Premenstrual Syndrome (PMS)

    Researchedby:
    Marina Shkayeva

    Fact-checked

    by:

    Mike Murray
    Last Updated: October 13, 2024

    PMS stands for premenstrual syndrome. PMS involves physical symptoms such as pain, bloating, and acne along with mood changes that occur prior to menstruation.

    examine-databaseExamine Database

    Premenstrual Syndrome (PMS) falls under the Women’s Health category.

    9 references on this page
    7,042 participants in 50 trials

    What is PMS?

    Premenstrual syndrome, or PMS, is a group of symptoms that start one to two weeks before menstruation. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. For some women, the symptoms are severe enough to interfere with their lives, which is a type of PMS called premenstrual dysphoric disorder (PMDD).[1]

    Is PMS different depending on what country you’re in?

    What are the main signs and symptoms of PMS?

    Common PMS symptoms are as follows:[1]

    How is PMS diagnosed?

    PMS is usually diagnosed if at least one of the symptoms listed above occurs during the five days before the start of menses for at least three cycles, two of which must be consecutive cycles. Additionally, these symptoms stop at least four days after the onset of menses and do not recur until the next cycle.[2]

    What are some of the main medical treatments for PMS?

    Over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen may help ease mild PMS symptoms (e.g., cramps, headaches, breast tenderness). When symptoms of PMS are severe, selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft) can be tried. Oral contraceptives have also shown some benefit for reducing PMS symptoms. Theoretically, these work by regulating fluctuations of estrogen and progesterone throughout a cycle.[2]

    Have any supplements been studied for PMS?

    Daily calcium supplements (calcium carbonate) have been shown to reduce symptoms of PMS. Vitamin D and vitamin B6 have also been assessed for PMS symptoms, but there is insufficient evidence to support their use.[2] Many herbs have also been studied, with chasteberry having the greatest volume of evidence behind it.[3]

    Do calcium supplements help reduce symptoms of PMS?

    How could diet affect PMS?

    Specific diets have not been studied for PMS. Some observational evidence has found that consuming foods high in calcium, vitamin D, thiamine, and riboflavin has been associated with a lower risk of PMS.[4][5] Common dietary recommendations for PMS include small and frequent meals as well as reducing consumption of salt, caffeine, and refined sugars. These modifications are intended to reduce irritability, insomnia, fluid retention, bloating, and weight gain during PMS.[6]

    Are there any other treatments for PMS?

    Exercise is often recommended for PMS because it can promote endorphin release which can improve mood and increase energy.[6] Psychological modalities such as cognitive-behavioral therapy (CBT) and other modalities such as acupuncture with and without herbal medicine have been studied for relieving PMS symptoms. However, more research is needed to determine their benefits. [2]

    What causes PMS?

    No one knows what causes PMS. It is likely that changes to the levels of estrogen and progesterone and individual sensitivity to these changes trigger PMS symptoms. These hormones affect levels of neurotransmitters such as gamma-aminobutyric acid, dopamine, and serotonin which in turn can affect mood. Some evidence suggests that suppressing estrogen can improve PMS symptoms,[2] and a deficiency of progesterone may worsen symptoms, but more research is needed.[7]

    Examine Database: Premenstrual Syndrome (PMS)

    Research FeedRead all studies

    Frequently asked questions

    What is PMS?

    Premenstrual syndrome, or PMS, is a group of symptoms that start one to two weeks before menstruation. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. For some women, the symptoms are severe enough to interfere with their lives, which is a type of PMS called premenstrual dysphoric disorder (PMDD).[1]

    Is PMS different depending on what country you’re in?

    Some research has found that PMS symptoms are reported in about 50% of women of reproductive age, while in other research, PMS symptoms are reported in up to 90% of younger women. The rates of PMS vary greatly between different geographic regions. For example, PMS is reported in about 34% of young adult women (attending university) in China, 40% in Taiwan, 65% in Egypt, 79% in Japan, and up to 92% in Turkey.[7] In other research, PMS is reported in up to 30% of women living in the United States, 12% in France, and up to 98% in Iran.[8] Why do different countries have such different rates of PMS and PMS symptoms? No one knows for sure. Some theories include differences in lifestyle and genetic factors, community practices during the time of menstruation, and diagnostic criteria and investigation methods.[7][8]

    What are the main signs and symptoms of PMS?

    Common PMS symptoms are as follows:[1]

    How is PMS diagnosed?

    PMS is usually diagnosed if at least one of the symptoms listed above occurs during the five days before the start of menses for at least three cycles, two of which must be consecutive cycles. Additionally, these symptoms stop at least four days after the onset of menses and do not recur until the next cycle.[2]

    What are some of the main medical treatments for PMS?

    Over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen may help ease mild PMS symptoms (e.g., cramps, headaches, breast tenderness). When symptoms of PMS are severe, selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft) can be tried. Oral contraceptives have also shown some benefit for reducing PMS symptoms. Theoretically, these work by regulating fluctuations of estrogen and progesterone throughout a cycle.[2]

    Have any supplements been studied for PMS?

    Daily calcium supplements (calcium carbonate) have been shown to reduce symptoms of PMS. Vitamin D and vitamin B6 have also been assessed for PMS symptoms, but there is insufficient evidence to support their use.[2] Many herbs have also been studied, with chasteberry having the greatest volume of evidence behind it.[3]

    Do calcium supplements help reduce symptoms of PMS?

    Several small and heterogeneous clinical studies suggest that daily supplementation with 500–1,200 milligrams of calcium for up to 3 menstrual cycles improves PMS symptoms such as bloating, food cravings, and pain when compared to placebo. Also, several observational studies have found that PMS symptoms are associated with lower total calcium levels. It is possible that calcium levels are reduced during menstruation, precipitating PMS symptoms. Estrogen may lower calcium in the blood by inhibiting bone resorption. During the menstrual cycle, estrogen has two peaks: right before the luteinizing hormone surge and during the luteal phase. Theoretically, the peaks in estrogen lower total calcium levels. In some, the lower blood calcium levels can increase parathyroid hormone levels and lower calcium levels in the smooth muscle, which in turn might precipitate PMS symptoms such as cramping and pain.[9]

    How could diet affect PMS?

    Specific diets have not been studied for PMS. Some observational evidence has found that consuming foods high in calcium, vitamin D, thiamine, and riboflavin has been associated with a lower risk of PMS.[4][5] Common dietary recommendations for PMS include small and frequent meals as well as reducing consumption of salt, caffeine, and refined sugars. These modifications are intended to reduce irritability, insomnia, fluid retention, bloating, and weight gain during PMS.[6]

    Are there any other treatments for PMS?

    Exercise is often recommended for PMS because it can promote endorphin release which can improve mood and increase energy.[6] Psychological modalities such as cognitive-behavioral therapy (CBT) and other modalities such as acupuncture with and without herbal medicine have been studied for relieving PMS symptoms. However, more research is needed to determine their benefits. [2]

    What causes PMS?

    No one knows what causes PMS. It is likely that changes to the levels of estrogen and progesterone and individual sensitivity to these changes trigger PMS symptoms. These hormones affect levels of neurotransmitters such as gamma-aminobutyric acid, dopamine, and serotonin which in turn can affect mood. Some evidence suggests that suppressing estrogen can improve PMS symptoms,[2] and a deficiency of progesterone may worsen symptoms, but more research is needed.[7]

    References

    1. ^MedlinePlus (Internet) Bethesda (MD): National Library of Medicine (US); (updated June 20 2016; cited April 28 2022)
    2. ^Hofmeister S, Bodden SPremenstrual Syndrome and Premenstrual Dysphoric Disorder.Am Fam Physician.(2016-Aug-01)
    3. ^Csupor D, Lantos T, Hegyi P, Benkő R, Viola R, Gyöngyi Z, Csécsei P, Tóth B, Vasas A, Márta K, Rostás I, Szentesi A, Matuz MVitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials.Complement Ther Med.(2019-Dec)
    4. ^Chocano-Bedoya PO, Manson JE, Hankinson SE, Willett WC, Johnson SR, Chasan-Taber L, Ronnenberg AG, Bigelow C, Bertone-Johnson ERDietary B vitamin intake and incident premenstrual syndrome.Am J Clin Nutr.(2011-May)
    5. ^Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JECalcium and vitamin D intake and risk of incident premenstrual syndrome.Arch Intern Med.(2005-Jun-13)
    6. ^Jarvis CI, Lynch AM, Morin AKManagement strategies for premenstrual syndrome/premenstrual dysphoric disorder.Ann Pharmacother.(2008-Jul)
    7. ^Gudipally PR, Sharma GKPremenstrual SyndromeStatPearls.(2022-07)
    8. ^Tiranini L, Nappi RERecent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome.Fac Rev.(2022)
    9. ^Arab A, Rafie N, Askari G, Taghiabadi MBeneficial Role of Calcium in Premenstrual Syndrome: A Systematic Review of Current Literature.Int J Prev Med.(2020)

    Examine Database References

    1. Migraine Symptoms - Zamani M, Neghab N, Torabian STherapeutic effect of Vitex agnus castus in patients with premenstrual syndromeActa Med Iran.(2012)
    2. Irritability - Momoeda M, Sasaki H, Tagashira E, Ogishima M, Takano Y, Ochiai KEfficacy and safety of Vitex agnus-castus extract for treatment of premenstrual syndrome in Japanese patients: a prospective, open-label studyAdv Ther.(2014 Mar)
    3. Breast Tenderness - Ma L, Lin S, Chen R, Zhang Y, Chen F, Wang XEvaluating therapeutic effect in symptoms of moderate-to-severe premenstrual syndrome with Vitex agnus castus (BNO 1095) in Chinese womenAust N Z J Obstet Gynaecol.(2010 Apr)
    4. Breast Tenderness - Schellenberg R, Zimmermann C, Drewe J, Hoexter G, Zahner CDose-dependent efficacy of the Vitex agnus castus extract Ze 440 in patients suffering from premenstrual syndromePhytomedicine.(2012 Sep 27)
    5. PMS Symptoms - Lauritzen C, Reuter HD, Repges R, Böhnert KJ, Schmidt UTreatment of premenstrual tension syndrome with Vitex agnus castus controlled, double-blind study versus pyridoxinePhytomedicine.(1997 Sep)
    6. PMS Symptoms - Anna Ambrosini, Cherubino Di Lorenzo, Gianluca Coppola, Francesco PierelliUse of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observationActa Neurol Belg.(2013 Mar)
    7. PMS Symptoms - Berger D, Schaffner W, Schrader E, Meier B, Brattström AEfficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS)Arch Gynecol Obstet.(2000 Nov)
    8. PMS Symptoms - R SchellenbergTreatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled studyBritish Medical Journal.()
    9. Irritability - Sampalis F, Bunea R, Pelland MF, Kowalski O, Duguet N, Dupuis SEvaluation of the effects of Neptune Krill Oil on the management of premenstrual syndrome and dysmenorrheaAltern Med Rev.(2003 May)
    10. Breast Tenderness - Sohrabi N, Kashanian M, Ghafoori SS, Malakouti SKEvaluation of the effect of omega-3 fatty acids in the treatment of premenstrual syndrome: "a pilot trial"Complement Ther Med.(2013 Jun)
    11. Depression Symptoms - Behboudi-Gandevani S, Hariri FZ, Moghaddam-Banaem LThe effect of omega 3 fatty acid supplementation on premenstrual syndrome and health-related quality of life: a randomized clinical trialJ Psychosom Obstet Gynaecol.(2018 Dec)
    12. PMS Symptoms - Mandana Z, Azar AComparison of the Effect of Vit E, VitB6, Calcium and Omega-3 on the Treatment of Premenstrual Syndrome: A Clinical Randomized TrialAnnu Res Rev Biol.()
    13. Depression Symptoms - Ghanbari Z, Haghollahi F, Shariat M, Foroshani AR, Ashrafi MEffects of calcium supplement therapy in women with premenstrual syndromeTaiwan J Obstet Gynecol.(2009 Jun)
    14. Depression Symptoms - Shobeiri F, Araste FE, Ebrahimi R, Jenabi E, Nazari MEffect of calcium on premenstrual syndrome: A double-blind randomized clinical trialObstet Gynecol Sci.(2017 Jan)
    15. PMS Symptoms - Thys-Jacobs S, Starkey P, Bernstein D, Tian JCalcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study GroupAm J Obstet Gynecol.(1998 Aug)
    16. PMS Symptoms - Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir JCalcium supplementation in premenstrual syndrome: a randomized crossover trialJ Gen Intern Med.(1989 May-Jun)
    17. PMS Symptoms - Samieipour, s, et alEFFECT OF CALCIUM AND VITAMIN B1 ON THE SEVERITY OF PREMENSTRUAL SYNDROME: A RANDOMIZED CONTROL TRIALInt J Pharm Tech.()
    18. PMS Symptoms - Sutariya S, Talsania N, Shah C, Patel M.An interventional study (calcium supplementation & health education) on premenstrual syndrome - effect on premenstrual and menstrual symptomsNat J Com Med.()
    19. Depression Symptoms - Agha-Hosseini M, Kashani L, Aleyaseen A, Ghoreishi A, Rahmanpour H, Zarrinara AR, Akhondzadeh SCrocus sativus L. (saffron) in the treatment of premenstrual syndrome: a double-blind, randomised and placebo-controlled trialBJOG.(2008 Mar)
    20. PMS Symptoms - Beiranvanda S, et alThe effect of Crocus sativus (saffron) on the severity of premenstrual syndromeEur J Integr Med.()
    21. Anxiety Symptoms - Fukui H, Toyoshima K, Komaki RPsychological and neuroendocrinological effects of odor of saffron (Crocus sativus)Phytomedicine.(2011 Jun 15)
    22. Depression Symptoms - Ebrahimi E, Khayati Motlagh S, Nemati S, Tavakoli ZEffects of magnesium and vitamin b6 on the severity of premenstrual syndrome symptomsJ Caring Sci.(2012 Nov 22)
    23. PMS Symptoms - De Souza MC, Walker AF, Robinson PA, Bolland KA synergistic effect of a daily supplement for 1 month of 200 mg magnesium plus 50 mg vitamin B6 for the relief of anxiety-related premenstrual symptoms: a randomized, double-blind, crossover studyJ Womens Health Gend Based Med.(2000 Mar)
    24. PMS Symptoms - Walker AF, De Souza MC, Vickers MF, Abeyasekera S, Collins ML, Trinca LAMagnesium supplementation alleviates premenstrual symptoms of fluid retentionJ Womens Health.(1998 Nov)
    25. PMS Symptoms - Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AROral magnesium successfully relieves premenstrual mood changesObstet Gynecol.(1991 Aug)
    26. PMS Symptoms - Quaranta S, Buscaglia MA, Meroni MG, Colombo E, Cella SPilot study of the efficacy and safety of a modified-release magnesium 250 mg tablet (Sincromag) for the treatment of premenstrual syndromeClin Drug Investig.(2007)
    27. Depression Symptoms - Dadkhah H, Ebrahimi E, Fathizadeh NEvaluating the effects of vitamin D and vitamin E supplement on premenstrual syndrome: A randomized, double-blind, controlled trialIran J Nurs Midwifery Res.(2016 Mar-Apr)
    28. PMS Symptoms - London RS, Sundaram G, Manimekalai S, Murphy L, Reynolds M, Goldstein PThe effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. II. Endocrine correlatesJ Am Coll Nutr.(1984)
    29. PMS Symptoms - Heidari H, Amani R, Feizi A, Askari G, Kohan S, Tavasoli PVitamin D Supplementation for Premenstrual Syndrome-Related inflammation and antioxidant markers in students with vitamin D deficient: a randomized clinical trialSci Rep.(2019 Oct 17)
    30. PMS Symptoms - Bahrami A, Avan A, Sadeghnia HR, Esmaeili H, Tayefi M, Ghasemi F, Nejati Salehkhani F, Arabpour-Dahoue M, Rastgar-Moghadam A, Ferns GA, Bahrami-Taghanaki H, Ghayour-Mobarhan MHigh dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescentsGynecol Endocrinol.(2018 Aug)
    31. PMS Symptoms - Abdollahi R, Abiri B, Sarbakhsh P, Kashanian M, Vafa MThe Effect of Vitamin D Supplement Consumption on Premenstrual Syndrome in Vitamin D-Deficient Young Girls: A Randomized, Double-Blind, Placebo-Controlled Clinical TrialComplement Med Res.(2019)
    32. PMS Symptoms - Tartagni M, Cicinelli MV, Tartagni MV, Alrasheed H, Matteo M, Baldini D, De Salvia M, Loverro G, Montagnani MVitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders in Adolescents with Severe Hypovitaminosis DJ Pediatr Adolesc Gynecol.(2016 Aug)
    33. Depression Symptoms - Siahbazi S, Behboudi-Gandevani S, Moghaddam-Banaem L, Montazeri AEffect of zinc sulfate supplementation on premenstrual syndrome and health-related quality of life: Clinical randomized controlled trialJ Obstet Gynaecol Res.(2017 May)
    34. PMS Symptoms - Jafari F, Amani R, Tarrahi MJEffect of Zinc Supplementation on Physical and Psychological Symptoms, Biomarkers of Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Young Women with Premenstrual Syndrome: a Randomized, Double-Blind, Placebo-Controlled TrialBiol Trace Elem Res.(2019 Jun 2)
    35. Depression Symptoms - Gianfranco C, Vittorio U, Silvia B, Francesco DMyo-inositol in the treatment of premenstrual dysphoric disorderHum Psychopharmacol.(2011 Oct)
    36. Depression Symptoms - Heydari N, Dehghani M, Emamghoreishi M, Akbarzadeh MEffect of Melissa officinalis capsule on the mental health of female adolescents with premenstrual syndrome: a clinical trial studyInt J Adolesc Med Health.(2018 Jan 25)
    37. PMS Symptoms - Akbarzadeh, M, et alComparison of the Effect of Melissa officinalis Capsule and Care Educational Programs on the Intensity of Physical, Mental and Social Symptoms of Premenstrual Syndrome in High School Female StudentsInt J Women's Health Repro. Sci.()
    38. PMS Symptoms - Mirghafourvand, M, et alThe efficacy of Lemon balm (Melissa officinalis L.) only and combined Lemon balm– Nepeta menthoides on premenstrual syndrome and quality of life among students: a randomized controlled trialJ Herb Med.()
    39. PMS Symptoms - Akbarzadeh M, Dehghani M, Moshfeghy Z, Emamghoreishi M, Tavakoli P, Zare NEffect of Melissa officinalis Capsule on the Intensity of Premenstrual Syndrome Symptoms in High School Girl Students.Nurs Midwifery Stud.(2015-Jun)
    40. PMS Symptoms - Doll H, Brown S, Thurston A, Vessey MPyridoxine (vitamin B6) and the premenstrual syndrome: a randomized crossover trialJ R Coll Gen Pract.(1989 Sep)
    41. PMS Symptoms - Kashanian M, Mazinani R, Jalalmanesh SPyridoxine (vitamin B6) therapy for premenstrual syndromeInt J Gynaecol Obstet.(2007 Jan)
    42. PMS Symptoms - Hagen I, Nesheim BI, Tuntland TNo effect of vitamin B-6 against premenstrual tension. A controlled clinical studyActa Obstet Gynecol Scand.(1985)
    43. PMS Symptoms - Williams MJ, Harris RI, Dean BCControlled trial of pyridoxine in the premenstrual syndromeJ Int Med Res.(1985)
    44. PMS Symptoms - Kendall KE, Schnurr PPThe effects of vitamin B6 supplementation on premenstrual symptomsObstet Gynecol.(1987 Aug)
    45. PMS Symptoms - Ozgoli G, Selselei EA, Mojab F, Majd HAA randomized, placebo-controlled trial of Ginkgo biloba L. in treatment of premenstrual syndromeJ Altern Complement Med.(2009 Aug)
    46. PMS Symptoms - Khayat S, Fanaei H, Kheirkhah M, Moghadam ZB, Kasaeian A, Javadimehr MCurcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trialComplement Ther Med.(2015 Jun)
    47. PMS Symptoms - Taavoni S, Barkhordari F, Goushegir A, Haghani HEffect of Royal Jelly on premenstrual syndrome among Iranian medical sciences students: a randomized, triple-blind, placebo-controlled studyComplement Ther Med.(2014 Aug)
    48. PMS Symptoms - Abdollahifard S, Rahmanian Koshkaki A, Moazamiyanfar RThe effects of vitamin B1 on ameliorating the premenstrual syndrome symptomsGlob J Health Sci.(2014 Jul 29)
    49. PMS Symptoms - Samieipour S, et al.EFFECT OF CALCIUM AND VITAMIN B1 ON THE SEVERITY OF PREMENSTRUAL SYNDROME: A RANDOMIZED CONTROL TRIALInt J Pharm Tech.()
    50. PMS Symptoms - Behboodi Moghadam Z, Rezaei E, Shirood Gholami R, Kheirkhah M, Haghani HThe effect of Valerian root extract on the severity of pre menstrual syndrome symptomsJ Tradit Complement Med.(2016 Jan 19)