Somewhere between five days and two weeks before your period starts, you may experience symptoms that let you know it's coming. These symptoms are known as premenstrual syndrome (PMS).
More than 90 percent of people experience PMS to some degree. For most, PMS symptoms are mild, but others have symptoms severe enough to disrupt daily activities.
If you have PMS symptoms that interfere with your ability to work, go to school, or enjoy your day, talk to your doctor.
PMS usually dissipates within a few days of menstruation. Here are the 10 most common signs that let you know your period is about to start.
Abdominal, or menstrual, cramps are also called primary dysmenorrhea. They're a common PMS symptom.
Abdominal cramps can start in the days leading up to your period and last for several days or longer after it starts. The cramps may range in severity from dull, minor aches to extreme pain that stops you from participating in your usual activities.
Menstrual cramps are felt in the lower abdomen. The achy, cramping feeling may also radiate out toward your lower back and upper thighs.
Uterine contractions cause menstrual cramps. These contractions help shed the inner lining of the uterus (endometrium) when a pregnancy doesn't take place.
The production of hormone-like lipids called prostaglandins trigger these contractions. Although these lipids cause inflammation, they also help regulate ovulation and menstruation.
Some people experience their most intense cramping while their menstrual flow is at its heaviest.
Certain health conditions can make cramps more severe. Those include:
- endometriosis
- cervical stenosis
- adenomyosis
- pelvic inflammatory disease
- fibroids
Cramps associated with these types of conditions are known as secondary dysmenorrhea.
Around half of all women notice an increase in acne about a week before their period starts.
Menstruation-related breakouts often erupt on the chin and jawline but can appear anywhere on the face, back, or other areas of the body. These breakouts occur from the natural hormonal changes associated with the female reproductive cycle.
If no pregnancy takes place when you ovulate, estrogen and progesterone levels decline and androgens, such as testosterone, increase slightly. The androgens in your system stimulate production of sebum, an oil produced by the skin's sebaceous glands.
When too much sebum is produced, acne breakouts can result. Period-related acne often dissipates near the end of menstruation or shortly afterward when estrogen and progesterone levels start to climb.
During the first half of the menstrual cycle (which starts on the first day of your period) estrogen levels start to increase. This stimulates growth of the milk ducts in your breasts.
Progesterone levels start to rise in the middle of your cycle around ovulation. This makes the mammary glands in your breasts enlarge and swell. These changes cause your breasts to get an achy, swollen feeling right before or during your period.
This symptom may be slight for some. Others find their breasts become very heavy or lumpy, causing extreme discomfort.
As your period approaches, your body shifts gears from getting ready to sustain a pregnancy to getting ready to menstruate. Hormonal levels plummet, and fatigue is often the result. Changes in mood may also make you feel tired.
On top of all that, some women have trouble sleeping during this part of their menstrual cycle. Lack of sleep can exacerbate daytime fatigue.
If your tummy feels heavy or it feels like you can't get your jeans to zip up a few days before your period, you may have PMS bloating. Changes in estrogen and progesterone levels can cause your body to retain more water and salt than usual. That results in a bloated feeling.
The scale may also go up a pound or two, but PMS bloating isn't actually weight gain. Many people get relief from this symptom two to three days after their period starts. Often the worst bloating occurs on the first day of their cycle.
Since your bowels are sensitive to hormonal changes, you may experience alterations in your typical bathroom habits before and during your period.
The prostaglandins that cause uterine contractions to occur can also cause contractions to take place in the bowels. You may find you have more frequent bowel movements during menstruation. You might also experience:
- diarrhea
- nausea
- gassiness
- constipation
Since hormones are responsible for generating the pain response, it's understandable that fluctuating hormonal levels might cause headaches and migraines to occur.
Serotonin is a neurotransmitter that often sets off migraines and headaches. Estrogen may increase serotonin levels and the number of serotonin receptors in the brain at certain points during the menstrual cycle. The interplay between estrogen and serotonin may cause migraines to occur in those who are prone to them.
More than 50 percent of women who get migraines report an association between the occurrence of migraines and their period. Migraines might occur before, during, or immediately following menstruation.
Some also experience migraines at the time of ovulation. A clinic-based study reported in Neurology found that migraines were 1.7 times more likely to occur one to two days before menstruation and 2.5 times more likely to occur during the first three days of menstruation in this population.
The emotional symptoms of PMS can be more severe than the physical ones for some people. You may experience:
- mood swings
- depression
- irritability
- anxiety
If you feel like you're on an emotional roller coaster or feel sadder or crankier than usual, fluctuating estrogen and progesterone levels may be to blame.
Estrogen can affect production of serotonin and feel-good endorphins in the brain, decreasing feelings of well-being and increasing depression and irritability.
For some, progesterone may have a calming effect. When progesterone levels are low, this effect may be diminished. Periods of crying for no reason and emotional hypersensitivity can result.
The uterine and abdominal contractions triggered by the release of prostaglandins may also cause muscle contractions to occur in the lower back.
An aching or pulling feeling may result. Some may have significant lower back pain during their period. Others experience mild discomfort or a nagging feeling in their back.
PMS symptoms like cramps, headache, and mood swings can all affect sleep, making it harder to fall or stay asleep. Your body temperature may also make it harder for you to catch those much needed Zzz's.
Core body temperature rises about half a degree after ovulation and stays high until you start to menstruate or shortly after. That may not sound like much, but cooler body temps are associated with better sleep. That half a degree can impair your ability to rest comfortably.
The range and severity of PMS symptoms you have will determine the types of treatments that are best for you.
If you have severe symptoms, you may have premenstrual dysphoric disorder (PMDD). This is a more severe form of PMS. A doctor's care may be the best treatment.
If you have severe migraines, you may also benefit from seeing your doctor. Underlying health issues, such as irritable bowel syndrome or endometriosis, might also make PMS more severe, requiring a doctor's help.
In some cases of PMS, your doctor might prescribe birth control pills to regulate your hormones. Birth control pills contain varying levels of synthetic types of estrogen and progesterone.
Birth control pills stop your body from naturally ovulating by delivering consistent and steady levels of hormones for three weeks. This is followed by one week of placebo pills, or pills that don't have hormones. When you take the placebo pills, your hormonal levels fall so you can menstruate.
Because birth control pills provide a steady level of hormones, your body may not experience the plummeting lows or escalating highs that can cause PMS symptoms to occur.
You can often relieve mild PMS symptoms at home, too. Here are some tips to consider:
- Reduce your salt intake to relieve bloating.
- Take over-the-counter pain relievers, such as ibuprofen (Advil) or acetaminophen (Tylenol).
- Use a hot-water bottle or warm heating pad on your abdomen to relieve cramps.
- Exercise moderately to improve mood and potentially reduce cramping.
- Eat small, frequent meals so your blood sugar remains stable. Low blood sugar can trigger a poor mood.
- Meditate or do yoga to promote feelings of well-being.
- Take calcium supplements. A study reported in Obstetrics & Gynecology Science found that calcium supplements were helpful for regulating depression, anxiety, and water retention.
It's very common to experience mild symptoms of PMS in the days leading up to your period. You can often find relief with at-home remedies.
But if your symptoms are severe enough to affect your ability to enjoy life or participate in your usual daily activities, talk to your doctor.