Premenstrual syndrome


Premenstrual syndrome (PMS) refers to a wide range of symptoms that:

Alternative Names

PMS; Premenstrual dysphoric disorder


The exact cause of PMS has not been identified. Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones.

PMS may be related to social, cultural, biological, and psychological factors.

Up to 3 out of every 4 women experience PMS symptoms during their childbearing years. It occurs more often in women:

The symptoms often get worse in a woman's late 30s and 40s as she approaches the transition to menopause.


PMS refers to a set of symptoms that tend to:

The most common physical symptoms include:

Other symptoms include:

Exams and Tests

There are no specific signs or lab tests that can diagnose PMS. To rule out other possible causes of symptoms, it is important to have a:

A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.


Keep a daily diary or log for at least 3 months. Record the type of symptoms you have, how severe they are, and how long they last. This symptom diary will help you and your health care provider find the best treatment.

A healthy lifestyle is the first step to managing PMS. For many women, lifestyle approaches are often enough to control symptoms.

Aspirin, ibuprofen, and other NSAIDs may be prescribed for headache, backache, menstrual cramping, and breast tenderness.

Birth control pills may decrease or increase PMS symptoms.

In severe cases, medicines to treat depression may be helpful. Antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are often tried first. You can reduce the need for medicines by using:

Other medicines that may be used include:

Outlook (Prognosis)

Most women who are treated for PMS symptoms get significant relief.

PMS symptoms may become severe enough to prevent you from functioning normally.

The suicide rate in women with depression is much higher during the second half of the menstrual cycle.

When to Contact a Medical Professional

Call for an appointment with your health care provider if:


Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012: chap. 36.

Brown I, O'Brien PMS, Marjoribanks I, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009;2:CD001396.

Review Date: 5/31/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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