Pre­men­stru­al syn­drome (PMS) includes phys­i­cal and psy­cho­log­i­cal symp­toms that recur in the time before men­stru­a­tion and sub­side again once bleed­ing begins. The sever­i­ty of symp­toms varies wide­ly. If PMS affects your dai­ly life or well­be­ing, tar­get­ed assess­ment and an indi­vid­u­al­ly tai­lored treat­ment plan may be advis­able. On this page, you can find out more about symp­toms, diag­no­sis and treat­ment options for PMS.

What is PMS?

Pre­men­stru­al syn­drome (PMS) refers to recur­ring phys­i­cal and psy­cho­log­i­cal symp­toms that occur in the sec­ond half of the cycle and sub­side again when men­stru­a­tion begins or short­ly after­wards. These may include, for exam­ple, irri­tabil­i­ty, mood swings, low mood, breast ten­der­ness, flu­id reten­tion, fatigue or pain.

The exact caus­es are not ful­ly under­stood. One sus­pect­ed fac­tor is increased sen­si­tiv­i­ty to the nor­mal hor­mon­al changes dur­ing the men­stru­al cycle.

What can I do myself to relieve PMS symp­toms?

Woman with lower abdominal pain due to an ectopic pregnancy

For milder symp­toms, reg­u­lar exer­cise, suf­fi­cient sleep and stress-reduc­tion mea­sures can be help­ful. Relax­ation tech­niques such as pro­gres­sive mus­cle relax­ation can also sup­port well­be­ing. Avoid­ing nico­tine and being mind­ful with alco­hol and caf­feine may also be advis­able.

Diet and cer­tain dietary sup­ple­ments are also being stud­ied in con­nec­tion with PMS. For some mea­sures, there are indi­ca­tions of a pos­si­ble effect, but the evi­dence varies depend­ing on the prod­uct. Dietary sup­ple­ments should there­fore not be used across the board, but select­ed indi­vid­u­al­ly as need­ed.

How is PMS treat­ed?

Treat­ment depends on which symp­toms occur, how severe they are and how much they affect dai­ly life. Sev­er­al mea­sures are often com­bined.

For phys­i­cal symp­toms such as pain, painkillers may be used, for exam­ple. For pro­nounced psy­cho­log­i­cal symp­toms or pre­men­stru­al dys­phor­ic dis­or­der (PMDD), selec­tive sero­tonin reup­take inhibitors (SSRIs) can be an effec­tive treat­ment option. Depend­ing on the med­ica­tion and indi­vid­ual sit­u­a­tion, they may be tak­en con­tin­u­ous­ly or for a lim­it­ed peri­od dur­ing the sec­ond half of the cycle.

Com­bined hor­mon­al con­tra­cep­tives can also reduce pre­men­stru­al symp­toms in some women. We will dis­cuss which treat­ment is appro­pri­ate on an indi­vid­ual basis, tak­ing into account your symp­toms, pos­si­ble risk fac­tors and any desire to have chil­dren.

In addi­tion, mea­sures such as exer­cise, stress reduc­tion and psy­chother­a­peu­tic approach­es such as cog­ni­tive behav­iour­al ther­a­py may be ben­e­fi­cial.

Do I have PMS?

Typ­i­cal symp­toms in the sec­ond half of the cycle include:

  • Breast ten­der­ness
  • Flu­id reten­tion
  • Fatigue or sleep dis­tur­bances
  • Mood swings, irri­tabil­i­ty or low mood
  • Head, back or low­er abdom­i­nal pain
  • Dif­fi­cul­ty con­cen­trat­ing

A symp­tom diary can pro­vide impor­tant clues. For at least two men­stru­al cycles, note which symp­toms occur, how severe they are and when they sub­side again. Typ­i­cal of PMS is a recur­ring pat­tern in the sec­ond half of the cycle with a clear improve­ment dur­ing or short­ly after the onset of men­stru­a­tion.

Dur­ing the med­ical con­sul­ta­tion, we will clar­i­fy your symp­toms and their tim­ing in rela­tion to your cycle. If need­ed, fur­ther exam­i­na­tions may be use­ful to rule out oth­er pos­si­ble caus­es. Blood or hor­mone tests are there­fore used selec­tive­ly when your med­ical his­to­ry or symp­toms indi­cate this.

If psy­cho­log­i­cal symp­toms are par­tic­u­lar­ly pro­nounced, we will also assess whether pre­men­stru­al dys­phor­ic dis­or­der (PMDD) may be present.

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Com­mon ques­tions about PMS

Which hor­mone is lack­ing in PMS?

With PMS, there is usu­al­ly no spe­cif­ic hor­mone that is lack­ing. Rather, it is assumed that those affect­ed are more sen­si­tive to the nor­mal hor­mon­al changes in the men­stru­al cycle. This is also why PMS or PMDD can­not be deter­mined on the basis of a sin­gle hor­mone lev­el.

When are PMS symp­toms at their worst?

PMS symp­toms typ­i­cal­ly occur in the days before men­stru­a­tion and can be par­tic­u­lar­ly pro­nounced short­ly before bleed­ing begins. They usu­al­ly improve sig­nif­i­cant­ly when men­stru­a­tion starts or short­ly after­wards.

Which vit­a­mins are lack­ing in PMS?

PMS does not auto­mat­i­cal­ly mean that there is a vit­a­min or min­er­al defi­cien­cy. For cer­tain nutri­ents such as cal­ci­um, there are indi­ca­tions that ade­quate intake may relieve spe­cif­ic PMS symp­toms. Whether dietary sup­ple­ments are indi­vid­u­al­ly advis­able should be assessed based on diet, symp­toms and any pre-exist­ing con­di­tions.

What helps imme­di­ate­ly with PMS?

For acute phys­i­cal symp­toms, depend­ing on the symp­tom, heat, exer­cise or suit­able painkillers may help. Relax­ation exer­cis­es can pro­vide addi­tion­al sup­port. How­ev­er, if symp­toms are reg­u­lar­ly severe, treat­ment should not be lim­it­ed to acute relief; instead, a med­ical assess­ment should clar­i­fy which longer-term ther­a­py is appro­pri­ate.

Can PMS be mis­tak­en for preg­nan­cy?

Yes. Symp­toms such as breast ten­der­ness, fatigue or mood swings can occur both before men­stru­a­tion and in ear­ly preg­nan­cy. If your expect­ed peri­od does not start, a preg­nan­cy test can pro­vide clar­i­ty.

Can PMS get worse with age?

PMS symp­toms can change over the course of life. Some women report stronger pre­men­stru­al symp­toms, par­tic­u­lar­ly dur­ing per­i­menopause. At the same time, oth­er symp­toms may occur dur­ing this phase of life, so a pre­cise dis­tinc­tion may be use­ful.