What a drama every month

What is premenstrual syndrome (PMS)?

Premenstrual syndrome (PMS) refers to a regularly recurring set of symptoms that appears in the second half of the cycle, i.e. after ovulation, and lasts until shortly before the start of menstruation. It includes both physical and psychological symptoms, which can vary in severity from person to person. While some people are only mildly affected, others find the symptoms significantly distressing.

What is characteristic is the close link to the menstrual cycle: symptoms occur only in a certain phase and usually subside completely with the onset of bleeding. This timing distinguishes PMS from other health problems.

Because hormonal regulation of the cycle is individual, people respond with different sensitivity to these biological processes. Cycle length can also vary from person to person, which further explains why PMS does not present the same way in everyone.

How can you recognise PMS?

PMS is noticeable through a wide range of complaints, which can be physical as well as psychological. Typical signs include feelings of breast tension, pain or swelling. Many people also report abdominal cramps, back pain or migraine‑like headaches that can radiate into the shoulders, neck or temples. Joint and muscle pains, hot flushes, nausea as well as dizziness, palpitations and light‑headedness are also common. In some cases, circulatory weakness or brief fainting episodes can occur.

Gastrointestinal symptoms such as bloating, a feeling of fullness, constipation or diarrhoea are also typical. Skin problems like acne, oily or irritated skin and tingling in the hands or feet can point to PMS. Many women notice a temporary weight gain before their period due to fluid retention, particularly around the ankles, hands or abdominal area. Food cravings, loss of appetite or marked changes in eating behaviour are also not uncommon. Sleep problems, such as difficulty falling or staying asleep, may occur as well.

On the psychological level, PMS often shows up as mood swings ranging from irritability and inner restlessness to depressive phases. Some people experience alternating states of hyperactivity and exhaustion during the day. Feelings of anxiety, nervousness or constantly being under pressure are also common. Lack of drive, loss of interest, concentration problems or a sense of being overwhelmed may appear. Some women report sudden anger, crying spells or the impression of losing control over themselves.

What causes PMS?

The exact triggers of premenstrual syndrome (PMS) are not yet fully understood. It is thought that several factors interact. Central to this are hormonal changes during the female cycle, particularly fluctuations in oestrogen and progesterone levels after ovulation. These natural fluctuations can trigger more sensitive reactions in the nervous system in some people, since certain hormone metabolites are believed to influence body temperature, sleep quality or mood.

Neurobiological processes also play a role: studies suggest that hormonal fluctuations may disturb the balance of neurotransmitters such as serotonin. This messenger is crucial for emotional well‑being and sleep. A rapid drop in serotonin can therefore be associated with symptoms like irritability or low mood. In addition to serotonin, other messengers such as dopamine or melatonin are discussed as possible contributors.

There is also evidence of a genetic component, as PMS often clusters in families. Genetic factors could increase sensitivity to hormonal fluctuations or affect how the brain processes stimuli. Recent studies also show that certain genes that modulate the response to sex hormones are more active in affected women.

Other factors relate to lifestyle and the environment. Chronic stress, an unbalanced diet, lack of exercise, sleep disturbances, smoking or alcohol consumption can, for example, worsen symptoms. A deficiency in certain nutrients, such as iron or B vitamins, is also discussed in this context. Thyroid function can play a role as its hormones influence energy balance and emotional well‑being.

Finally, the psychosocial aspect is considered. Negative attitudes towards one's cycle or culturally transmitted images of femininity can lead to bodily changes in the second half of the cycle being perceived as more burdensome.

What is the difference between PMS and PMDD?

Both premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are cycle‑related complaints that occur in the second half of the menstrual cycle. They differ, however, in their severity and impact. While PMS is associated with a variety of physical and psychological symptoms, PMDD is a particularly severe form in which psychological distress predominates.

A key difference is the severity of symptoms. PMS often manifests as mild to moderate complaints. PMDD, by contrast, is dominated by intense psychological symptoms such as marked irritability, sudden outbursts of anger, anxiety, hopelessness or depressive moods that go well beyond normal mood fluctuations. These symptoms can be so severe that they significantly affect social and occupational life.

Another difference is in diagnosis: for PMS the occurrence of individual symptoms before the period is sufficient. For PMDD, however, the DSM‑V criteria require at least five symptoms to occur regularly across cycles, including at least one severe affective symptom. Characteristically, these complaints begin a few days before menstruation and resolve with the onset of bleeding.

In PMDD the emotional component plays a central role: affected people often feel overwhelmed and exhausted, withdraw socially or experience a dramatic personality change. These psychological complaints are usually accompanied by physical symptoms but are more intense and longer‑lasting than in PMS.

Can I get pregnant during the PMS phase?

Although it initially sounds unlikely, pregnancy during the PMS phase is not entirely impossible – especially if the cycle is irregular or shortened. The premenstrual phase normally marks the end of the cycle, that is the time after the release of the egg and before the next menstruation. In a typical cycle this phase is not fertile because the egg's fertilisable window has passed. Nevertheless, exceptions exist that can make this period potentially risky.

One reason is the natural variability of the female cycle: ovulation can shift due to external influences such as stress, illness or hormonal fluctuations – either later or earlier. This can lead to mistakenly believing you are in a “safe” phase when the fertile window has just begun or is about to begin.

Another aspect concerns the lifespan of sperm. They can survive in the female body for up to five days. If a woman has sex shortly before a delayed ovulation – for example towards the end of the PMS phase – viable sperm may still be present at the time of egg release. Pregnancy can therefore occur even if intercourse took place several days before the actual ovulation.

Women with short or variable cycles should therefore be particularly careful. PMS symptoms are not a reliable indicator of infertility. Only a reliable contraceptive method provides protection against an unwanted pregnancy – also in cycle phases that appear outside the fertile window.

What to do about PMS symptoms: helpful tips

• Ensure regular, restorative sleep of preferably 7 to 9 hours per night. Go to bed and get up at approximately the same times every day, including weekends. Avoid screens, caffeine and heavy meals before bedtime.
• Actively reduce stress during the second half of the cycle. Schedule relaxing activities such as walks, quiet evenings or breathing exercises and avoid unnecessary strain in daily life.
• Include light exercise in your daily routine. Even 20 minutes of yoga, swimming or a walk outdoors help relieve cramps and lift the mood. Outdoor activity enhances the effect through light and fresh air.
• Also pay attention to a magnesium‑rich diet to help prevent cramps. Eat a portion daily of magnesium‑rich foods such as pumpkin seeds, oats or green leafy vegetables – for example in a salad, as a topping or in muesli.
• If you have digestive problems, eat fibre‑rich foods daily. Include, for example, a portion of lentils, wholegrain bread or fruit with the skin in your meals. Drink enough fluids to support the effect of the fibre.
• For headaches or PMS‑related migraine, drink a glass of water and cool your forehead. A cold, damp cloth or a cooling pad on the forehead can relieve pain. Combine this with rest in a darkened room.
• Use herbal teas specifically for digestive complaints. After meals, drink a cup of fennel‑anise‑caraway tea or chamomile to gently ease bloating, nausea or abdominal pressure.
• For abdominal pain, you can apply a hot water bottle or heating pad to the lower back or lower abdomen. Use the heat source for at least 15 minutes, ideally during a rest break. Warm clothing around the lower back can also be soothing.
• For nausea, ginger in the form of tea or capsules can help. For example, drink freshly prepared ginger tea with lemon or take standardized ginger capsules in the morning before breakfast.
• For headaches, apply peppermint oil to the temples. Massage one to two drops in with circular movements, taking care to avoid contact with the eyes.
• To reduce inner restlessness, drink lavender tea or use lavender oil. A warm lavender bath or a drop of lavender oil on the pillow can be relaxing and help with sleep.
• Use chasteberry (vitex) to treat premenstrual complaints (premenstrual), such as breast tension or depressive symptoms. It helps stabilise progesterone levels, alleviates suffering, including before menopause, and can be a useful complement to non‑hormonal contraceptives.
• Track your symptoms using an app. Record your mood, pain, sleep, diet and medications daily to identify patterns and individual triggers.
• If bleeding is heavy, avoid painkillers containing aspirin (ASA). Instead, opt for ibuprofen or other suitable medications, but only after consulting a doctor to avoid side effects.
• For severe psychological symptoms, doctor‑supervised use of SSRIs in the second half of the menstrual cycle can be helpful. Discuss this option with a specialist. A targeted, time‑limited regimen can reduce side effects while remaining effective.

PMS is not an inevitable fate. Through self‑monitoring and appropriate measures, this phase can often be made considerably easier.