08/25/2023 3:51 p.m.

The premenstrual syndrome (PMS) and its causes, symptoms and treatments.

Dr. Niels van de Roemer
Dr. Niels van de Roemer Medical Adviser
The premenstrual syndrome

What is PMS?

Premenstrual syndrome (PMS) is defined as a condition that manifests in distressing physical, behavioral, and psychological symptoms, despite the absence of organic or underlying psychiatric disease. It occurs regularly during the luteal phase of each menstrual cycle and either disappears or diminishes significantly by the end of menstruation.

Despite its widespread occurrence, PMS is not a clearly defined disease but rather a functional disorder that can significantly impact daily life, depending on its severity.

Understanding the causes of premenstrual syndrome

The specific cause of PMS remains a mystery. However, cyclic ovarian activity and hormones, particularly estrogen and progesterone, are considered key aspects. Other influencing factors could include genetic predispositions, hormonal imbalances, or specific dietary and lifestyle factors.

Possible causes and contributing factors:

  • Hormonal imbalances
  • Genetic predisposition
  • Stress and lack of sleep
  • Nutrient deficiencies (e.g. magnesium, vitamin B6, calcium)
  • Unhealthy lifestyle habits such as caffeine or alcohol consumption

Recognising symptoms of premenstrual syndrome

PMS symptoms are extensive and can include both physical and emotional aspects. The symptoms of premenstrual syndrome can vary greatly in type and intensity. They usually occur 5 to 11 days before the start of menstruation and disappear afterwards.

Physical symptoms

  • Breast tenderness or pain
  • Headaches or migraines
  • Water retention (edema)
  • Joint and muscle pain
  • Bloating, constipation, or diarrhea
  • Increased need for sleep or sleep disturbances
  • Food cravings, especially for sugar or salt

Emotional and cognitive symptoms

  • Irritability or aggression
  • Mood swings
  • Tearfulness or sadness
  • Difficulty concentrating
  • Anxiety or inner restlessness
  • Feeling overwhelmed
PMS-Symptoms

Differences in intensity

The intensity and severity of PMS symptoms vary from woman to woman. While some experience only minor discomfort, others may be severely affected by symptoms, significantly reducing their quality of life.

Assessing the severity and frequency of premenstrual syndrome

  • Mild: Mild symptoms with little to no impact on daily life
  • Moderate: Noticeable symptoms that cause some limitations
  • Severe: Significant impairment of performance and quality of life

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder affects about 3–8% of menstruating women. It is the most severe form of PMS and is considered a serious psychiatric condition, often treated with antidepressants. Symptoms may include:

  • Intense irritability
  • Feelings of hopelessness
  • Sleep disturbances
  • Social withdrawal
  • Suicidal thoughts (medical attention required!)
DIAGNOSIS

How is PMS diagnosed?

Since there are no specific lab tests or imaging procedures to diagnose PMS, the diagnosis is based entirely on symptoms. Cycle tracking is the most important tool in this process.

  • Track symptoms for at least 2–3 cycles
  • Identify patterns linked to specific phases of the cycle
  • Rule out other conditions (e.g. thyroid disorders, depression)

A helpful tool to support diagnosis is a cycle computer, which not only tracks fertile days but also allows for digital monitoring of PMS symptoms.

A healthy diet to help manage PMS symptoms

A balanced diet rich in nutrients can support you in your wellness. Research suggests that calcium and vitamin D, when sufficiently present in the diet, can reduce the risk of PMS.

Recommended Nutrients and Diet

  • Calcium: Helps reduce irritability, mood swings, and fatigue
  • Magnesium: Relieves headaches, muscle cramps, and irritability
  • Vitamin B6: Supports serotonin production; helps with depression and anxiety

  • Omega-3 fatty acids: Anti-inflammatory, mood-lifting, and nerve-protective

  • Eat regular meals to avoid blood sugar fluctuations

  • Prioritize whole foods: whole grains, legumes, fresh fruits and vegetables
  • Stay hydrated: at least 1.5–2 liters of water daily
  • Avoid crash diets – they can worsen hormonal imbalances

What should be avoided?

  • High-sugar foods: Can worsen blood sugar spikes and mood swings
  • Caffeine (coffee, cola, energy drinks): Increases irritability, sleep issues, and breast tenderness
  • Alcohol: May disrupt hormone balance and worsen depressive moods
  • Processed foods high in salt: Promote water retention and bloating

Understanding PMS and taking targeted action

Premenstrual Syndrome (PMS) is a recurring challenge for many women—both physically and emotionally. Its causes are varied, ranging from hormonal fluctuations to lifestyle factors. With targeted strategies such as cycle tracking, a balanced diet, regular exercise, and stress reduction, symptoms can often be significantly eased.

In cases of severe symptoms, especially with Premenstrual Dysphoric Disorder (PMDD), medical evaluation is essential. Developing a conscious awareness of your cycle is key to improving overall well-being.

FAQs

Is PMS equally severe for every woman?

No. Some women barely notice any symptoms, while others suffer significantly. The intensity of PMS symptoms varies depending on factors such as genetics, lifestyle, and hormonal balance.

Can PMS be treated with natural remedies?

In many cases, yes — nutrition, exercise, and relaxation techniques can be highly effective. However, for more severe symptoms, medical treatment may also be necessary.

Is PMS normal?

No, PMS is not “normal” — it's common, but treatable. Many women experience it, but that doesn't mean you have to simply accept it. PMS is a signal that the body may be out of balance — hormonally, emotionally, or due to lifestyle factors. It should be taken seriously and addressed to improve quality of life.

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