Premenstrual

Premenstrual refers to the time before menstruation and is commonly used in relation to premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). PMS describes recurring physical, emotional, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve with the onset of menses.

Symptoms can include mood swings, irritability, sadness, anxiety, fatigue, sleep disturbance, bloating, breast tenderness, headaches, and cramps. Most people experience mild symptoms, but PMDD involves more severe symptoms that cause distress or impairment and is diagnosed when at least five symptoms are present in the week before menses, with at least one being mood-related.

Timing is typically in the luteal phase, roughly two weeks before the start of menses, with symptoms improving or disappearing with the onset of menstruation. Prevalence estimates vary by definition and population: PMS is reported by a substantial share of reproductive-age people, while PMDD is thought to affect about 1-5% of people who menstruate, with a larger portion experiencing milder PMS symptoms.

Causes are not fully understood but involve hormonal fluctuations that interact with brain chemistry, particularly neurotransmitters such as serotonin. Risk factors may include a personal or family history of mood disorders, stress, and certain medical conditions.

Diagnosis is usually based on tracking symptoms over at least two menstrual cycles to confirm a consistent, cyclical pattern and to rule out other causes.

Management ranges from lifestyle and self-care measures—regular exercise, adequate sleep, balanced nutrition, and reducing caffeine or alcohol intake—to pharmacologic treatments. NSAIDs or diuretics can help with cramps and bloating. For PMDD, selective serotonin reuptake inhibitors are commonly used, and hormonal therapies such as combined oral contraceptives or GnRH agonists may be considered in some cases. Treatment is individualized based on symptom pattern and severity.