Premenstrual Syndrome Symptoms

Symptoms of Premenstrual Syndrome That Should Not Be Ignored

Most PMS symptoms are not serious. If symptoms are severe, persist, worsen or are new or affect your daily activities, they should not be ignored. They may be associated with other health conditions such as depression, anxiety, thyroid disease, irritable bowel syndrome and perimenopause. These conditions can cause symptoms that are similar to those of PMS.

It is recommended to get medical advice if symptoms are severe, persistent, new, worsening, or affecting your daily life. Such symptoms of PMS and what they may indicate are listed in the table below:

Depression, anxiety, thyroid disorders, irritable bowel syndrome and perimenopause can mimic or overlap with PMS. Depression and anxiety can also be present throughout the month and worsen before menstruation.

Why Do Premenstrual Syndrome Symptoms Occur?

The exact cause of premenstrual syndrome is not completely understood. These symptoms are associated with changes in hormone levels throughout the menstrual cycle. The ovaries release varying amounts of hormones, such as estrogen and progesterone. Some people may be more sensitive to these hormonal changes.

Hormonal changes affect brain chemicals called neurotransmitters. The RCOG indicates that PMS may be associated with changes involving neurotransmitters, such as serotonin and gamma-aminobutyric acid (GABA). These patterns may cause mood changes and other PMS symptoms.

Fluid retention can contribute to bloating or swelling, while hormonal changes may contribute to breast tenderness, headaches, appetite changes and skin changes.

Symptoms of Premenstrual Syndrome That Require Immediate Medical Attention

PMS does not always lead to a medical emergency. However, severe psychological symptoms associated with Premenstrual Dysphoric Disorder (PMDD) can require immediate help. It is recommended to seek medical assessment immediately if the following symptoms are present:

• Severe emotional disturbance with an inability to function normally

• A sudden worsening of mental health symptoms

• Severe abdominal or pelvic pain that is sudden or markedly different from usual symptoms

• Heavy or unusual vaginal bleeding accompanied by weakness or dizziness

• Persistent vomiting with an inability to keep fluids down

• Fainting or near-fainting associated with severe pain or bleeding

• Thoughts of suicide

• An immediate risk of self-harm

Suicidal thoughts are not routine PMS symptoms. They can occur with severe PMDD or another mental health condition and require immediate emergency assessment.

Symptoms of Premenstrual Syndrome Based on Type

PMS can involve mainly physical symptoms or psychological symptoms, or a mixture of both. This describes the dominant symptom pattern rather than separate diseases. The usual patterns and their characteristic symptoms of PMS are given in the table below:

Symptoms of Premenstrual Syndrome-Specific Conditions

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a severe premenstrual disorder in which mood and behavioural symptoms are particularly intense and substantially interfere with everyday functioning.

Possible symptoms include:

• Severe irritability or anger

• Marked mood swings

• Depression or feelings of hopelessness

• Significant anxiety or tension

• Difficulty concentrating

• Loss of interest in usual activities

• Very low energy

• Changes in sleep

• Changes in appetite or overeating

• Physical symptoms such as bloating or breast tenderness

Symptoms of Premenstrual Syndrome in Children

PMS does not occur before menstruation begins. However, adolescents can develop premenstrual symptoms after menarche, and thus, current clinical guidance on premenstrual disorders includes adolescents.

Some PMS symptoms that may be noticed by parents in children can include:

• Irritability or mood swings before periods

• Feeling anxious, upset or unusually emotional

• Tiredness

• Difficulty sleeping

• Headaches

• Bloating or abdominal discomfort

• Breast tenderness

• Food cravings or appetite changes

Symptoms that repeatedly affect school attendance, studies, relationships, sleep or normal activities should be medically assessed. Keeping a symptom diary can help determine whether they consistently occur during the premenstrual phase.

Can You Have Premenstrual Syndrome Without Symptoms?

No. PMS is defined by recurring physical, emotional or behavioural symptoms associated with the premenstrual phase of the menstrual cycle. A person can experience the normal hormonal changes of the menstrual cycle without developing PMS. Mild premenstrual changes that do not cause meaningful problems may also not meet the clinical definition of PMS.

When Can Premenstrual Syndrome Symptoms Become Life-Threatening?

PMS itself is not usually life-threatening. The main serious concern is severe psychological distress associated with PMDD or symptoms that actually indicate another medical emergency.

The table below briefly describes some of the PMS symptoms that necessitate immediate medical attention:

How are Premenstrual Syndrome Symptoms Diagnosed?

There is no single blood test or scan used to diagnose premenstrual syndrome. Healthcare professionals evaluate the severity and timing of symptoms and check whether they follow a consistent pattern throughout the menstrual cycle to confirm PMS.

The following assessments may be used when evaluating PMS symptoms or ruling out other conditions: