Behavioral & Physical Symptoms of Premenstrual Syndrome & Tips to Manage Them

A set of symptoms that occur a week before the onset of menstrual cycle and that interferes with the daily normal life of women is known as premenstrual syndrome or PMS. These symptoms differ from woman to woman and generally include mood swings, irritation, headaches, bloating, acne, tiredness and tender breasts.

Up to 80% women of child bearing age report some of these symptoms occurring to them before their periods but if it is only a bother and a nuisance, it does not qualify as premenstrual syndrome. It qualifies as premenstrual syndrome only when it interferes with their daily routine and normal life. It also must have some physical symptoms along with the emotional ones to qualify as premenstrual syndrome. It is qualified as such only in 20 to 30% women.

Premenstrual syndrome was not considered an actual problem back in the day. Women who suffered from these symptoms were told its “all in their head”. Edward Clarke in 1873 actually went on to say in his book “Sex in Education” that female operatives suffer less than schoolgirls because of the fact that they use their brains less and hence expend less energy which in turn is used for more normal operation of their reproductive structures.

Needless to say that he became an enemy of women all over the world and feminists quite vehemently opposed his view, saying that women can work outside their homes quite efficiently in spite of their bodily functions. And well what do you know? Amelia Earhart, Madame Curie, Helen Keller and Mother Teresa actually prove it!

The symptoms of premenstrual syndrome occur usually 6 days before the onset of periods and disappear before or at the start of the menstruation. If the woman gets pregnant or enters the menopausal phase of her life, the symptoms disappear.

Premenstrual syndrome may be a nuisance for all women suffering from it but it doesn’t necessarily have to affect your life. You can manage it well enough with some precautions and lifestyle changes and if it is quite severe then there are medications that can help you with that.

There are two kinds of symptoms associated with premenstrual syndrome, emotional or behavioral symptoms as well as physical ones. There are quite a lot of symptoms associated with premenstrual syndrome, in fact more than 200 symptoms have been found to be associated with premenstrual syndrome but most women only experience a few of these even though they can be different for different women. The symptoms also vary from cycle to cycle and can change over time as well. Some of these symptoms of premenstrual syndrome are as follows:

Behavioral and Emotional Symptoms of Premenstrual Syndrome

Behavioral and emotional symptoms of include those that affect emotions and cause changes in behavioral patterns of women such as:

  • Stress
  • Tension and anxiety
  • Difficulty with sleep or insomnia
  • Mood swings
  • Inability to concentrate
  • Anger, irritation or sadness without any reason which sometimes results into crying sessions
  • Craving for food or loss of appetite
  • Getting more emotionally sensitive
  • Changes in sexual interest
  • Withdrawal from people and society and preferring being alone

Physical Symptoms of Premenstrual Syndrome

There are some actual physical symptoms associated with premenstrual syndrome as well. Some of these physical symptoms and signs include:

  • Bloating
  • Weight gain due to fluid retention
  • Abdominal cramps
  • Pain in lower back area
  • Tenderness or swelling of the breasts
  • Digestive problems which can result into either diarrhea or constipation
  • Acne which arise only a week or so before menstruation
  • Joint or muscle pain
  • Headache
  • Tiredness or fatigue due to lack of energy for no apparent reason

Sometimes these symptoms become very severe or disabling enough that it makes it impossible for a person to retain normal routine. This extreme form of premenstrual syndrome is known as Premenstrual Dysphoric Disorder or PMDD.

Causes of Premenstrual Syndrome

The exact cause for the occurrence of premenstrual syndrome is unknown but there are many theories to suggest why premenstrual syndrome occurs. Premenstrual syndrome is associated with luteal phase of the menstrual cycle.Here are few reasons to suggest the possible causes of premenstrual syndrome:

Hormonal Changes

Cyclic changes in hormones are thought to be a cause of premenstrual syndrome. Endocrine system is responsible for the generation of hormones and a female’s endocrine system is quite complex and therefore the changes that occur in the hormones and their levels in a woman’s body can be responsible for premenstrual syndrome. However, it is still a mystery why these changes affect some women while the others remain unaffected.

Chemical Changes in the Brain

Serotonin, a brain chemical and a neurotransmitter may be responsible for premenstrual syndrome. Low level of serotonin can cause depression, anxiety, food cravings and fatigue and it may be responsible for triggering premenstrual syndrome symptoms.


Even though stress and depression do not actually cause premenstrual syndrome but they may be responsible for making it worse.

Genetic Control

Genetic causes may also be responsible for premenstrual syndrome as it is found that most women suffering from premenstrual syndrome have at least one other close relative or family member suffering from it as well.

Some other possible causes of premenstrual syndrome are high levels of sodium such as those present in salty foods, low levels of minerals and vitamins in the body and excess drinking of alcohol and caffeine can also cause some of the symptoms of premenstrual syndrome such as bloating and water retention. Excess intake of alcohol and caffeine can also cause tiredness, fatigue and mood swings.

Treatment of Premenstrual Syndrome

Following medicines are usually used to treat premenstrual syndrome:


Women are given antidepressant drugs to manage the symptoms of severe premenstrual syndrome. They are sometimes recommended to take these drugs such as fluoxetine and sertraline etc. only on days when the symptoms are expected to occur. These drugs may reduce the symptoms but there are some side-effects associated with them as well, such as nausea and weakness.

Hormonal Medications

Hormonal medications such as oral combined contraceptive pills and contraceptive patches are used to reduce the physical symptoms of premenstrual syndrome though they do not have any effect on emotional symptoms. Progesterone is also used in some cases even though there is no evidence of its efficiency.

Alternative Medicine

There is some evidence of the usefulness of some alternative medications such as Vitamin B6 and chasteberry in curing the symptoms of premenstrual syndrome. Other alternative medicines used for the treatment of premenstrual syndrome include folic acid, Vitamin E, magnesium, Evening Primrose oil and black cohosh etc.

Tips to Manage Premenstrual Syndrome

Apart from the above mentioned medications there are some other tips, precautions and treatments that can be used to manage the symptoms of premenstrual syndrome. It is a well-known fact that today’s changing lifestyle is causing a lot of problems and if women would just change their lifestyle a bit it can help a lot in managing their premenstrual syndrome. These tips are as follows:

  • Calcium and Vitamin D supplementation may also prove helpful to manage mild premenstrual syndrome.
  • Diuretics such as spironolactone can prove to be helpful in handling water retention.
  • Anti-inflammatory medicines such as naproxen can help you in managing some of the physical symptoms.
  • Do not take any medicine without consulting your doctor first.
  • Change your lifestyle for the better.
  • Exercise daily and include some aerobics and muscle strengthening exercises in your routine.
  • Try yoga. It will help you in managing mood swings, stress and depression.
  • Eat healthy foods such as fresh fruits, green vegetables and whole grains. They not only contain minerals and vitamins but are also rich in fibers.
  • Avoid excessively salty and sugary food as they can cause bloating due to water retention.
  • Reduce your alcohol and caffeine intake. They not only cause bloating but also mood changes and depression.

Do not smoke tobacco or cigarettes. They are injurious to health and can also increase your premenstrual syndrome symptoms. Manage stress. To that end you can try talking to a person you trust, get a massage, try yoga or aromatherapy etc. Do something that makes you happy and relaxed.

Sleep for at least 8 hours everynight. You can try scented candles and darkened room to get uninterrupted, deep and peaceful sleep.

Diagnosis of Premenstrual Syndrome

There is no laboratory test or proper diagnosis procedure for premenstrual syndrome but the following three features should be there to qualify the problem as premenstrual syndrome:

  • The women should have physical symptoms as well as emotional and behavioral ones to qualify the problem as premenstrual syndrome as it is quite common for women to have the behavioral problems.
  • Symptoms must occur only during the luteal phase and they must disappear shortly before or during the menstruation. The symptoms must also remain absent during the follicular or preovulatory phase.
  • The symptoms must be severe enough to interfere in a woman’s daily life.

There are some other disorders and problems with similar symptoms that get increased or magnified before menstruation in a process termed as menstrual magnification. So before a doctor pronounces the symptoms to be caused by premenstrual syndrome, he or she must eliminate other problems with similar symptoms such as anemia, hypothyroidism, eating disorders and substance abuse etc.

Women are also advised to record their symptoms on a calendar for at least two cycles before consulting the doctor and they should show the doctor their calendar. This will enable the doctor to better diagnose the problem.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:November 22, 2018

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