questions to ask before PMS

Overview

Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that many women and people who menstruate experience in the days before their period. It usually goes away once the period starts.

Yes, PMS is very common. Most people who menstruate experience at least a few PMS symptoms at some point.

It affects women and people who menstruate, often starting in the late teens or twenties and becoming more bothersome in the thirties or perimenopause. It can last until periods stop.

Symptoms

Common symptoms

• Bloating or water retention
• Breast tenderness or swelling
• Mood swings, irritability, or tearfulness
• Feeling tired or low on energy
• Acne or skin changes
• Headaches or migraines
• Difficulty sleeping
• Cravings for certain foods
• Feeling anxious or depressed

Symptoms in children

• In young people who have just started having periods, symptoms can be similar to adults. They may also feel confused or embarrassed by mood changes and may not realise the link with their cycle.

Symptoms in older adults

• In people approaching menopause, PMS symptoms can become more intense or change. They can also overlap with perimenopause symptoms like hot flushes and sleep problems.

Causes

Main causes

• Natural changes in hormone levels (like estrogen and progesterone) during your menstrual cycle
• Changes in brain chemicals, such as serotonin, that affect mood
• Lifestyle factors like stress, poor sleep, or lack of exercise

Risk factors

• High levels of stress
• An imbalance in certain vitamins or minerals, such as low magnesium or vitamin B6
• A family history of PMS
• High intake of salt, caffeine, or alcohol
• Not getting enough physical activity

When to see a doctor

See a doctor urgently if:

• If you have thoughts of harming yourself or anyone else
• If you feel severely depressed or unable to cope

Book a routine appointment if:

• If PMS symptoms are interfering with your work, school, or relationships
• If you want help finding ways to manage your symptoms
• If you have questions about whether what you are feeling is normal

Diagnosis

Your doctor will ask about your symptoms, when they happen, and how they affect you. They may ask you to keep a diary of your symptoms for at least two months to see the pattern.

Tests that may be done

• There is no single test for PMS.
• Your doctor may arrange a pelvic exam, blood tests for hormone levels, thyroid function, or other checks to rule out other conditions.
• Sometimes a doctor will ask you to track your symptoms on a chart or calendar.

What to expect at your appointment

The doctor will review your symptom diary, ask about your medical history, and talk to you about what might help. They will also ask questions to make sure your symptoms are not being caused by something else.

Treatment

Treatment for PMS focuses on reducing symptoms and improving your quality of life. It often starts with lifestyle changes, and if those are not enough, a doctor can discuss other options.

Self-care at home

• Take regular physical activity, like walking, swimming, or cycling
• Try to keep a regular sleep schedule
• Reduce salt to lessen bloating
• Limit caffeine and alcohol around your period
• Practise stress-relief techniques like deep breathing, mindfulness, or yoga
• Keep a symptom diary to understand your patterns

Medical treatments

Your doctor may offer treatments such as certain types of hormonal contraception (for example, the combined pill) to help stabilise hormone levels. They might also prescribe medicines to help with severe mood symptoms or pain. Always discuss any medication with your doctor or pharmacist, and never take medicines without professional advice.

When is surgery considered?

Surgery is not a standard treatment for PMS. In extremely rare and severe cases with other medical reasons, a specialist may discuss other options. This is not a decision to take lightly.

Living with this condition

Keeping a symptom diary can help you predict when PMS is coming. Use that time to rest more, plan lighter workloads, and talk to people around you about what you need.

Lifestyle tips

• Exercise regularly, even if it is light
• Get outside and get some daylight
• Talk to friends or family about how you feel
• Plan enjoyable activities for your premenstrual days
• Avoid comparing yourself to others when you feel low

Diet and exercise

Eating a balanced diet with fruit, vegetables, and whole grains can help. Aim to reduce sugar, salt, and highly processed foods. Regular exercise can lift your mood, improve sleep, and ease bloating.

Mental health and emotional wellbeing

PMS can make you feel anxious, irritable, sad, or hopeless. These feelings are real, but they are not your fault. If you notice them getting worse, speak to a doctor or counsellor. You deserve support.

Prevention

PMS cannot always be prevented, but a healthy lifestyle may reduce the severity of symptoms. Knowing what to expect can help you prepare.

Vaccines

There is no vaccine that prevents PMS.

Screening programmes

There is no routine screening test for PMS. Your doctor may suggest blood tests or other checks to rule out other conditions, but that is not screening.

Complications

If left untreated

• If PMS is severe and not managed, it can affect your work, school, or relationships
• Some people may develop a more severe form called premenstrual dysphoric disorder (PMDD), which includes intense mood changes and can greatly affect mental health

Long-term outlook

Most people find ways to manage PMS well with self-care and support. Even if symptoms are severe, there are effective treatments available. You do not have to suffer in silence.

Find support

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