Everything You Need to Know About PMS And How to Cope

Cramps, bloating, headaches, and bad moods: If one or more of these troublesome symptoms are far too familiar, then you must be well acquainted with premenstrual syndrome, otherwise known as PMS.

Welcome to the club: Research indicates that about half of women of reproductive age around the world experience PMS, and while the symptoms may simply be a nuisance to some, others have pain so severe it impacts their daily lives. And that’s not OK.

“PMS may be really common, but that doesn’t mean you need to suffer through the symptoms,” says Kate White, MD, MPH, assistant professor of obstetrics and gynecology at Boston University.

Getting familiar with your own cycle and learning the factors that can make your symptoms better or worse can help you better manage PMS. Arm yourself with the info below.

What is PMS?

PMS refers to a group of symptoms that usually start about a week before your period, typically after ovulation and before menstruation. No one knows exactly why some women experience PMS, but some experts think it occurs because the levels of estrogen and progesterone fall so dramatically between ovulation and menstruation. The symptoms usually go away a few days after bleeding starts when hormone levels begin to rise again.

“Abrupt changes in any hormones—not just estrogen and progesterone—can have an effect somewhere in the body,” says White. “If your thyroid hormone plummets or skyrockets, for example, it has an effect. Hormones are the signal conductors that make the subways run and they keep everything humming along the way it’s supposed to. If there’s a drastic change in any of them it can have downstream effects.”

Changes in brain chemistry may also play a role: An insufficient amount of the brain chemical serotonin is thought to increase the risk for depression, fatigue, sleep problems, and food cravings.

How Common is PMS?

As many as three in four women experience at least some PMS symptoms at some point in their lives, according to research. You may be more likely to experience PMS if you have high levels of stress, a family history of depression, or a personal history of depression or postpartum depression.

What Are the Symptoms of PMS?

That depends on the woman. Some experience physical symptoms of PMS, some experience emotional symptoms, some experience both, and some experience neither. You may experience different symptoms during different times of your life, and symptoms may become more intense or more mild over time.

Some women notice their symptoms become more severe as they reach their late 30s or 40s and begin a transition to menopause known as perimenopause. This is usually more likely to occur in women who are sensitive to hormone changes since hormone levels can go up and down in unpredictable ways in the years leading up to menopause. PMS goes away once periods stop due to menopause.

Some of the most common physical symptoms include:

• Tender or swollen breasts
• Muscle or joint pain
• Cramping
• Constipation or diarrhea
• Bloating, gassiness, or weight gain due to water retention
• Fatigue
• Headache
• Increased acne
• Changes in appetite or food cravings
• Clumsiness
• Sensitivity to light or noise

Some of the most common emotional or mental symptoms include:

• Irritability
• Anxiety
• Tension
• Mood swings
• Depressed mood
• Insomnia
• Social withdrawal
• Crying spells
• Trouble concentrating
• Lower libido

How Do I Know If I Have PMS?

There’s no way to test for PMS, but if you’re having symptoms that interfere with your life, it’s best to make an appointment with your doctor. Tracking your symptoms and how severe they are in the Fitbit app can help you have an informed conversation with your doctor and choose some possible treatment options.

You most likely have PMS if your symptoms:

• Start sometime in the five days before your period (for at least three menstrual cycles in a row)
• Go away within four days after your period starts
• Prevent you from performing or enjoying your regular activities

How Can I Help Reduce My PMS Symptoms?

For many women with PMS, lifestyle changes may help in reducing symptoms, so don’t despair. Here are a few things that may help you feel relief:

• Ramp up your cardio. Research shows that aerobic exercise (think: running, dancing, cycling, etc.) can help ease symptoms including depression, fatigue, and an inability to concentrate. One study found that 30 minutes of treadmill training three times a week was enough to significantly decrease symptoms. But remember to always listen to your body and take it easy if you’re not feeling up for intense exercise.
• Cut back on some known dietary triggers. Reducing the amount of sugar, salt, caffeine, dairy, and alcohol you consume may help make a big difference in some symptoms like bloating and fluid retention.
• Increase the amount of healthy carbs you eat. Researchers believe that eating frequent, smaller portions of foods high in complex carbohydrates (like whole-grain breads, pumpkin, oats, etc.) may help alleviate mood swings. If you’re not sure how to stay accountable, the Fitbit app’s macro-tracking feature is a great place to start.
• Get enough sleep. Establishing a regular sleep routine may help decrease symptoms like fatigue and moodiness. Adults typically need about seven to nine hours of shut-eye each night to feel rested and recharged.
• Consider supplements. Some women find relief by supplementing their diets with certain vitamins and minerals, but every woman is different, and there isn’t enough scientific evidence to confirm their effectiveness. Always check with your doctor before taking any medication or supplement.
• Manage your stress. Studies have shown a clear link between feelings of stress and more pronounced PMS, so learning to cope with everyday stressors may help reduce your symptoms. Everything from yoga to meditation to massage has been shown to help ease premenstrual issues.
• Don’t smoke. There are a million reasons not to smoke, but if you have PMS, consider this a million and one: Research has found that women who smoke report more and worse PMS symptoms than women who don’t.

Can Medication Help?

“If lifestyle changes don’t improve your symptoms, don’t despair,” says White. “There are several different medication options that might really help.”

If you have physical symptoms like cramps or breast soreness, some over-the-counter medications like ibuprofen, naproxen, and aspirin may help reduce the pain. Taking these medications during and/or just before your symptoms hit may help ease discomfort.  

If your symptoms are more severe, your doctor may suggest prescription medications. These may include:

• Hormonal birth control methods that stop ovulation, which may help reduce symptoms. “One of the most common reasons women take birth control pills even when they don’t need birth control is to help control PMS symptoms,” says White. “Forms of hormonal birth control that stop ovulation even out those peaks and valleys of hormones that you get with a normal cycle. By having a steady state of hormones every day, some women find great relief.”
• Diuretics, which can help your body shed excess fluid through the kidneys so you feel less bloated.
• Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) that have been shown to help improve mood.
• Anti-anxiety medications to help reduce anxiousness.  

What is Premenstrual Dysphoric Disorder (PMDD)?

For most women with PMS, symptoms are mild. But a small subset of women (between three and eight percent), experience a severe type of PMS called premenstrual dysphoric disorder (PMDD). Women with PMDD may have symptoms that significantly affect their lives, including:

• Extreme irritability or anger
• Panic attacks
• Feelings of intense sadness, or even thoughts of suicide
• Physical symptoms like cramps, muscle pain, headache, bloating, and breast tenderness

When Should I See My Doctor?

If you’re experiencing physical, emotional, and/or psychological symptoms of PMS that affect your everyday health and activities, it’s important to see your doctor. Be sure to track the frequency and severity of your symptoms so your doctor can help you find the best possible solution.

“I talk to my patients a lot about what’s ‘normal’ and ‘normal’ is different for everyone,” says White. “But if you’re ‘normal’ involves deep emotional pain once a month with crying jags, loss of sleep, and/or general feelings of hopelessness, this doesn’t need to stay ‘normal’ for you. There’s help available.”

Michelle Konstantinovsky

Michelle Konstantinovsky is a contributing Health & Wellness Editor for Fitbit. Michelle is a San Francisco-based journalist, marketing specialist, ghostwriter, manatee enthusiast, and pop culture fiend. She was born and raised in San Francisco and earned a master’s degree at UC Berkeley’s Graduate School of Journalism. She covers health, nutrition, fitness, sexual health, chronic conditions, and more, and her work has appeared in Cosmopolitan, Marie Claire, Teen Vogue, Seventeen, Slate, SPIN, Entrepreneur, SF Weekly, 7×7 Magazine, The Huffington Post, WebMD, and California Home + Design Magazine, among others.