Premenstrual Syndrome (PMS): Recognizing the Early Signs

Typical Premenstrual Symptoms

Timing

• Symptoms begin 1–2 weeks before menses (luteal phase).
• Resolve within 1–2 days of menstrual onset.
• Must be absent in follicular phase for diagnosis.

PMS vs. PMDD

Premenstrual Dysphoric Disorder (PMDD) is a severe subset (≥5 symptoms with marked functional impairment). Requires prospective daily rating for ≥2 cycles.

When to Consult a Clinician

• Symptoms disrupt work, relationships, or daily activities.
• Symptoms persist throughout cycle (suggests other mood disorder).
• New onset after age 35.
• Desire for pharmacologic management (SSRIs, OCPs, GnRH agonists).

Self-Care Strategies

• Regular aerobic exercise.
• Calcium 1200 mg/day, vitamin B6 50–100 mg/day (evidence modest).
• Limit caffeine, alcohol, salt in luteal phase.
• Stress reduction (CBT, mindfulness).

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Domain	Symptoms
Emotional	Irritability, anxiety, sadness, mood swings, sensitivity to rejection
Physical	Breast tenderness, bloating, headache, fatigue, joint/muscle pain, acne flare
Behavioral	Food cravings (salty/sweet), increased appetite, sleep disturbance, decreased concentration