Premenstrual syndrome (PMS) involves symptoms that occur in relation to the menstrual cycle and which interfere with the woman's life. The symptoms usually begin 5 to 11 days before the start of menstruation. Symptoms usually stop when menstruation begins, or shortly thereafter.

See also premenstrual dysphoric disorder (PMDD).

An exact cause of PMS has not been identified. However, it may be related to social, cultural, biological, and psychological factors. PMS can occur with apparently normal ovarian function (regular ovulatory cycles).

PMS is estimated to affect up to 75% of women during their childbearing years.

It occurs more often in women between their late 20s and early 40s, those with at least one child, those with a family history of a major depression disorder, or women with a past medical history of either postpartum depression or an affective mood disorder.

As many as 50-60% of women with severe PMS have an underlying psychiatric disorder.

A wide range of physical or emotional symptoms have been associated with PMS. By definition, such symptoms must occur during the second half of the menstrual cycle (14 days or more after the first day of the menstrual period) and be absent for about 7 days after a menstrual period ends (during the first half of the menstrual cycle).

The most common symptoms include:

• Headache
• Swelling of ankles, feet, and hands
• Backache
• Abdominal cramps or heaviness
• Abdominal pain
• Abdominal fullness, feeling gaseous
• Muscle spasms
• Breast tenderness
• Weight gain
• Recurrent cold sores
• Acne flare-ups
• Nausea
• Bloating
• Constipation or diarrhea
• Decreased coordination
• Food cravings
• Less tolerance for noises and lights
• Painful menstruation

Other symptoms include:

• Anxiety or panic
• Confusion
• Difficulty concentrating
• Forgetfulness
• Poor judgment
• Depression
• Irritability, hostility, or aggressive behavior
• Increased guilt feelings
• Fatigue
• Slow, sluggish, lethargic movement
• Decreased self-image
• Sex drive changes, loss of sex drive
• Paranoia or increased fears
• Low self-esteem

There are no physical examination findings or lab tests specific to the diagnosis of PMS. It is important that a complete history, physical examination (including pelvic exam), and in some instances a psychiatric evaluation be conducted to rule out other potential causes for symptoms that may be attributed to PMS.

A symptom calendar can help women identify the most troublesome symptoms and to confirm the diagnosis of PMS.