more emotionally sensitive
  • difficulty concentrating
  • feeling overwhelmed or less able to cope
  • reduced interest in usual activities
  • wanting more time alone

Not everyone experiences all of these symptoms.

Persistent low mood, significant anxiety or emotional symptoms occurring throughout the month deserve assessment rather than automatically being attributed to PMS.

What causes PMS?

The exact cause isn't fully understood.

Research suggests PMS is associated with the body's response to the normal reproductive-hormone changes that occur after ovulation.

Brain signalling systems involved in mood, including serotonin and GABA, may also play a role.

This doesn't mean someone with PMS necessarily has unusually high or low hormone levels.

Sleep, stress, physical health, mental health and everyday circumstances can also affect how symptoms are experienced, but they don't provide a single explanation for PMS.

Premenstrual symptoms can be particularly noticeable during adolescence and during perimenopause, when menstrual patterns and hormone fluctuations can be less predictable.

You can also read more about the luteal phase and how hormones can affect mental health.

What helps relieve PMS symptoms?

There isn't one PMS treatment that works for everyone.

Start with the symptoms that bother you most rather than trying to overhaul your diet, exercise routine and lifestyle all at once.

Move in a way that feels manageable

Regular physical activity supports general physical and mental wellbeing and may help some people manage premenstrual symptoms.

Australian guidance suggests around 30 minutes of moderate physical activity on most days.

Walking, swimming, cycling, strength training, yoga or Pilates are all reasonable choices. Find movement you can realistically maintain and that feels good in your body.

You don't have to exercise through significant pain or fatigue.

Our guide to working out during your period has more ideas.

Support sleep and rest

Sleep can be affected before a period and tiredness can make other symptoms harder to manage.

A reasonably consistent sleep routine may help if sleep disruption is part of your pattern.

Relaxation practices such as slow breathing, meditation or gentle yoga may also help with stress or tension, although they aren't stand-alone treatments for significant PMS.

Eat regularly without turning PMS into a diet

A varied diet containing vegetables, fruit, whole grains, protein foods, calcium-rich foods and enough fluid supports general health.

You don't need to eliminate carbohydrates, sugar, dairy or other food groups simply because you experience PMS.

Some people find that caffeine or alcohol affects their sleep, anxiety, breast tenderness or other symptoms and choose to reduce them before a period.

If you think a food or drink affects you, tracking your own response for a couple of cycles is more useful than assuming everyone needs the same restrictions.

For practical ideas and a closer look at the research, read our guide to food and PMS.

Ease bloating and cramps

Bloating and cramping can be part of PMS.

A comfortably warm heat pack, heating pad, warm bath or shower can help with menstrual cramps.

TENS may also reduce menstrual pain for some people, although the evidence is less certain than for established pain medicines.

If you're using a heat or TENS device, follow the manufacturer's instructions and check whether there are any reasons you shouldn't use it.

Read our guides to period bloating, period-pain remedies and TENS and EMS machines.

You can also browse our TENS devices.

What about supplements and herbal remedies?

Supplements are commonly promoted for PMS, but the evidence varies considerably.

Calcium

Calcium has some of the more supportive research among nutrients investigated for PMS.

Clinical guidance includes calcium as an option that may help some people, although the certainty of the evidence is limited.

That doesn't mean everyone with PMS needs a calcium supplement. Your usual dietary intake, age and individual health should be considered.

Magnesium

Magnesium supplements are frequently recommended for PMS, including cramps, bloating and mood symptoms.

Some people find them helpful, but good-quality research remains limited and results are inconsistent.

Vitamin B6

Vitamin B6 is sometimes included in supplements marketed for premenstrual symptoms, but supplementary vitamin B6 can cause peripheral neuropathy, which may cause tingling, burning or numbness in the hands or feet.

The Therapeutic Goods Administration has received reports of neuropathy at doses below 50 mg per day and in people taking several different supplements containing vitamin B6.

Vitamin B6 may be listed on labels as pyridoxine or pyridoxal 5-phosphate and is sometimes included in magnesium products, B-complex supplements and multivitamins.

Check the labels of all supplements you're taking rather than considering each product separately.

Chasteberry, evening primrose and other herbal products

Chasteberry, evening primrose oil and other herbal remedies are widely promoted for PMS.

Research is mixed or limited and herbal products can interact with prescription medicines, hormonal contraception and other treatments.

Ask a pharmacist, GP or appropriately qualified health professional before starting a supplement specifically for PMS, particularly if you take other medicines, are pregnant or are breastfeeding.

What medical treatments are available?

If PMS is affecting your quality of life, you don't have to manage it through lifestyle changes alone.

A GP can help match treatment to the symptoms that are causing you the most difficulty.

Pain-relief medicines

Anti-inflammatory medicines such as ibuprofen, naproxen and mefenamic acid can help with menstrual cramps and some other physical symptoms.

They aren't suitable for everyone, including some people with stomach, kidney, cardiovascular or asthma-related conditions.

Ask a pharmacist or GP if you're unsure whether they're suitable for you.

SSRIs and other antidepressant treatment

Selective serotonin reuptake inhibitors, or SSRIs, are among the better-supported treatments for significant premenstrual mood symptoms.

Depending on the symptom pattern, they may sometimes be taken continuously or during the premenstrual part of the cycle.

A prescriber can discuss whether this approach is appropriate for you and explain possible side effects.

Hormonal treatment

Combined hormonal contraceptives can reduce premenstrual symptoms for some people by changing or suppressing normal ovarian hormone cycling.

Response varies, and hormonal contraception can affect mood differently from one person to another.

Your GP can help you weigh the potential benefits against contraception needs, health risks and previous experience with hormonal methods.

See our guide to contraception options in Australia.

Cognitive behavioural therapy

Cognitive behavioural therapy, or CBT, is another recognised option for troublesome premenstrual symptoms, particularly where mood, distress or the impact of recurring symptoms is significant.

Using psychological therapy doesn't mean PMS is imagined or simply caused by negative thinking.

CBT can help with coping, communication and the impact symptoms have on everyday life.

How can you track PMS symptoms?

Tracking symptoms across your whole menstrual cycle is one of the most useful ways to see whether they follow a premenstrual pattern.

Australian guidance recommends showing your doctor a symptom record covering at least two menstrual cycles.

You might record:

  • the first day of menstrual bleeding
  • bloating and cramps
  • breast tenderness
  • headaches
  • energy and sleep
  • appetite and cravings
  • mood, anxiety and irritability
  • concentration
  • how much symptoms affect work, study or relationships
  • days when symptoms are minimal or absent

Continue recording for several days after your period begins. The improvement or disappearance of symptoms is part of the pattern clinicians look for.

Period Shop's free printable period trackers can help you record these changes.

They're a useful starting point rather than a diagnostic test, and your doctor may suggest a more detailed daily symptom chart if necessary.

What is the difference between PMS and PMDD?

Premenstrual dysphoric disorder (PMDD) is different from everyday PMS.

PMDD involves severe recurring mood symptoms such as depression, anxiety, irritability, hopelessness or feeling overwhelmed that substantially interfere with daily functioning.

Both PMS and PMDD follow a cyclical pattern, with symptoms developing before menstruation and improving after it begins.

An existing mental health condition can also become worse before a period. This is known as premenstrual exacerbation (PME) and is different again.

Tracking symptoms throughout the month can help a clinician work out which pattern best fits what you're experiencing.

For more detail, read our PMDD guide and our article about hormones and mental health.

When should you see a GP?

Speak with a GP if PMS symptoms:

  • interfere with work, study, relationships or everyday activities
  • are getting worse
  • have changed significantly from your usual pattern
  • continue throughout much of the month rather than mainly before your period
  • don't improve after menstruation starts
  • aren't improving enough with self-care
  • are causing significant emotional distress

If pregnancy is possible or your bleeding pattern has changed, mention this during your assessment.

If you don't feel your symptoms are being taken seriously, it's reasonable to ask for another review or seek a second opinion.

If emotional symptoms are severe

If you're thinking about suicide or self-harm, seek support immediately rather than waiting to see whether symptoms improve when your period starts.

Call triple zero (000) if you're in immediate danger. Lifeline provides 24-hour crisis support on 13 11 14 and the Suicide Call Back Service is available on 1300 659 467.

Frequently asked questions

How long does PMS last?

PMS symptoms generally occur during the week or two before a period and improve within the first few days after bleeding begins. If symptoms continue throughout much of the month, talk with your GP about whether another condition may be contributing.

Can PMS start two weeks before a period?

Yes. PMS occurs during the luteal phase after ovulation, so symptoms may start one to two weeks before menstruation. The exact timing varies because not everyone ovulates on the same cycle day.

Can you have PMS with normal hormone levels?

Yes. PMS doesn't necessarily mean your oestrogen or progesterone levels are abnormal. Current research suggests individual sensitivity to normal hormonal changes may be more important.

Does PMS get worse during perimenopause?

It can. Some people notice more troublesome premenstrual symptoms during perimenopause as hormone levels and menstrual cycles become less predictable. New or significant mood symptoms still deserve assessment rather than automatically being attributed to perimenopause.

Do supplements help PMS?

Some supplements, particularly calcium, have supportive research, but evidence varies and isn't strong enough to recommend the same supplement for everyone. Magnesium, vitamin B6, chasteberry and other products have more limited or inconsistent evidence. Ask a pharmacist or GP before using supplements specifically for PMS.

When does PMS become PMDD?

PMDD isn't simply “very bad PMS”. It has specific diagnostic criteria and is characterised by severe cyclical mood symptoms that substantially impair daily life. If your emotional symptoms feel overwhelming or repeatedly disrupt your relationships, work or ability to function, ask your GP about PMDD.

Understanding your own pattern

PMS can look very different from one person to another.

You don't need to follow a perfect diet, eliminate particular foods or try every supplement in order to manage it well.

Start by identifying the symptoms that affect you most and look for a repeating pattern across your cycle.

Simple self-care may be enough for some people. Others benefit from medication, hormonal treatment, psychological support or a combination.

If symptoms are regularly interfering with your life, that's reason enough to ask for help.

Download Period Shop's free period tracker to start recording your symptoms.

Related reading

Sources and further reading

This article provides general health information and isn't a substitute for individual medical or mental health advice.