Premenstrual Syndrome (PMS)

Symptoms

Physical symptoms:

• Breast tenderness and swelling
• Abdominal bloating, gas
• Headache or more frequent migraines
• Tiredness, low energy
• Joint or muscle pain
• Appetite changes, cravings for sweet or salty foods
• More acne breakouts
• Difficulty sleeping

Emotional and behavioral symptoms:

• Irritability, short temper
• Mood swings, sudden sadness
• Anxiety, tension
• Difficulty concentrating
• Social withdrawal or more conflict
• Loss of interest

In PMDD there are at least five symptoms; at least one of them must be mood swings (emotional lability), marked irritability, hopelessness or anxiety. Symptoms worsen in the week before the period, improve within a few days after the period starts and become minimal in the week after the period. Loss of functioning is marked.

Diagnosis

Diagnosis is based on showing that the symptoms are cyclical. Keeping a daily symptom diary for two or three cycles is recommended. The diary records period dates and symptom severity (for example on a 1–5 scale). PMS is considered if symptoms are clear in the luteal phase and absent or minimal in the follicular phase (after the period).

Conditions to rule out include thyroid disease, anemia, depression, anxiety disorder, polycystic ovary syndrome and perimenopause. These conditions can get worse before a period, but their symptoms continue throughout the whole cycle. Pregnancy should also be ruled out. Physical examination and laboratory tests are usually normal; the diagnosis is clinical.

When to see a doctor

• If symptoms disrupt work, school or relationships
• If lifestyle changes are not enough
• If you have severe emotional symptoms, hopelessness or thoughts of harming yourself
• If menstrual bleeding is very heavy, prolonged or painful
• If you are over 40 and symptoms have newly started or clearly worsened
• If the diagnosis is still unclear after keeping a diary for two cycles

Severe emotional symptoms may need a psychiatric assessment. In an emergency (thoughts of harming yourself), seek help without delay.

Treatment options

No single treatment suits every woman. In most cases, more than one approach is used together.

Lifestyle:

• Regular exercise (a few times a week, at moderate intensity)
• Enough sleep
• Cutting down on caffeine, alcohol and salt (especially in the two weeks before the period)
• Regular meals and a diet rich in complex carbohydrates and calcium
• Stress management (relaxation, a regular daily routine)

Medication:

• Selective serotonin reuptake inhibitors (SSRIs) are one of the first-line options for emotional symptoms. They can be taken continuously or only in the luteal phase (the 14 days before the period).
• Combined oral contraceptives are effective for general PMS symptoms. Some products containing drospirenone are approved for PMDD. The risk of thrombosis is assessed.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can help with pain and headache.
• In severe cases that do not respond to treatment, GnRH agonists (with add-back hormone therapy) or, rarely, surgical options may be discussed.

Psychological support:

• Cognitive behavioral therapy (CBT) is effective for emotional symptoms and its effect lasts a long time.
• Support groups or individual counseling can help.

Supplements:

• Calcium and vitamin D have reduced symptoms in some studies.
• Magnesium and vitamin B6 are tried, with limited evidence.
• Herbal products (for example agnus castus, also called chasteberry) have a low level of evidence and may interact with hormonal treatment.

The choice of treatment takes into account symptom severity, pregnancy plans, thrombosis risk and the preferred method. Follow-up intervals are set individually.

Our approach at SoftCare

At SoftCare Clinic, PMS assessment begins with a gynecological history and examination. We ask for a symptom diary covering two cycles. Tests may be ordered to rule out pregnancy, thyroid disease and anemia. An ultrasound is planned if there is abnormal bleeding or pelvic pain.

When discussing treatment, SSRIs, combined oral contraceptives and lifestyle options are each considered separately. For severe emotional symptoms, a referral to psychiatry is made. If perimenopause is suspected, it is addressed together with the approach described on our menopause page. After treatment, the response is monitored with a symptom diary.

Appointments: +90 212 241 30 10 · softcareclinic.com

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Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026