Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) refers to complaints that women can have before their monthly period. Mood swings, headaches and stomach pain are typical. PMS can badly affect a person's quality of life. Various measures can help to alleviate the symptoms.

At a glance

  • PMS is an abbreviation for premenstrual syndrome: it describes complaints that women can have before their monthly period.
  • Typical symptoms are headaches, stomach pain, mood swings, irritability, tiredness, water retention, and breast tenderness.
  • Around 20 to 40 percent of all women have bad PMS and feel affected in their everyday life.
  • Various treatments and measures can help to alleviate the PMS symptoms.
  • There is no definitive explanation what causes PMS.

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

What is premenstrual syndrome?

For many women, the days before their period are tough. Typical complaints include stomach pains, headaches, irritability and tearfulness. Many also feel bloated or just generally unwell. What is described here is typical of premenstrual syndrome, or PMS for short.

Most women do not have bad PMS. They can be more or less relaxed about their problems. But some women are very badly affected by PMS. It is so bad that they are unable to carry out their everyday activities during this time. They can then alleviate the symptoms through various treatments and measures.

Which symptoms indicate premenstrual syndrome (PMS)?

Premenstrual syndrome is a combination of regularly recurring physical and mental problems. They usually occur a few days to two weeks before the period.

Typical symptoms are breast tenderness and stomach pain. Headaches, back ache, joint ache and muscle pains, water retention, sleeping and digestion problems, skin blemishes and a ravenous appetite also occur. Some women also experience problems concentrating and mood swings. Before their period women with PMS often feel exhausted, irritable, listless, depressed, insecure or angry.

Important: When PMS is bad, everyday life can be severely impacted. It can affect relationships with loved ones, friends and co-workers.

Premenstrual dysphoric disorder (PMDD) is a particularly severe form of PMS. It impacts the mind severely and can cause depression and feelings of anxiety.

What causes premenstrual syndrome (PMS)?

As yet there is no definitive explanation what causes PMS. The hormonal fluctuations during the female cycle are probably responsible for the symptoms.

While the hormone level of women with PMS may not be changed, they may react more sensitively to progesterone by-products. The body mainly produces progesterone in the second half of the cycle, before the period begins.

Experts also believe that there is an interaction between progesterone and the messengers in the brain. The messenger serotonin seems to play a key role in this. Genetic predisposition and environmental factors probably affect PMS too.

How common is premenstrual syndrome (PMS)?

Around 20 – 40% of all women experience day-to-day stress as a result of PMS symptoms.

Most women have occasional mild PMS symptoms before their period. But they are not badly affected by them.

Around 20 to 40 percent of all women get multiple, and worse forms of, PMS symptoms. It affects them badly in their everyday life.

Around 3 to 8 percent of all women suffer from a severe form of PMS. The symptoms, primarily mental problems, are so bad that their life is severely impacted. This severe form of PMS is known as premenstrual dysphoric disorder (PMDD).

What course does premenstrual syndrome (PMS) take?

PMS symptoms are limited to the second half of the monthly cycle, after ovulation. That is when the body produces more of the hormone progesterone. At the same time, less of the female sex hormone estrogen is produced.

The PMS symptoms fade away when the period starts and a new cycle begins. The symptoms vanish entirely by the end of the period at the latest. They can then only reoccur after the next ovulation.

There are women who have symptoms in some cycles but not in others. The severity can also differ hugely, and change as the years go by. It is impossible to predict how the symptoms will develop. It is just clear that the PMS will disappear with the final period at the menopause, at the latest.

How is premenstrual syndrome (PMS) diagnosed?

To find out whether the symptoms are caused by PMS, doctors ask about the woman's symptoms and when they occur. The aim is to rule out illnesses with similar symptoms, such as depression, thyroid conditions and irritable bowel syndrome.

Women who are affected can keep a diary in order to identify the symptoms during the cycle. They should record all their symptoms for at least 2 to 3 months.

How is premenstrual syndrome (PMS) treated?

As yet there are only few reliable studies dealing with the issue of what helps against PMS symptoms. So the effectiveness of many treatments is still unclear.

Sufferers often use a range of products and methods to alleviate their symptoms. Even small lifestyle changes can have positive results, for instance more exercise, less alcohol and coffee, or a low-salt diet. Relaxation techniques and acupuncture also seem to help some women. Others try herbal medicines and food supplements, for example chaste berry, St. John's wort, calcium and vitamin B6.

Important: A range of drugs can be considered for women whose symptoms are severe. However, many of these drugs have not been approved for PMS therapy and may have side effects.

The following drugs are often prescribed:

  • Hormonal products like the pill or hormonal patches: they affect the hormone level and alleviate PMS and PMDD symptoms.
  • Anti-depressants: so-called SSRI (selective serotonin reuptake inhibitors) can help when the PMS or PMDD comes with severe mental symptoms.
  • Painkillers: they can alleviate severe period pains and are usually well-tolerated. As yet there has been almost no research into whether they also help with PMS symptoms.
  • Diuretics: they can be used if the patient is suffering from bad water retention.

Women who have bad mental problems can try cognitive behavioral therapy. But it has not been proven whether this also helps with PMS symptoms.

More detailed information about PMS and how it can be treated can be found at

What can be done in everyday life in case of PMS symptoms?

Many women with PMS benefit from taking things easier at such times. They take more breaks and relax more than usual. Helpful strategies might include going for a walk, having a warm bath, or a relaxed evening with a book or in front of the TV.

Some women talk to their partner or family about their symptoms. This can lead to them getting more understanding, attention and support during such times.

Other women fear that speaking out will lead to misunderstandings. For example, if they get irritable or angry, others might not take a problem seriously because they attribute their feelings to the PMS. There are also women who suffer from the prejudice that they are at the mercy of their hormones at such times, making them irrational and unpredictable.

In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).

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