What is premenstrual syndrome (PMS)?

PMS can take you by surprise, or you know exactly what is going on.

What is premenstrual syndrome (PMS)?

PMS, premenstrual syndrome or “premenstrual tension” refers to physical and psychological complaints in the second half of the cycle (luteal phase) that are caused by the female hormone balance.

Who doesn’t know them, those annoying days before your period: your lower abdomen aches and your breasts feel tender. Have you ever wondered why PMS complaints torment you so much? All of these disturbances are grouped together under menstrual complaints.

It is assumed that up to 30 % of all women of reproductive age notice premenstrual complaints in the second half of the month. These can vary in intensity and be physical or psychological in nature.⁸

Do you suffer from PMS? Do the PMS self-check!

Would you like to know whether the symptoms troubling you could be PMS? Then compare them with the complaints described on this page. Please only take into account the complaints that appear shortly after the time of ovulation and last until your menstrual bleeding.

Which PMS symptoms and complaints can occur?

With premenstrual syndrome, a distinction is made between physical and psychological complaints. These can occur either individually or together.

The graphic gives you an overview of the most common PMS symptoms. Many women suffer from premenstrual syndrome, but the symptoms can differ from woman to woman.

Physical and psychological PMS symptoms

Physical PMS symptoms

Many PMS complaints are the same as those of period pain. However, they are often joined by others:

• Lower abdominal pain & back pain
• Water retention, weight gain and food cravings: other physical complaints include water retention in the tissue, also known as oedema. Water retention makes the body look “bloated”, which is why you feel fatter than at the beginning of the month. The water retention and hormonal fluctuations often lead to weight gain. The food cravings that occur can also contribute to unwanted weight gain.
• Tender breasts: painful tension or swelling of the breasts (mastodynia) can also occur. Being touched then becomes unpleasant.
• Tiredness & exhaustion
• Nausea, diarrhoea or constipation, a feeling of fullness
• Circulation problems
• Headaches or migraines
• Irritability: increased sensitivity to stimuli such as light, smell, noise or touch can also be felt.
• Blemished skin

Psychological PMS symptoms

In most cases, PMS is accompanied not only by physical but also by emotional complaints.

The psychological symptoms of premenstrual syndrome include:

• Mood swings
• Depression, depressive moods
• Listlessness
• Hyperactivity & restlessness
• Anxiety
• Feeling of being overwhelmed & loss of control
• Aggressiveness & irritability
• Loss of appetite & food craving attacks
• crying or laughing for no reason
• reduced self-esteem

PMS types: which one are you?

Depending on the predominant PMS symptoms, four different PMS types can be distinguished. Different hormonal causes are suspected behind them:

1. PMS type D (depression): here women mainly suffer from depressive moods, forgetfulness, sleepless nights and confusion. The reason for this may be too much progesterone and low serotonin and dopamine levels.
2. PMS type A (anxiety): depressive moods and forgetfulness are predominant here too, but they are joined by mood swings. The suspected cause is an elevated oestrogen level after ovulation.
3. PMS type C (craving): this type is plagued by food craving attacks, a stimulated appetite, headaches, dizziness and a racing heart. An increased insulin effect in the second half of the cycle and a tendency towards low blood sugar may be a possible cause.
4. PMS type H (hyperhydration = excess water): water retention, weight gain, oedema and painful breasts are the predominant symptoms of this PMS type. A possible cause is thought to be a change in the so-called renin-angiotensin-aldosterone axis. Under the influence of progesterone, this regulates blood pressure and blood volume.

The four PMS types, their symptoms and possible causes

PMS symptoms: duration and onset

In the first 2 to 3 weeks of the menstrual cycle, most women feel comfortable in their own skin, are in a positive mood and enjoy a high libido. PMS then makes itself felt in the second half of the cycle.

When does PMS start?

PMS occurs almost exclusively in cycles with ovulation. It is therefore counted among the physical ovulation symptoms. The psychological and physical complaints usually begin up to 14 days before menstrual bleeding.

The effects are particularly strong around five days after the progesterone level has reached its peak. That is 4 to 10 days before the onset of menstruation. As soon as menstruation starts, the complaints usually subside again, as the progesterone level drops. However, they can also persist beyond that.²

Duration of the PMS phase

The duration of this phase varies from one affected woman to another. The symptoms can show throughout the entire 2nd half of the cycle and even worsen until the bleeding starts. However, they can also occur on individual days or over a shorter period of time.

Tracking PMS symptoms

If you suspect that you suffer from PMS, you should document your complaints. A cycle app like cyclotest mySense can help you with this better than a period calendar or a PMS diary. In the fertility tracker, you can record all your period details over several cycles and also note when which symptoms occur and how severe they are. This allows you to check whether the impairments are actually related to the menstrual cycle.

Track your symptoms in the cyclotest mySense app

Ideally, you should make entries in your cyclotest mySense app for at least 2 to 3 months. You can then export your cycle curve including cycle data as a PDF. You can then take the values with you to your next gynaecologist appointment. That way, you always have your digital PMS diary with you.

If you enter “sensitive” or “sad” under mood during your PMS time, a cloud in your cycle triangle will additionally alert you to the critical phase.

The smart mini computer cyclotest myWay also shows you the PMS time. This helps affected women to better assess when the critical time is coming up and to take preventive measures.

If you would like to get an initial overview of the cycle app and its functions, download the cyclotest mySense app from your app store and try out the features that interest you in the free demo mode.

What causes premenstrual syndrome?

To this day, there are no precise findings as to why women have to suffer from these annoying complaints.

An overview of the most likely causes of PMS:

• Hormone fluctuations in the second half of the cycle (luteal phase): the hormonal changes lead to an imbalance between oestrogen and progesterone. Specifically, the release of oestrogen decreases while at the same time the production of progesterone (a corpus luteum hormone) sets in.
• Falling serotonin level in the second phase of the cycle: the messenger substance serotonin also seems to play a special role: the serotonin level and the amount of the body’s own endorphins fall in the second half of the cycle. Studies suggest that an interplay between the autonomic nervous system, brain metabolism and the function of the ovaries triggers the complaints. However, the exact metabolic factors are still unknown to this day.²
• Altered melatonin level: during the second half of the cycle, the night-time melatonin level rises later and less strongly. This can lead to a disturbed sleep rhythm. Sleep problems in turn encourage PMS.⁹
• Unfavourable lifestyle: lifestyle (poor diet, too little exercise, stress) is also said to determine the severity of PMS complaints. These can be brought about, or at least encouraged, in particular by a lack of vitamins or by stress.^1,3 Coffee or caffeine and nicotine, for example, can have an unfavourable effect; the same applies to sleep problems and a lack of exercise.
• Psychosocial conflicts: other possible factors are psychosocial conflicts such as relationship problems and excessive strain at work, as well as a family history of mental illness (for example depression). These factors are considered a risk factor for PMS.

What to do about PMS? Diagnosis & treatment

If you suffer from PMS, there are various ways to ease the effects and improve how you feel. Since not all affected women suffer from the symptoms to the same extent, every woman has to try out which measures help her best.

Medication, especially herbal medicines, a healthy diet and moderate exercise can relieve PMS complaints.

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Which medicines help with PMS?

• Painkillers for e.g. headaches and lower abdominal pain^{10, 5}
• Diuretic medicines for water retention^{10, 5}
• Mood-lifting preparations such as antidepressants for depression^{10, 5}
• Chasteberry: relieves breast pain in particular and can have a positive effect on the cycle. This herbal medicine is one of the best-researched medicinal plants and has earned itself a firm place in the treatment of PMS. In one study, freedom from complaints or an improvement was achieved in 79 – 85 % of participants after three months of treatment with chasteberry. ^{6, 11,12}
• Maca: the Peruvian plant can help to reduce stress and balance the hormone levels.¹³

Diet for PMS

You can counteract a low mood before your period with the right diet for PMS. You should pay attention to the following³:

• Avoid salty & sugary foods: you should steer clear of salty foods and milk chocolate, as these products are not only bad for your health when eaten in excess but can also encourage the discomfort.
• Eat regular meals: this can reduce your cravings for sweets.⁷
• Avoid eating dairy products, processed foods as well as red and fatty meat.
• Make sure you get enough vitamins and minerals: especially vitamin B6, calcium, magnesium and vitamin D.
• Eat low-fat foods with plenty of complex carbohydrates.
• Drink less coffee.
• Avoid alcohol.
• Eat foods containing serotonin: through your diet, you can increase serotonin with nuts, omega-3 fatty acids and even dark chocolate. This helps you feel happier.

Tips against PMS: exercise, avoiding stress and relaxation

A lack of serotonin, the so-called happiness hormone, is held partly responsible for the mood swings, low moods and irritability. You can give it a boost with the following³:

• plenty of daylight or light therapy
• Exercise: some women swear by doing moderate exercise during the PMS time. You could do yoga, for example, as it combines movement and relaxation. This improves the blood circulation in the body and tackles the causes of abdominal cramps.
• Relaxation techniques or massages