What Is Premenstrual Syndrome (PMS)?
Premenstrual syndrome (PMS — Premenstrual Syndrome) is a collection of physical, psychological, and behavioral symptoms that appear during the luteal phase of the menstrual cycle — typically 7-14 days before menstruation begins — and diminish or disappear after menstruation starts.
According to statistics, approximately 75-90% of women of reproductive age experience at least one PMS symptom each cycle. Of these, 20-30% have symptoms severe enough to affect daily activities, and 3-8% suffer from the severe form PMDD (Premenstrual Dysphoric Disorder).
Causes of PMS
The exact cause of PMS has not been fully determined, but research points to several related factors:
Sex hormone changes
After ovulation, progesterone levels rise sharply then drop rapidly before menstruation, while estrogen also fluctuates significantly. These hormonal changes affect the brain and entire body, causing PMS symptoms. Notably, women with PMS do not necessarily have abnormal hormone levels — they are more sensitive than normal to hormonal changes.
Serotonin — Neurotransmitter
Serotonin (the “happiness hormone”) decreases during the luteal phase in women with PMS, explaining psychological symptoms: sadness, irritability, anxiety, and sweet cravings.
Other factors
- Calcium and magnesium deficiency: Related to muscle cramps, fatigue, and mood changes
- Vitamin B6 deficiency: Affects serotonin metabolism
- Genetic factors: Women whose mothers or sisters have PMS are at higher risk
- Stress: Worsens PMS symptoms
Detailed PMS Symptoms
Physical symptoms
Pain and discomfort:
- Breast pain and tenderness (mastodynia) — the most common symptom
- Lower abdominal pain, feeling of heaviness
- Headaches or migraines
- Back pain, muscle and joint pain
Digestive disturbances:
- Bloating and abdominal distension
- Constipation or diarrhea
- Food cravings, especially sweets and carbohydrates
- Nausea
Systemic changes:
- Mild swelling: face, hands, feet, abdomen (due to water retention)
- Temporary weight gain of 0.5-2 kg
- Fatigue, lethargy, lack of energy
- Acne breakouts
- Changes in bowel habits
Psychological and behavioral symptoms
Emotional changes:
- Irritability and quick temper — the most common psychological symptom
- Sadness, crying without reason
- Anxiety and restlessness
- Sudden mood swings
Cognitive disturbances:
- Difficulty concentrating, forgetfulness
- Indecisiveness
- Decreased work performance
Behavioral changes:
- Loss of interest in daily activities
- Social withdrawal
- Sleep disturbances: insomnia or excessive sleeping
- Decreased libido
How PMS Is Diagnosed
There is no specific test to diagnose PMS. Diagnosis is based on:
Symptom diary
The most important method. Record symptoms daily for at least 2-3 consecutive cycles. PMS is confirmed when:
- Symptoms appear during the luteal phase (after ovulation)
- Symptoms clearly improve within 4 days after menstruation begins
- Symptoms do not appear during the follicular phase (days 4-12 of the cycle)
- Symptoms are severe enough to affect daily activities
Ruling out other conditions
The doctor needs to rule out conditions with similar symptoms: depression, anxiety disorders, thyroid disease, chronic fatigue syndrome, irritable bowel syndrome, and endometriosis.
Effective PMS Management Solutions
Lifestyle changes — The foundation of treatment
Regular exercise: Aerobic exercise for 30 minutes/day, 5 days/week (brisk walking, swimming, cycling) is the most effective non-medication measure. Exercise releases endorphins — “natural happiness hormones” — reducing pain and improving mood and sleep quality.
Diet:
- Eat small, frequent meals; avoid skipping meals
- Increase green vegetables, fruits, and whole grains
- Reduce salt (reduces swelling), reduce refined sugar (stabilizes blood sugar and mood)
- Limit caffeine (reduces breast tenderness, anxiety, and insomnia)
- Avoid alcohol (worsens depression and fatigue)
Sleep: Get 7-8 hours of sleep per night, maintain a regular sleep schedule, and create a comfortable sleep environment.
Stress management: Meditation, yoga, deep breathing, journaling, and spending time on personal hobbies.
Micronutrient supplementation
Several micronutrients have been proven to help reduce PMS symptoms:
- Calcium: 1000-1200 mg/day — reduces abdominal pain, breast tenderness, and mood changes
- Magnesium: 200-400 mg/day — reduces swelling, headaches, and sweet cravings
- Vitamin B6: 50-100 mg/day — improves mood, reduces swelling
- Vitamin E: 400 IU/day — reduces breast pain and tenderness
- Omega-3: Reduces abdominal pain and improves mood
Medical treatment
When lifestyle changes and micronutrient supplementation are not sufficient:
- Pain relievers: Ibuprofen, naproxen — reduce abdominal pain, headaches, and breast pain
- Mild diuretics: Spironolactone — reduces severe swelling
- Combined oral contraceptives: Stabilize hormones and reduce PMS symptoms
- SSRIs (selective serotonin reuptake inhibitors): For severe PMS or PMDD — can be used continuously or only during the luteal phase
PMDD — The Most Severe Form of PMS
Premenstrual Dysphoric Disorder (PMDD — Premenstrual Dysphoric Disorder) affects approximately 3-8% of women and is classified as a psychiatric disorder under DSM-5. PMDD differs from PMS in the severity of psychological symptoms:
PMDD symptoms
- Severe depression: Deep sadness, hopelessness, feelings of worthlessness
- Intense anxiety: Tension, restlessness, feeling “out of control”
- Uncontrollable irritability: Quick to anger, conflicts with others
- Extreme mood swings: Crying without reason, excessive sensitivity
- Complete loss of interest in daily activities
- Difficulty concentrating, feeling of “brain fog”
- In severe cases: thoughts of self-harm or suicide
PMDD diagnosis
Requires at least 5 symptoms (including at least 1 prominent psychological symptom) appearing during the luteal phase, clearly improving within a few days after menstruation begins, and causing significant functional impairment. A symptom diary for at least 2 cycles is mandatory to confirm the diagnosis.
PMDD treatment
- SSRIs (selective serotonin reuptake inhibitors): Fluoxetine, sertraline — can be used continuously or only during the luteal phase. This is the most effective treatment for PMDD
- Oral contraceptives containing drospirenone: Yaz, Yasmin — hormone stabilization
- GnRH agonists: Complete ovarian suppression, short-term use
- Psychological counseling: Cognitive behavioral therapy (CBT)
Symptom Diary: An Important Tool
Keeping a PMS symptom diary not only helps with diagnosis but also helps you:
- Recognize patterns: Know in advance when symptoms will appear to prepare
- Identify triggers: Which stressors, foods, or activities worsen symptoms
- Evaluate treatment effectiveness: Compare before and after applying PMS reduction measures
- Provide information to your doctor: Helps ensure more accurate diagnosis
How to keep a PMS diary
Each day, record:
- Day of the menstrual cycle
- Symptoms present (physical and psychological)
- Severity level (1-10)
- Special foods and beverages consumed
- Stress level, sleep quality
- Medications or measures used
Many phone apps are available for convenient menstrual cycle and PMS symptom tracking.
PMS and Relationships
PMS can cause tension in family and social relationships. Some suggestions:
- Share with loved ones: Explain PMS so those around you understand and empathize
- Recognize patterns: Knowing the symptom phase in advance helps you and your loved ones prepare
- Delay important decisions: Avoid making major decisions or resolving conflicts during severe PMS
- Self-care: Take time for yourself, relax
- Couples counseling: If PMS causes prolonged conflict in your relationship
When Should You See a Doctor?
You should see a specialist when:
- PMS seriously affects work, studies, or relationships
- Severe depression symptoms, intense anxiety, or thoughts of self-harm
- Self-care measures do not improve symptoms
- Symptoms change suddenly or appear for the first time after age 35
- Need to differentiate PMS from other conditions (depression, anxiety disorders, thyroid disease)
Related Articles
- Stress and menstruation — Stress worsens PMS symptoms
- Severe menstrual cramps — Menstrual pain in PMS and when it indicates disease
- Menstrual disorders — Common menstrual disorders
- Gynecological treatment services — PMS examination and treatment at Phong Kham Bac Sy Lam
At Phong Kham Bac Sy Lam, BSCKI. Tran Thi Thuy Lam, with over 30 years of experience, formerly working at the National Cancer Institute, Hanoi Medical University Hospital, Hanoi Andrology Hospital, and Medlatec Hospital, will provide comprehensive evaluation, rule out underlying conditions, and develop a personalized PMS management plan for each patient.
Book an Appointment
If PMS is affecting your life, don’t suffer in silence — contact us for consultation and treatment.
Phong Kham San Phu Khoa Bac Sy Lam
- Address: 125 Ham Nghi, Kim Tan, Lao Cai
- Phone: 0986 321 000
- Working hours: Monday – Saturday
Book now: 0986 321 000 — 125 Ham Nghi, Kim Tan, Lao Cai
