Health library

PMS can make a few days of every month miserable. Find out how to keep it under control.

Bloating, fatigue, mood swings and headaches—for many women, symptoms such as these usher in menstruation every month.

When the symptoms show up around the same time in every menstrual cycle, there's a good chance it's a case of premenstrual syndrome (PMS). Though the exact cause isn't known, there are treatments that can help.

What is PMS?

PMS happens in the second half of the menstrual cycle, after ovulation. Symptoms can start up to 14 days before your period. The symptoms usually go away soon after your period starts.

According to the American College of Obstetricians and Gynecologists, possible symptoms of PMS include:

• Fatigue.
• Irritability.
• Mood swings.
• Social withdrawal.
• Difficulty concentrating.
• Depression.
• Bloating.
• Headache.
• Changes in sex drive.
• Breast tenderness.
• Constipation.
• Appetite changes.
• Food cravings.

Some women have many of these symptoms, and others have only a few. PMS symptoms can also vary slightly from one month to the next for the same woman.

Pegging PMS

If you think you may have PMS, the college suggests keeping a daily record of your symptoms. Note the symptoms that you have each day, and how severe the symptoms are. If it is PMS, you should notice a regular pattern of when symptoms start and stop each month.

According to the college, a clear case of PMS meets these criteria:

• Symptoms are present in the five days before your period for at least three months in a row.
• Symptoms end within four days after your period starts.
• Symptoms are severe enough to interfere with normal activities.

Sweet relief

In some cases, changes in diet, exercise and lifestyle are enough to tame PMS symptoms. The American Academy of Family Physicians offers these tips:

Eat more complex carbohydrates and less fat. Include more whole-grain breads, pasta and cereals in your diet, and cut back on sugar and fat.

Cut back on salt. Especially in the days before your period, this can help reduce bloating and swelling.

Curb caffeine. Drinking less caffeine can ease tension and irritability, and may reduce breast soreness.

Don't drink. Drinking alcohol before your period can amplify feelings of depression.

Eat small. Try having several small meals each day instead of a few large ones.

Exercise. Aim for 30 minutes, four to six times a week.

Sleep well. Try to get about eight hours of sleep every night.

Schedule out stress. Don't plan stressful events just before your period. Try to move them to the week after.

It can also help to take vitamins and calcium pills. For some women, calcium helps relieve water retention, cramps and back pain.

Medicines can help with PMS too:

Diuretics may help relieve bloating, weight gain, breast pain and abdominal pain by helping your body get rid of extra sodium and fluid.

Pain relievers such as ibuprofen and naproxen may take the edge off headaches and cramping.

Antidepressants may help women who have severe irritability, depression and anxiety.

Birth control pills can relieve PMS symptoms for some women by evening out hormone levels throughout the menstrual cycle.

A doctor's help

If over-the-counter medicines and lifestyle changes aren't enough to control your PMS, make an appointment with your doctor and take your symptom record to the visit.

Your doctor may do tests to rule out other health problems that have similar symptoms. And he or she can write prescriptions for medicines such as hormones and antidepressants that you can't get over the counter.

Your doctor can also determine if you have premenstrual dysphoric disorder (PMDD), a severe form of PMS that may require a different treatment approach.

Reviewed 11/16/2023