Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It's estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome.

Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from just slightly noticeable all the way to intense.

Still, you don't have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.


The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems.

Emotional and behavioral signs and symptoms

  • Tension or anxiety
  • Depressed mood
  • Crying spells
  • Mood swings and irritability or anger
  • Appetite changes and food cravings
  • Trouble falling asleep (insomnia)
  • Social withdrawal
  • Poor concentration
  • Change in libido

Physical signs and symptoms

  • Joint or muscle pain
  • Headache
  • Fatigue
  • Weight gain related to fluid retention
  • Abdominal bloating
  • Breast tenderness
  • Acne flare-ups
  • Constipation or diarrhea
  • Alcohol intolerance

For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days after the start of the menstrual period for most women.

But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of premenstrual syndrome (PMS) is called premenstrual dysphoric disorder (PMDD).

premenstrual dysphoric disorder (PMDD) signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.

When to see a doctor

If you haven't been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, see your doctor.


Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:

  • Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.
  • Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that's thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
  • Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms

Feb 25, 2022

  1. Frequently asked questions. Gynecologic problems FAQ057. Premenstrual syndrome. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Premenstrual-Syndrome-PMS . Accessed Oct. 9, 2017.
  2. Yonkers KA, et al. Epidemiology and pathogenesis of premenstrual syndrome and premenstrual dysphoric disorder. https://www.uptodate.com/contents/search. Accessed Dec. 22, 2017.
  3. Kellerman RD, et al., eds. Premenstrual syndrome. In: Conn's Current Therapy: 2018. Philadelphia, Pa.: Saunders Elsevier; 2018. https://www.clinicalkey.com. Accessed Dec. 22, 2017.
  4. Ferri FF. Premenstrual syndrome. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 26, 2017.
  5. Management of premenstrual syndrome: Green-top guideline No. 48. BJOG: An International Journal of Obstetrics and Gynaecology. 2017;124:e73.
  6. Casper RF, et al. Treatment of premenstrual syndrome and premenstrual dysmorphic disorder. https://www.uptodate.com/contents/search. Accessed Dec. 22, 2017.
  7. Natural medicines in the clinical management of premenstrual syndrome. Natural Medicines. http://naturalmedicines.therapeuticresearch.com. Accessed Dec. 22, 2017.
  8. Chiaramonte D, et al. Integrative women's health. Medical Clinics of North America. 2017;101:955.
  9. Verkaik S, et al. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2017;217:150.
  10. Parazzini F, et al. Magnesium in the gynecological practice: A literature review. Magnesium Research. 2017;30:1.
  11. Butler Tobah YS (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 29, 2018.


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