Premenstrual Syndrome

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Many premenstrual syndrome (PMS) symptoms improve with treatment. Treatment options range from medication therapy to birth control pills to diet modification, including vitamin and mineral supplementation, herbal medicines and exercise.

Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) are typically recommended to women with severe mood-related symptoms such as anxiety, depression or mood swings.

Overall, common treatment options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications are used to relieve premenstrual headache and other menstrual-cycle related pain. A variety of NSAIDs are available including over-the-counter ibuprofen products (Motrin) and others or naproxen sodium (Aleve). They usually cost less and have fewer side effects than other treatments. Prescription NSAIDs also are available.
    Note: NSAIDS carry some risks, such as an increased risk of serious cardiovascular (CV) events, including heart attack and stroke. As a result, the FDA has issued a “black box” warning highlighting this risk, as well as the risk of potentially life-threatening stomach bleeding. If you’ve recently had heart surgery, you shouldn’t take NSAIDS. All other women considering NSAIDS to ease PMS or any other condition should discuss these potential risks with their health care professional.

  • Contraceptive hormones. Some women with PMS or PMDD experience relief of their symptoms after they start taking birth control pills. (Other women, however, feel worse on birth control pills.) You can take the pill continuously to avoid having a menstrual period, thus preventing the hormonal changes that can lead to PMS/PMDD. The combination birth control pills Yaz (containing 3 mg of drospirenone, a progestin, and 20 mcg ethinyl estradiol, a form of estrogen) and Beyaz and Safyral (containing 3 mg of drospirenone, 20 mcg ethinyl estradiol and a daily dose of folic acid) are FDA approved for the treatment of PMDD. However, these contraceptives should only be used to treat PMDD if you choose to use them for birth control because other forms of treatment don’t carry the same risks as oral contraceptives. Birth control pills containing drospirenone may cause some serious side effects in rare cases, including blood clots in the legs and lungs, so be sure and talk to your health care provider about your risks and benefits. Oral contraceptives are not recommended for women who smoke because of increased cardiovascular risks.

  • GnRH agonists (gonadotropin-releasing hormone). These medications include leuprolide (Lupron), among others. They belong to a class of hormones used to temporarily shrink fibroids and relieve endometriosis. They also may be recommended to treat PMS because they “turn off” the menstrual cycle by blocking estrogen production. Side effects may include menopausal symptoms like hot flashes, vaginal dryness and bone loss. That’s why low-dose hormone therapy, a combination of estrogen and progestin hormones, is typically prescribed along with GnRH agonists. Some women may experience a return of their PMS symptoms with the additional hormone therapy. GnRH agonists are usually considered only as a short-term treatment option (given for no longer than six months) because of the increased health risks such as osteoporosis associated with low estrogen levels.

  • Antidepressant medications. Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are the preferred antidepressants for treating severe PMS and PMDD symptoms, including depression. SSRIs include sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro),and fluoxetine (Prozac, Sarafem). Other types of antidepressants may also be prescribed to treat PMS and PMDD, including venlafaxine (Effexor) and clomipramine (Anafranil). The U.S. Food and Drug Administration approved Zoloft, Paxil and Serafem for treatment of PMDD, but warns that women taking antidepressants should monitor their symptoms closely, with the help of their health care professional, for signs that their condition is getting worse or that they are becoming suicidal, especially when they first start therapy or when their dose is increased or decreased.

  • Anti-anxiety medications such as alprazolam (Xanax) are sometimes prescribed when anxiety is the main symptom associated with PMS or PMDD. These drugs can be taken during the 14 days between ovulation and menstruation (the luteal phase) when symptoms occur (rather than daily). Dependence and serious withdrawal reactions can occur with Xanax, so its dosage and discontinuation should be carefully monitored.

  • Calcium supplements (1,000 to 1,200 mg daily). Additional calcium in any form may help relieve some PMS symptoms. Low-fat dairy products (milk, yogurt and cheese) are a primary source of calcium, but you can also gain calcium from the following:

    • Tofu and other soy products
    • Rice milk
    • Broccoli
    • Dark greens, like turnip greens
    • Green or red cabbage (raw)
    • Salmon and sardines

    Taking an over-the-counter calcium supplement can also help. In one study, women who took 600 mg of calcium twice a day experienced fewer PMS symptoms than women who took a placebo. But be patient; it may take two to three months to relieve PMS symptoms with calcium supplementation. If symptoms persist, have your vitamin D levels checked or change the type of calcium supplement you’re using. Low levels of vitamin D can affect how the body absorbs calcium, and some generic supplements may not have enough calcium available for absorption.

  • Exercise. Regular exercise can also help relieve and possibly prevent PMS symptoms. You will get the greatest benefits if you exercise for at least 30 minutes, at least five days a week. But even taking a 20- to 30-minute walk three times a week can improve your mood.

  • Chasteberry. The extract of the fruit of the chasteberry tree is shown to be a safe and effective treatment for PMS. This therapy is used primarily outside the United States. It may be obtained over the counter, but the dose and purity may be uncertain.

In addition, there’s some evidence that some nutritional supplements such as vitamin E, magnesium and vitamin B-6 may help ease symptoms of PMS. Discuss these and other strategies with your health care professional before taking any dietary supplement.

There is no single treatment that works well for every woman who experiences PMS. Typically, it’s wise to try the most conservative treatment options first, which include lifestyle changes such as modifying your diet and exercising more. Discuss your symptoms with your health care professional if strategies you’ve tried don’t work, so he or she can recommend other treatment options.


Can premenstrual syndrome (PMS) be prevented? Many women report benefits from a variety of lifestyle change including dietary changes, exercise and stress management. Dietary changes may include:

  • Increasing calcium intake.

  • Decreasing consumption of refined sugar.

  • Decreasing or avoiding caffeine and nicotine, which act as stimulants and can increase tension and anxiety as well as interfere with sleep patterns. For some women, the severity of PMS symptoms increases as caffeine consumption increases.

  • Decreasing alcohol consumption, which can act as a depressant. If you experience PMS, you may have an increased sensitivity to alcohol premenstrually.

  • Decreasing salt intake and increasing water consumption to avoid water retention and bloating.

  • Avoiding sodas, which may contain high levels of caffeine, salt, sugar and/or artificial sweeteners.

  • Drinking natural diuretics, such as herbal teas.

Ironically, some PMS symptoms, such as mood swings, irritability, bloating, hunger, carbohydrate cravings and fatigue, may lead you to consume foods that aggravate the condition.

Premenstrually, you may crave either refined sugar (usually combined with chocolate) or fat (combined with salt). Generally, foods high in refined sugars and fat temporarily raise energy levels. But within several hours or less, as your body metabolizes these foods, you may “crash,” meaning you’ll feel worse than before you ate them. Foods high in sugar content can also leave you feeling jittery.

To alleviate mood swings and fatigue, try adding more high-quality, complex carbohydrates to your diet such as:

  • Whole grain breads, pastas and cereals
  • Potatoes (white or sweet)
  • Rice (preferably brown or wild)
  • Fresh vegetables, particularly corn and legumes, such as peas, chickpeas and lentils
  • Fresh fruits

These complex carbohydrates help keep blood sugar levels even while providing your body with a long-lasting source of energy.

It’s not uncommon for your appetite to increase just before your period begins. To combat the munchies and extra weight gain, try eating smaller, low-fat healthful meals using the food choices listed above.

Make sure you include adequate calcium in your diet; calcium may help prevent irritability, anxiety and other PMS symptoms. Good sources of calcium include:

  • Low-fat milk and milk products like yogurt, ice cream and cheese
  • Broccoli
  • Dark greens (like turnip greens)
  • Green or red cabbage (raw)
  • Cooked collards
  • Salmon and sardines
  • Soy products, such as tofu and soy milk
  • Calcium-fortified orange and grapefruit juices

Another good way to prevent PMS symptoms is through regular exercise in the form of aerobic activities such as brisk walking, jogging, biking or swimming. You will get the greatest benefits from exercise if you do it for at least 30 minutes, five or more days a week. But even taking a 20- to 30-minute walk three times a week can:

  • Increase endorphin and serotonin production, brain chemicals that may help decrease pain and discomfort and improve mood, respectively
  • Decrease stress and anxiety
  • Increase REM sleep

Other lifestyle changes that will help you control PMS include:

  • Sleeping consistent hours
  • Establishing a bedtime routine to help cue body and mind for sleeping
  • Keeping a PMS symptom checklist, also called a menstrual cycle diary, to identify when symptoms and which symptoms occur so you can be prepared for them

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Like clockwork, many women experience premenstrual symptoms including body tenderness and bloating. These symptoms typically arise a few days before you get your period each month and fade as it goes by.

When symptoms are severe enough to disrupt your daily activities, it’s called PMS: premenstrual syndrome. PMS is an array of symptoms that includes mood changes, cramps, body aches, pain, and fatigue. About 90 percent of girls and women have PMS during their lifetimes and 20 to 40 percent experience severe PMS symptoms.

As women age, they tend to accept and cope with PMS challenges. But some women actually find their PMS worsens as the years go by. If this sounds like you, read on.

The Hormone Connection

If you’re approaching menopause, fluctuating hormone levels may be responsible for worsening PMS symptoms. Research shows that women who suffer from PMS earlier in life tend to have a rockier transition to menopause later in life.

These hormonal changes can cause PMS to flare up more noticeably every month. Your mood may feel darker and more irritable. You might have “brain fog” or experience reduced alertness. You may have more body aches, breast tenderness, and persistent headaches.

The Bigger Picture

Not close to menopause? Then it’s particularly important to talk to your doctor about worsening PMS symptoms. Other issues could be at play.

Thyroid disease, for example, can mimic some of the symptoms of PMS. Polycystic ovary syndrome (PCOS) is often associated with chronic PMS, but is really another set of health issues. A doctor can sort through your exact symptoms and get to the root cause.

PMS can also make existing health issues worse. If you have the following conditions, you will likely experience more symptoms when you’re experiencing PMS:

Depression or anxiety. These mental health issues can become worse during PMS and your period.

Irritable bowel syndrome (IBS). The cramping and bloating that come with IBS can worsen with PMS.

Bladder pain. If you already experience bladder pain, PMS may add to the pain.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Some research shows that women with ME/CFS tend to have heavy menstrual bleeding and more severe PMS.


In the last few decades, another period-related health issue has come into focus: PMDD, or premenstrual dysphoric disorder. This is a severe form of PMS that occurs in about 3 to 8 percent of women who have PMS.

PMDD has the following characteristics:

  • Predictable, cyclical monthly pattern
  • Severe disruption of daily activities
  • Extreme moodiness that may include hopelessness or anger
  • Mental health concerns like depression or anxiety

If you suspect you may have PMDD, speak to a doctor as soon as possible. PMDD can have long-term effects on your mental health. Your doctor may recommend treatments like:

  • Antidepressants, which help with emotions, fatigue, food cravings, and sleeplessness.
  • Birth control pills, which reduce PMS and PMDD symptoms in some women.
  • Vitamins and supplements, which ease nutritional imbalances.
  • Diet and lifestyle changes, which can support overall wellness.

Coping With Worsening Symptoms

PMS symptoms can be stubborn and frustrating. But research shows that you can take certain steps to ease its impact on your body, mind and lifestyle. Here are some tips.

Focus on food. Eating a healthy diet rich in nutrients is important every day, but it’s particularly important before and during your period. Include whole grains, protein, low-fat dairy, and a variety of fruits and vegetables. Eat foods rich in calcium for bone health.

Avoid triggers. You might be craving chocolate or coffee, but these can trigger PMS symptoms in many women. Try to avoid caffeine, alcohol, chocolate and salt.

Reduce inflammation. Aspirin and ibuprofen are anti-inflammatories and can reduce the swelling that often accompanies PMS.

Try low-impact exercise. Your period might not make you feel like exercising, but mild exercise can ease PMS symptoms. Explore low-impact exercises like walking, swimming and cycling.

Concerned about PMS or PMDD? Reach out to the experts at Johnson Memorial Women’s Health Specialists.

Signs of PMS vs. PMDD

Up to 75% of women who have their periods may have mild PMS, but PMDD is much less common. It affects only between 3% and 8% of women. Women with mild PMS may not need a doctor’s help to cope with the symptoms. But women who have PMDD might need to talk to their doctor about ways to improve their issues.

At first glance, PMS and PMDD may seem to be the same because they have many of the same symptoms, including:

  • Bloating
  • Tender breasts
  • Headaches
  • Muscle or joint aches and pains
  • Fatigue
  • Trouble sleeping
  • Food cravings
  • Changes in mood

But PMS and PMDD are different in several ways. For example:

Depression. If you have PMS, you may feel depressed. But if you have PMDD, your sadness may be so extreme that you feel hopeless. You might even have thoughts about suicide.

Anxiety. You could feel anxious when you have PMS. But with PMDD, the anxiety you feel is probably on a very different level. Some women with PMDD describe feeling very tense or on edge.

Mood swings. When you have PMS, you can get moody. You feel happy one minute and upset or angry the next, and you’re more likely to cry. But with PMDD, your mood swings will be much more severe. You may become very angry, and things are likely to irritate you that wouldn’t normally bother you. You might pick fights, even if this isn’t your usual style. You may also cry about things that wouldn’t usually upset you. You may feel out of control of your life.

Feelings about your life. If you have PMS and feel depressed, you may feel a little detached from your usual routine. But if you have PMDD, you’re likely to stop caring about your job, your hobbies, your friends and family — anything that otherwise might put you in a good mood.

How to Identify Implantation Cramps

The truth is: the phrase implantation cramps is a misnomer. The process of implantation cannot be felt physically. When an embryo implants into the uterine wall it is painless and imperceptible—and it happens on such a small cellular level that it simply isn’t possible to physically feel.

But as long as we’re symptom spotting, let’s indulge ourselves and review what happens in early pregnancy.

Here, we’ll explain:

  • The most likely causes of cramping in early pregnancy
  • Myths about implantation, including implantation bleeding and implantation pain
  • The physical changes that occur in early pregnancy

How do you tell the difference between implantation cramps and your period?

If you’re cramping and it’s still a few days before your period is due, you might wonder whether what you’re experiencing is implantation pain and could be an early sign of pregnancy. Though some women do experience cramps or light spotting during early pregnancy, this isn’t one of the common first signs of pregnancy.

At such an early stage in pregnancy, there is absolutely no way to tell whether any symptoms you’re experiencing mean you could be pregnant or that your period is just on its way. (And if you’re trying to get pregnant, cycle tracking can help.)

What are implantation cramps?

There is no evidence that implantation causes cramps or pain. When someone claims to have implantation cramps, it’s much more likely that the cramping is due to other physical processes that lead to mild cramping.

The hormone progesterone can cause bloating and abdominal discomfort. Progesterone levels are increased during early pregnancy and during the end of your menstrual cycle. It’s impossible to tell the difference between cramping that is caused by your upcoming period, or cramping that is caused by pregnancy, since the same hormone—progesterone—is responsible for both.

What does implantation feel like?

While you may find accounts that implantation feels similar to menstrual cramps, the truth is that implantation doesn’t feel like anything at all. The process of implantation occurs on a microscopic level—far too small to cause cramping, pain, or bleeding.

If it’s not implantation, what could be the cause of mild cramping?

The short answer? If you’re about to get your period, it could be higher levels of progesterone. Here’s why:

  • Progesterone levels are high in the second half of your cycle, called the luteal phase (whether you are pregnant or not)
  • Progesterone slows down digestion
  • This slow down can lead to cramping

Here’s a more detailed description of what happens:

Your menstrual cycle has two phases: the follicular phase and the luteal phase. It’s helpful to think of these as the “egg prep” (follicular) phase and “waiting for pregnancy” (luteal) phase. Each month, whether you ultimately get pregnant or not—your body is preparing for the possibility of pregnancy.

So, it’s likely that the hormonal processes involved in the “waiting for pregnancy” phase, are what causes cramping that gets misconstrued as a potential sign of implantation. After you ovulate and a mature egg is released, the corpus luteum is formed from the remains of the ovarian follicle, which is basically a shell around the egg.

The corpus luteum secretes high levels of progesterone and moderate levels of estrogen. Progesterone is what tells your uterine lining to thicken so that—if you do get pregnant this cycle—the embryo will have a place to attach and grow. So, late in the luteal phase, in the days before your period is due, levels of progesterone are very high.

Progesterone also relaxes your digestive muscles and slows down the digestion of food, leading to cramping. So, it doesn’t mean you’re not pregnant, but the cramping itself should not be considered a sign of anything.

Once LH secretions fall below a certain level, the corpus luteum will degenerate and levels of estrogen and progesterone will fall. You will shed your uterine lining (i.e. get your period) and the next cycle will begin.

When does implantation occur?

While it is possible for implantation to occur anywhere from six – 12 days past ovulation (DPO), the vast majority of the time implantation occurs between eight – 10 DPO. Even if you are going to get pregnant this cycle before implantation occurs, you are not pregnant yet, and no symptoms that you experience have any significance for your chances of being pregnant.

This is why it’s very helpful to track your cycle. If you know when you ovulated and how many days past ovulation you are, you will know if it’s even possible for symptoms you are experiencing to be related to pregnancy. (Also, check out our implantation calculator post, which will help you estimate when implantation could have occurred.)

If you’re only five days past ovulation and you experience some cramping, it can help put things into perspective: it’s impossible for implantation to have occurred yet, so you can give yourself permission to stop thinking about it!

The bottom line.

The truth is, cramping, pain, or bleeding before your period are not positive signs of pregnancy. The best course of action is to wait until your period was supposed to arrive, then take a pregnancy test.

By Lindsay Meisel | Sep 9, 2018 Tags: cramps, implantation, luteal phase, menstruation, progesterone

Lindsay Meisel

Early pregnancy symptoms by days past ovulation (DPO)

Share on PinterestEarly pregnancy symptoms can be similar to PMS symptoms.

While some women experience many early pregnancy symptoms, others experience few or no symptoms at all.

Also, early pregnancy symptoms can be very similar to the symptoms experienced around the time of ovulation, during PMS, and by those taking fertility medications.

This is why DPO symptoms are not a reliable measure of whether or not a woman has become pregnant. Women should talk with a doctor about their specific symptoms.

Days 0–7 past ovulation

Ovulation is the moment an ovary releases an egg.

As soon as an ovary releases an egg, the luteal phase of the menstrual cycle begins. The luteal phase ends with a menstrual period unless pregnancy occurs.

Women will not experience any pregnancy symptoms during the earliest part of the luteal phase. This is because pregnancy does not occur until the fertilized egg implants into the wall of the uterus.

During the luteal phase, the body produces more progesterone, which is a hormone that helps sustain an early pregnancy. The levels of progesterone peak at 6–8 days after ovulation, even when a woman does not become pregnant.

Progesterone levels can affect a woman’s mood and body — this means that after a week or so, they may experience similar symptoms in early pregnancy as they do before a period.

When a fertilized egg reaches the uterus, it implants itself into the wall of the uterus. This is called implantation and marks the start of pregnancy. Implantation typically happens 6–12 days after fertilization.

This is the time when women may begin to experience pregnancy symptoms, including:

  • breast tenderness
  • bloating
  • food cravings
  • increased nipple sensitivity
  • headaches and muscle aches

However, these symptoms may also occur in those who are not pregnant. This is because of the increased levels of progesterone that are present during the last stages of the menstrual cycle.

Days 7–10 past ovulation

When the fertilized egg implants itself in the uterus, around one-third of women will notice light bleeding or spotting, which is called implantation bleeding.

This spotting typically lasts only a day or two and is very light in flow. Implantation bleeding is one of the earliest signs of pregnancy since it happens around the time the woman becomes pregnant.

However, even when a woman notices bleeding around the time of implantation, they may still not get a positive pregnancy test. They may have a very early miscarriage called a chemical pregnancy, or the bleeding might be due to something else.

At implantation, the body begins producing a pregnancy hormone called human chorionic gonadotropin (hCG). Known as the pregnancy hormone, hCG — along with progesterone and estrogen — is responsible for early pregnancy symptoms. It is also the hormone that pregnancy tests identify.

However, it can take several days for hCG to reach to a detectable level, so pregnancy tests may not pick up the hormone, and symptoms may not develop immediately.

Days 11–14 past ovulation

A few days after implantation, hCG levels may be high enough to cause early pregnancy symptoms. However, this is also the phase of the menstrual cycle when a woman is most likely to experience symptoms that mean they are about to get their period.

Women who are aware of how their body behaves each month might be better able to identify whether their symptoms are due to pregnancy or regular menstruation.

Some other symptoms of early pregnancy include:

  • darkening in the color of the nipples
  • fatigue
  • food cravings or increased hunger
  • increased need to use the bathroom
  • gastrointestinal changes, such as cramping or diarrhea

By the time a woman has experienced several early pregnancy symptoms, it is possible that the hCG levels are high enough that a pregnancy test can indicate a pregnancy. However, hCG levels vary, so this is not always the case.

The 4 Phases of the Menstrual Cycle

The luteal phase is the opposite of the follicular phase, it consists of the second half of the cycle from ovulation to menstruation. If you’re trying to conceive this is the phase when implantation and pregnancy could potentially occur. It’s also the time when PMS is experienced, if you are prone to it.

Typically the end of the cycle (when the period starts again) is about 2 weeks after ovulation, so if you ovulate on cycle day 14 then you’ll probably get your period again around cycle day 28. If you ovulate much earlier or later than cycle day 14, your cycle may be shorter or longer than the standard estimation of 28 days.

What’s happening with hormones

As soon as an egg is released from the ovaries the follicle it was released from transforms into a temporary progesterone-producing structure called a luteal body – this is where the luteal phase gets its name. The luteal body continues to make progesterone for about about 2 weeks, which causes the uterine lining to remain stable and keeps the uterus a few degrees warmer (you’ll notice this if you take your basal body temperature to chart your cycle.)

Estrogen is also produced, but in smaller amounts than in the follicular phase, so progesterone is said to dominate the luteal phase. Some PMS symptoms, however, may be caused by excess estrogen during the this phase.

If pregnancy occurs, the growing embryo signals the ovaries to keep making progesterone until the placenta can take over that task. This keeps the period from starting before pregnancy can become established. If pregnancy does not occur, then luteal body naturally stops working, progesterone and estrogen levels drop off, and the cycle re-starts.

How you’ll feel

It’s common for energy levels and libido to be lower during this phase, especially in the week prior to bleeding. It’s also common for mood to change, sometimes drastically, during the luteal phase. Irritability and weepiness are especially common, along with breast tenderness, changes to digestion, muscle tension, and possibly changes to temperature regulation, causes a warm sensation in the body.

How to support

Even though energy levels are lower during the luteal phase, exercise can still be beneficial as it helps to release endorphins and supports the liver to clear out excess hormones from the system. Even though libido is low, have sex or masterbating may also be helpful for improving mood tension in the body.

If you are prone to PMS, I recommend trying my Peaceful Period herbal tincture and Chill Out Tea blend. The Dandelion Detox supports the liver to metabolize excess hormones from the system and reduces symptoms of PMS and my Chill Out Tea is a gentle blend of relaxing herbs that nourish anxious or irritable nervous systems.

For those trying to conceive, an embryo may be developing during this phase. Take the usual precautions of pregnancy, such as avoiding alcohol, smoking, medications that aren’t safe in pregnancy, hot tubs/baths, x-rays, and dental work. You can also focus on eating foods that support implantation.

6 Self-Care Habits That Ease PMS Symptoms, According to Gynecologists

The whole point of self care is to look after your own needs—so you feel happier and healthier and function at your best. And really, is there any more crucial time to give yourself some extra TLC than in the days before your period?

About 85% of women say they deal with one or more PMS symptoms, reported a 2016 study, including cramps, fatigue, and bloating as well as fogginess and trouble sleeping. Then there’s that general ragey feeling that makes you feel snappish and out of sorts. It sucks.

RELATED: What PMS Symptoms Mean in Your 20s, 30s, and 40s

While there’s no cure-all to keep these hormone-induced changes at bay, you can take some in-the-moment steps to ease the fallout and make yourself feel a whole lot better until your flow begins and your hormones go on the upswing again. These 6 hacks will help you get through.

Indulge in protein and fat

PMS exhaustion and irritability might be making you crave donuts hard. But these and other empty-carb sugar bombs just make your symptoms a whole lot worse, causing your energy to spike and then crash and affecting your mood, cognition, and even bloat level. “ is often a time when we load up on the carbs, which is actually counter-productive and worsens our bloating,” says Nikki Walden, MD, ob-gyn at BodyLogicMD in Dallas.

Instead, swap the pastry for hearty, satisfying meals with lots of protein and good fats—like a veggie omelet, poke bowl, chicken on a bed of greens, or a yogurt and avocado smoothie. Protein plus healthy fats (like omega-3s) will decrease inflammation and reduce muscle cramps, while the whole grains have a good amount of protein and magnesium to relax your body and manage stress levels. “The cleaner you can eat, the better you will feel,” she says.

RELATED: 8 Ways to Get Rid of Period Cramps That Actually Work

Have an orgasm (or two, or three)

Sex will take your mind off your bloated belly or foul mood, but there’s more to it than that. Touching and being touched by your partner can help calm frazzled nerves, and having an orgasm will flood your brain with oxytocin, the hormone responsible for feelings of comfort and pleasure, explains Alyse Kelly-Jones, MD, ob-gyn at Novant Health Mintview Obstetrics and Gynecology in North Carolina.

Not partnered up at the moment, or have a spouse who is unavailable? PMS relief can come from your vibrator or by giving yourself a hand.

Sweat in your favorite gym class

It might be the last place you want to go, but you’ll be happy after a sweaty workout you know you love. “30 minutes a day of moderate intensity exercise may help improve mood and overall sense of well-being,” says Dr. Walden, thanks to the release of mood-boosting endorphins.

So even if you’re dragging and want to bag yoga or dance class, do your best to get yourself there anyway; think of it as a treat that you know will make you feel better fast. You can still veg out on the couch all evening, just a half-hour later than you planned.

RELATED: How to Add Self Care to Your Workout Routine

Snack on almonds

These superstar nuts are loaded with magnesium, which can reduce cramping and alleviate tension, says Dr. Walden. Keep a bowl of them at your desk at work to munch on, or go with other magnesium-rich foods such as edamame and leafy greens like spinach and kale. If you’re not feeling snacky, popping 400 mg of magnesium citrate during each PMS day can do the trick, adds Dr. Walden.

Add this to a long, hot bath

Heat makes everything feel better, and that goes for PMS-related cramps and tension as well. For even more relief, add Epsom salt to the steamy water. The magnesium in the salt will relax sore muscles and make your body feel happier overall, says Dr. Walden.

RELATED: Ready to ditch added sugar? Sign up for our 14-Day Sugar Detox Challenge!

Tuck yourself in early

Sleep problems during PMS days are a common complaint. But if there’s one time when you should really make an effort not to stay up binging on Netflix, it’s during your pre-period days—when hormonal changes are messing with your energy level. A solid 7-8 hours of sleep will help you feel refreshed.

“Sleep is a natural mood restorer; when we get into REM sleep, our body can begin to repair itself to take on the next day,” explains Dr. Kelly-Jones, referring to the sleep stage that’s associated with learning and memory. That means repairing PMS-related muscle soreness as well, she says.

11 Signs Your PMS Is Bad Enough That You Should See A Doctor, According To Experts

It’s natural to hate that time on the month. Whether your period woes are severe or not, it can still have an impact on your mood and energy. If you notice signs your PMS symptoms are abnormally bad, and you might need to see a doctor, make sure to schedule an appointment ASAP and get checked. If you keep with the pain, you might put yourself at risk for other health conditions (and it’ll just suck, especially).

As a certified health coach, I work with clients on managing their PMS symptoms and also being in tune with their bodies. That way, if something’s off, you can get to the root of the cause right away and start feeling back to normal. When on your period, you might experience the typical symptoms, like moodiness, abdominal cramps, ravenous appetite, and more, but there can also be a slew of uncommon symptoms that require additional guidance. If you’re starting to feel different this month, don’t just sit idly and take it. Here are 11 signs your PMS is worse than you think and you might need to get a second look at what’s really going on down there. A doctor can help you take the next steps.

1. You’re Having Intense Mood Swings


While moodiness might occur normally during a period, if you’re having crazy swings, it could be linked to a serious issue, says Dr. Michael Cackovic, an OB/GYN at The Ohio State University Wexner Medical Center, over email with Bustle. “By definition, affective (mood) symptoms predominate in women with PMDD, although most women with this condition also have physical symptoms such as bloating, food cravings and fatigue to name but a few,” Cackovic says.

2. You’re Having Suicidal Thoughts


According to Cackovic, suicidal thoughts can be a sign of abnormal PMS. “Some work suggests that women with PMDD, especially those with more severe symptoms, have an elevated risk of suicidal ideation and attempts,” Cackovic says. If you have these, see a doctor and therapist to discuss.

3. You’re Depressed


According to OBGYN and Professor Andrea Rapkin at the UCLA School of Medicine over interview with CBS, if you’re feeling super depressed during this time, and it’s pretty chronic, it could demonstrate a PMS abnormality. See a doctor to get tested for any complications, if so.

4. You Don’t Socialize


This isn’t the same as staying in to Netflix and chill during your period. If you’re feeling withdrawn from all human contact and social activities, especially activities you’d normal participate in, it could be linked to strange PMS symptoms, explains Cackovic.

5. Your Cycle Is Super Short


If the length of your cycle changes, and it’s super short, it could mean you’re experiencing abnormal PMS symptoms and should get checked out by a physician. It might seem great to have a one-day flow, but it could mean your hormones are off.

6. You Have Heavy Bleeding


According to the Centers of Disease Control and Prevention, if you’re bleeding heavily during your period, more so than you normally would, it could indicate that you’re suffering from scary PMS symptoms. If left untreated, it could lead to a hysterectomy or other blood disorders.

7. You’re Unusually Tired


It’s natural to feel more sluggish during your period, but if you’re feeling way more lethargic than usual, it could indicate a larger problem with your hormonal balance. A few ways to stay more awake when on your period is to time your eating habits and napping, track your menstrual cycle on an app, and increase your exercise the week before your period.

8. You’re Getting Huge Breakouts


Yes, a pimple or two during this time of the month is perfectly acceptable, and expected, but if you’re getting huge flareups, it could mean you’re hormones are out of whack. Bad acne during your period can mean something’s off, so getting a physical could help you get some answers as to what’s really going on.

9. You Have Blood Clots


A few clots here and there is okay, but if you’re getting some serious blood clots throughout your period, it could signify a greater problem down there. It could be related to anemia, as you’re losing a lot of blood, for instance. If you’re clotting a lot, go see a doctor for better guidance.

10. You’re Blood Is Gray


If you’re seeing shades of red, that’s totally normal. For instance, blood might be redder and brighter at the start, and more dark and brown towards the end. However, if you see shades of gray (not the good kind), you might have an infection or be pregnant. See a gyno immediately.

11. Your Period Is Super Long


The dreaded never-ending period; not fun. If your flow is lasting past a week, it might be time to see a doctor to see what’s going on. Even if this is normal for you, it’s not normal for the average person. It could be linked to hypothyroidism or iron deficiency.

If you experience any of these PMS symptoms, or extremities of the more common, normal ones, make it a priority to get a second look at what could be going on.

Cat’s story: Living with premenstrual dysphoric disorder

I have lived with premenstrual dysphoric disorder (PMDD) since I was 13, but I was only diagnosed at 27. For over 10 years I had been diagnosed as depressed and in and out of community mental health departments.

After stopping the Pill and having a baby aged 21, my hormones went crazy and I suffered pre- and postnatal depression. In the years that followed I began noticing a pattern to my moods and depression. At times, I thought I really was severely mentally ill. I always had PMS, but I realised that my worst times happened when I was due on my period. My PMS was so severe that it had begun to take over my life, wreck relationships, ruin jobs, studying and caused me so much emotional pain that I often found myself considering suicide. I would become housebound, with no social life or friends and fearful of ever making an appointment because I could never guarantee how I would be feeling.

It was only my persistence and researching that made me realise I did in fact have a mood disorder and not straight forward depression. I Googled ‘mood disorders’ instead of depression and discovered PMDD – Premenstrual Dysphoric Disorder. I read the only book available at that time, and began to track my moods using a chart from the book. I found a GP willing to listen, took in printed information and my charts and got the correct diagnosis of Premenstrual Dysphoric Disorder. Coming to terms with what that meant took many years, and sometimes I still struggle.

PMS is one thing, many women suffer with moodiness, anger, irritability at pre-menstruation, but my PMDD threatened to destroy everything. As a mother, I felt I wasn’t well enough to look after my children, I have been unable to work and feel really separated from the rest of the world. Only 3-8% of women suffer with PMDD, the rest get through each month without disaster. It is very difficult to find people to talk to who understand what I’m experiencing when PMDD is so rare, and when menstrual problems are often seen as something to joke about or ridicule. I have often dealt with comments like ‘pull yourself together’ and ‘get a grip’, and even people denying that PMDD exists.

PMDD is distinguishable by the dysphoria that is experienced. Feelings of being completely overwhelmed, spiralling thoughts, outrage, anger, frustration, anxiety and suicidal ideation coupled with the physical symptoms, which can include, bloating, IBS, tender breasts, cramps, lower back pain, lethargy, and sleep and appetite changes. I am sensitive to the changes in hormones during my cycle, and I also experience a few days of unstable moods and physical symptoms during ovulation. My PMDD does not occur once a month but twice a month, leaving on average 10-14 days of feeling like me, and the rest being spent coping with symptoms. This will continue until menopause.

I am now 34 and have tried every medication offered to me. I have discovered that I am very sensitive to any type of hormone and cannot tolerate the Pill or IUD. I spent a total of 5 years on anti-depressants, which never really worked for me. They took the edge off, but didn’t stop the extreme lows and outbursts. I have seen psychiatrists and gynaecologists. At one point, I went through hormone treatment to stop all my hormones and put me into a chemical menopause. This is often a route that works for PMDD sufferers, and many go on to have hysterectomies. Unfortunately, this option did not work for me, and the treatment made me very ill.

I have found that counselling has helped, along with mind techniques such as CBT, NLP and meditation. Finding support is essential. Being able to talk through the irrational thoughts can usually avert disaster. Keeping busy is also a good way to keep the mind focused, so I draw, create, paint, write and bake lots!

I am now medication free for the first time in my life. I have had to learn my cycle and I now plan things around it. I avoid busy social situations when I know it will be too much for me. Eating healthily, regular exercise and avoiding stress has also helped improve my symptoms. Making sure I continue to communicate with loved ones and work through problems, finding strength to leave the house even when I don’t want to and being open and outspoken about my disorder all contribute to life feeling easier and less stressful and traumatic. Fitting into society and getting a regular job is a whole other problem. After all, who would employ someone who can only function and deal with stressful situations for 10-14 days out of every month? I focus on my children and being the best mother I can be, my writing, art and getting through each month without trauma. One day I hope to be self-employed.

Living with PMDD is very challenging, but I am trying to make the best of my life, for me and my children. There is always hope, the negative feelings and dysphoria will always pass. Life is a rollercoaster but as someone once said to me€“ you’re a long time dead. Women need to speak out and stop being ashamed of suffering from PMS/PMDD. Every voice helps change the way people think and I find talking and being honest is always the best option.

You can find out more by reading my PMDD blog and check out my artwork.

Here’s How PMS Can Change in Your 20s, 30s, and 40s

Bloating, cramps, food cravings, brain fog, mood swings—at this point in your life, you’re well acquainted with these and other symptoms of PMS, or premenstrual syndrome. Up to 85% of women experience at least one PMS symptom during the week before their period, while others deal with several, including acne breakouts, fatigue, headaches, breast tenderness, and depression.

While the severity of these symptoms normally varies month to month, they tend to change more noticeably as you get older. Why isn’t PMS consistent throughout your reproductive years? Like everything else related to your cycle, it’s a hormone thing. As levels of estrogen and progesterone naturally fluctuate with age, the symptoms you’re used to fluctuate as well.

RELATED: 5 Ways to Beat the Bloat

To get the lowdown on what PMS in your 20s, 30s, and 40s can be like, we talked to Suzanne Fenske, MD, assistant professor of obstetrics, gynecology and reproductive science at Icahn School of Medicine at Mount Sinai in New York City.

In your 20s, PMS can be rough

In this decade, PMS can feel like a rollercoaster. “PMS tends to be worse early and late in a woman’s reproductive years because there’s just much more fluctuation in hormones during those times,” says Dr. Fenske. It’s unclear why some women experience more aggressive symptoms than others—or why an estimated 3%-8% of women develop premenstrual dysphoric disorder (PMDD), a more serious form of PMS that makes regular symptoms severe and even debilitating.

Certain lifestyle habits that women in their 20s are more likely to have—not prioritizing sleep, an all-over-the-place meal schedule, smoking, and avoiding the gym—can amplify PMS symptoms. So your skin issues, fatigue, and irritability, for example, can hit harder and be more difficult to manage.

RELATED: What Your Period Reveals About Your Health

If you’re in your 20s and your PMS isn’t so bad, it could be because of your birth control. Twentysomething women tend to be more focused on work or education, and they’re not necessarily thinking about having kids. For this reason, many rely on hormonal methods such as the Pill or implant. The artificial hormones in these methods prevent ovulation and put your natural cycle is on hold—which eases or eliminates PMS as well, says Fenske.

By your 30s, symptoms tend to ease

In this decade, PMS tends to even out and not feel so extreme. Women in their 30s are likely to have fewer symptoms—or the ones they do have may not be as severe.

One reason why: For many women, their 30s are the decade when they become moms, and pregnancy and breastfeeding can provide a reprieve from PMS symptoms, says Dr. Fenske. Getting pregnant puts a halt to ovulation and regular periods, and without a period, there’s no PMS.

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Still, sometimes the 30s are the worst decade for PMS. That can be the case if you’ve been on hormonal birth control all through your 20s and then go off the Pill in your 30s to have kids. The time between going off birth control and before conception can be a wild hormonal ride, as your natural hormones kick in and start the week-by-week fluctuations that lead to PMS.

After 40, PMS can return with a vengeance

While PMS in your early 40s can be similar to what it feels like in your 30s, symptoms will likely get worse when you reach perimenopause, the five- to 10-year stretch before menopause actually hits. (The average age when women enter menopause is 51.) Generally speaking, whatever symptoms you’ve already been having will likely be ramped up.

But what makes PMS in this decade a little trickier is that your period may start to become irregular thanks to decreasing hormone levels. You won’t necessarily know exactly when to expect the mood swings, fatigue, or other PMS issues. The other thing is, what you think might be PMS could just be hormonal weirdness caused by perimenopause.

“If a woman did not have a history of PMS and has a sudden onset of PMS-like symptoms in her 40s, it’s more likely perimenopausal changes rather than sudden onset of PMS,” says Dr. Fenske.

How to deal with PMS in any decade

Whatever decade you’re in, one of the keys to managing PMS is to adhere to a healthy lifestyle—eating right, working out regularly, and keeping stress and anxiety at bay. “You can also treat psychological symptoms with antidepressant and antianxiety medications, either daily or only during the two weeks prior to your period,” says Dr. Fenske. Hormonal birth control can provide relief as well.

In a recent Instagram pic, Malin Olofsson poses in a sports bra and underwear, her expanded stomach on full display. No, she’s not pregnant. And no, she doesn’t have a “food baby,” either. The Swedish weight lifter is dealing with premenstrual syndrome, also known as PMS. And her stomach expands like this for an entire week every month as a result of her PMS symptoms. “This is how PMS looks for me, and many other women,” Olofsson captioned her picture. “And it’s nothing to be ashamed of. It is simply water retention and, yes, it is really uncomfortable.”

Olofsson is far from alone in having PMS symptoms. A whopping 85 percent of menstruating women experience at least one PMS symptom each month, according to the U.S. Department of Health and Human Service’s Women’s Health department. PMS is a group of symptoms that can start about seven to ten days before a woman gets her period. PMS affects all women differently, and the severity and types of symptoms can vary. Emotional PMS symptoms include anxiety, mood swings, crying spells, and depression, according to the Mayo Clinic. And physical symptoms include joint pain, headache, fatigue, breast tenderness, acne flare-ups, and abdominal bloating, like Oloffsson experiences.

“You absolutely can see bloating with PMS,” Jamil Abdur-Rahman, M.D., board-certified ob/gyn, tells SELF. Abdur-Rahman explains that PMS is typically caused by an imbalance of the hormones progesterone and estrogen. And during this time, the body can retain way more water than usual, leading to bloating in the belly and breasts. “You can see bloating and a pretty large protuberant belly depending on where you’re having a lot of that water retention with PMS,” he says.

Abdur-Rahman typically tells patients with abdominal bloating from PMS to decrease their salt intake to help decrease water retention. And he recommends they drink more water, too. “The more water they take in the less water their body tends to want to retain, so that can help.” He’d also make sure more serious issues weren’t at play. If a woman experiences five or more of the same PMS symptoms each month, she could have premenstrual dysphoric disorder (PPMD), a mentally debilitating form of PMS. “You can also see bloating with PPMD, which is a more severe form of PMS,” he says.

Olofsson’s not letting PMS affect her self-esteem. She shared the body positive pic to show that she’s still loving herself—bloat and all—and to encourage other women to love themselves, even when PMS changes their body.

“Trying to fight your physical body and how it appears during this time will not be a good idea since you’re already more sensitive to physical neglect and self-loathing,” she writes on Instagram, referring to the emotional symptoms of PMS. “It is really important that you learn to love yourself no matter how your body looks/how you perceive it. Your body’s shape/size/form will not be a constant factor. And this is what I look like for at least one week a month. And that is many weeks in a lifetime.”

She’s so right—life’s too short to loathe your body for an instant, let alone an entire week each month. Major props, Malin, for sharing such an honest pic.

Check out Malin Olofsson’s Instagram pic below.


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Menstrual cycles are dynamic. They can vary for many reasons and in many ways. The length of your cycle, the heaviness of your period, and the symptoms you experience can all fluctuate. These variations are usually normal and healthy. In some cases though, they can point to something more serious, like a medical condition that needs your attention.

Having a menstrual cycle is like having an extra vital sign – like your pulse or body temperature. Your cycle can tell you when you’re in your usual rhythm, when something is a bit off or when you may have a medical condition that could need treatment.

Clinically speaking, cycles are described in two ways: regular and irregular. This refers to a cycle’s length, and how much cycle length varies, cycle-to-cycle. There are also regular and irregular ranges for menstrual bleeding, and regular and irregular ranges for pain.

No one is perfectly “regular”

A period that comes every cycle at exactly the same time is not the norm. Of course cycles are irregular when they’re first starting, as they’re coming to an end, and around the times of pregnancy and changes to contraceptive methods. But even outside of those times, slight variations in timing and symptoms are common. If you are stressed out during the first half of your cycle, for example, your ovulation may happen a couple of days later than usual. Progesterone (the hormone that’s dominant after ovulation) will then peak later in your cycle. This will cause certain symptoms (such as sore breasts) to happen later as well. Your period will also then be a couple of days late (1).

These types of variations are extremely common and happen in most peoples’ cycles (1,2). They can be caused by changes in your environment, behavior, or health, including things like diet and exercise, sleep changes and jetlag and smoking (3,4). Slight changes in your cycle length, period length, and period volume are also normal over time (1)

Why does variation happen?

Anything that affects the balance of your reproductive hormones can affect your cycle’s length as well as your symptoms and the length and heaviness of your period.

Menstrual cycles are caused by the rhythmic ups and downs of your reproductive hormones, and the physical changes those ups and downs cause. They trigger the growth of follicles in the ovaries, the release of an egg (ovulation) and the growth and shedding of the uterine lining (the period). The reproductive hormones include estrogen, progesterone, follicle stimulating hormone, luteinizing hormone, testosterone and others.

In a way, hormones in the menstrual cycle act a bit like they are in a relay race. As the cycle moves forward, one hormone often triggers the next, which then triggers the next, moving the cycle through its different phases. Having more or less of certain hormones will create changes in the pace and timing of the cycle. If one hormone doesn’t “pass the baton,” things can slow down or stop altogether. It’s a delicate and important balance (5).

Regular ranges: what’s normal?

A cycle is considered clinically regular when the majority of someone’s cycles and periods are within these ranges:

  • Adolescents: Cycles within the range of 21–45 days (6)
  • Adults: Cycles within the range of 24–38 days (7)
  • Adults: Cycles that vary in length by up to 7–9 days (for example, a cycle that is 27 days long one month, 29 the next) (8)
  • Periods that last 8 days or fewer (8)

Regular mid-cycle spotting may be caused by ovulation (1). Any unpredictable spotting or continual changes to period length should be addressed with a healthcare provider (8). If the majority of your cycles fall outside these ranges, read more here.

Noticing bigger changes in your cycle

Variations that are more significant also occur. They are often temporary, lasting only one or two cycles. These can happen for reasons such as an undetected miscarriage, high stress, or not getting enough calories. If you don’t ovulate at all in one cycle, for example, that cycle may be longer with a slightly lighter period (1). The cycle and period following that one may also be a bit different. Temporary irregularities in the menstrual cycle are usually nothing to worry about (1,2,9).

But irregular cycles can also be longer lasting. These are cycles that continually fall outside of “regular” ranges (or the majority of cycles in the past 6 months). Long-term irregularities can happen in response to things such as working night shifts and high-intensity exercise or due to medical conditions such as polycystic ovary syndrome (3,8,9,10). Many people have undiagnosed medical conditions which affect their cycle (10). Periods that are very heavy, or painful may also signal an issue—endometriosis, for example, is a common (and underdiagnosed) cause of painful menstruation.

Reproductive hormones play a role well beyond reproduction. They affect everything from your sleep, mental health and weight to your bone density and heart health (11-12). Cycles that consistently fall outside of “normal” ranges should be addressed with a healthcare provider.

Read more about irregular cycles and their causes.

Know your cycle

Learning what your average cycle looks like will help you identify when variations – of any type – occur. Tracking other things will help you identify what things tend to impact your cycle. If your cycle becomes (or is always) irregular, the information you gather with Clue may provide you and your healthcare provider with information that could help in the diagnosis and management of a medical condition. It may help you come up with an individualized treatment plan, or identify a change like menopause or pregnancy.

Common reasons a “regular” cycle can vary:

Life stages and pregnancy

  • After menarche (the years after menstruation begins)
  • Perimenopause (as cycles come to an end)
  • Pregnancy
  • The postpartum period (after a pregnancy)
  • Miscarriage (known or unknown)
  • Abortion (13)


  • Changing or stopping hormonal birth control
  • IUDs (hormonal or copper)
  • Emergency contraception (14-16)

Sleep/Wake Cycles

  • Shift work or working night shifts
  • Sleep changes
  • Jet lag/long distance travel (3)

Physical/Emotional Changes

  • Stress
  • Substance use
  • Diet changes
  • Not getting enough calories
  • Intensive exercise
  • Substance use
  • Big emotional changes, such as grief
  • Quick changes in weight
  • Certain medications (17-20)

Pms worse after 30

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