What are the 11 symptoms of PMDD

PMS - Premenstrual Syndrome

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What is Premenstrual Syndrome (PMS)?

PMS, premenstrual syndrome or "premenstrual tension" refers to physical and psychological complaints caused by the female hormone balance in the second half of the cycle (luteal phase).

Who does not know them, those annoying days before the days: the abdomen hurts and the breasts are tense. Have you ever wondered why you are so tormented by PMS symptoms? All of these disorders are summarized under menstrual cramps.

Here you can find out what the term premenstrual syndrome means, what its causes and which symptoms are associated with PMS. Do you already know about it? Then you can start right away with the PMS test and get the following tips.

What are the causes of premenstrual syndrome?

To date, there is no precise information as to why women have to suffer from the annoying complaints.

The most likely causes of PMS at a glance:
  • Hormone fluctuations in the second half of the cycle (luteal phase): The hormonal changes lead to an imbalance of estrogen and progesterone. Specifically, the release of estrogen is reduced, while at the same time the production of progesterone (a corpus luteum hormone) begins.
  • Falling serotonin level in the second cycle phase: The messenger substance serotonin also seems to play a special role: The serotonin level and the amount of endorphins in the body decrease in the second half of the cycle. Studies indicate that an interplay between the autonomic nervous system, the brain metabolism and the function of the ovaries trigger the symptoms. The exact metabolic factors are not yet known.2
  • Unfavorable lifestyle: The lifestyle - improper diet, too little exercise, stress - should also cause the severity of the complaints. These can be brought about or at least favored in particular by a lack of vitamins or stress.1, 3 The consumption of coffee, caffeine or nicotine, for example, can have a negative effect; the same applies to insomnia and lack of exercise.
  • Psychosocial conflicts: Other possible factors are psychosocial conflicts such as relationship problems and occupational overload as well as a family history of mental illnesses (e.g. depression). These factors are considered a risk factor for PMS.

Who does PMS affect?

It can be assumed that every second woman of sexually mature age experiences premenstrual symptoms in the second half of the month. These can vary in severity and be of a physical or psychological nature. Women over 35 are more likely to notice signs of PMS.1, 3 About 25 percent of those affected suffer from it. Around 5 percent feel this has a significant impact on their everyday life.

In the period before menopause, menstrual periods no longer take place regularly. This change is also accompanied by fluctuations in hormones. Less estrogen is produced and the progesterone level can drop. This can trigger or worsen PMS-like symptoms. However, it can also happen that they are reduced or even prevented during the menopause.3

What are the typical symptoms of PMS?

In premenstrual syndrome, a distinction is made between physical and psychological ailments. These can occur either individually or together.

The graphic gives you an overview of the most common symptoms of PMS. Many women have premenstrual syndrome, but symptoms can vary from woman to woman.

Physical and Psychological PMS Symptoms

Physical PMS symptoms

Many PMS symptoms are the same as for period pain: These include cramps in the lower abdomen, abdominal pain, nausea, back pain or irritability.

Other physical impairments include water retention in the tissue, which is also known as edema. The water retention makes the body appear "bloated", which is why you feel thicker than at the beginning of the month.

Often times, the water retention and hormonal fluctuations lead to weight gain. The cravings that occur can also contribute to the unwanted weight gain. In addition, painful tension or swelling of the breasts (mastodynia) can occur. Touching it then becomes uncomfortable.

In addition, many women feel very tired or exhausted before the period. Because of the tiredness, many of those affected would prefer to stay in bed all day. Nausea, diarrhea or constipation, bloating, circulatory problems, headaches or migraines can also occur. Increased sensitivity to stimuli such as light, smell, noise or touch can also be felt. Blemished skin often occurs during the PMS period.

Mental PMS Symptoms

In most cases, PMS is not only associated with physical, but also emotional complaints.

The mental symptoms of premenstrual syndrome include:

  • Mood swings
  • Depression, depressed moods
  • Listlessness
  • Hyperactivity, restlessness
  • Anxiety
  • Feeling overwhelmed and losing control
  • Aggressiveness, irritability
  • Loss of appetite, food cravings
  • crying or laughing for no reason
  • decreased self-esteem

Note: If you have psychological PMS symptoms, it does not mean that you are also mentally ill. The mental changes are - just like the physical ones - caused by the changed level of the hormones. A special form of PMS that is characterized by a depressed mood is premenstrual dysphoric disorder.

PMS symptoms: duration and onset

In the first 2 to 3 weeks of the menstrual cycle, most women feel comfortable in their skin, are positive and enjoy a high libido. PMS then becomes noticeable in the second half of the cycle.

When does PMS start?

PMS occurs almost exclusively during cycles with one ovulation. It is therefore counted among the physical symptoms of ovulation. The psychological and physical difficulties usually begin up to 14 days before the menstrual bleeding.

The effects are particularly pronounced about five days after the progesterone level has peaked. That is 4 to 10 days before the onset of menstruation. As soon as menstruation begins, the symptoms usually subside as the progesterone level drops. However, it can also happen that they last longer.2

Duration of the PMS phase

The duration of this phase varies from person to person. Symptoms can show up for the entire second half of the cycle and even get worse until the bleeding starts. However, they can also occur on individual days or over a shorter period of time.

Tracking of PMS symptoms

If you suspect you have PMS, you should document your symptoms. A cycle app like cyclotest mySense can help you better than a period calendar or a PMS diary. In the fertility tracker, in addition to all period details over several cycles, you can also note which symptoms occur when and how strong they are. This allows you to check whether the impairments are actually related to the menstrual cycle.

The entry in your cyclotest mySense app should ideally take place over a period of at least 2 to 3 months. You can then export your cycle curve including cycle data as a PDF. You can then take the values ​​with you when you next visit your gynecologist. So you always have your digital PMS diary with you.

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If you observe a worsening of your symptoms or you already have symptomatic pain in the first weeks of your monthly cycle, there could be more to it than “just PMS” and you should clarify this during a gynecological examination with a gynecologist.

PMS, pregnancy or endometriosis? - Diagnostics and delineation

PMS is a so-called exclusion diagnosis, i. This means that all other differential diagnoses must first be ruled out. In the case of PMS therapy, a possible corpus luteum disease should always be examined, as this is often the basis for PMS, which often manifests itself in painful complaints.

In individual cases, the symptoms represent signs of illness. Typical pelvic pain could indicate endometriosis if it does not occur during the PMS period. In the case of such a disease, in which the lining of the uterus grows outside the uterus, further symptoms usually occur, such as severe menstrual cramps or pain during sex. It could also be the onset of menopause (e.g. when hot flashes and sweats are associated with it) or, in exceptional cases, a thyroid disorder.3

Certain signs of PMS can also be mistaken for symptoms of early pregnancy.1 These first signs of pregnancy include, for example, breast tenderness, pulling in the lower abdomen, food cravings or mood swings. It can therefore happen that the signs of pregnancy are confused with those of premenstrual syndrome. Therefore, the question “PMS or pregnant?” Is entirely justified.

However, only the (non) absent menstrual bleeding, a urine test to determine pregnancy and / or a visit to the doctor can provide clarity. Many women state that they noticed a pregnancy immediately and were able to differentiate it from PMS. However, you need to be very familiar with your own body and its signals in order to be able to interpret them correctly.

Typically, the psychological symptoms in particular occur in PMS. In addition, the symptoms only occur in the second half of the cycle, the so-called luteal phase. So if you know your cycle, you can rule out PMS if the symptoms occur during the first half of your cycle.

Do you suffer from PMS? Take the PMS test!

Do you want to know if the symptoms that plague you could be PMS? Then take the test! However, please only consider the symptoms that appear in you shortly after ovulation and up to menstrual bleeding.

PMS test questions

  1. Do you suffer from mood swings before your period or are you irritable for no reason?
  2. Do you feel tired before your period, knocked out? and without energy?
  3. Do you often crave sweets before your days?
  4. Do you have more sensitive breasts than usual before your period?
  5. Do you suffer from a headache, backache or stomachache before your period?
  6. Are you more forgetful or less focused than usual?
  7. Do you feel restricted in your performance due to physical complaints or pain?
  8. Do you worry more often and are you more uncertain about decisions than usual?

PMS test: evaluation

  • You answered yes to 1 question or none - probably not a PMS
  • You answered yes to between 2 - 5 questions - slight tendency towards PMS

You are not unfamiliar with the symptoms described, but you can live with them because you don't struggle with it all the time. If you follow our tips, you can certainly reduce the effects even further.

  • You answered yes to more than 5 questions - you probably suffer from PMS

Do you recognize yourself 1: 1 and think that you are exactly described here? Then you obviously suffer from PMS. Small consolation: It's not just you. And there is help - read our tips or ask your gynecologist. Cheer up - the effects can be alleviated.

What to do at PMS - Therapy & Treatment

If you have PMS, there are several ways you can alleviate the effects and improve your condition. Since not all those affected suffer from the same symptoms, every woman has to try out which measures are best for her.

With a smart app, you can easily evaluate your cycle and determine when the critical cycle time begins - simply display the PMS time. In this way, you are warned, can take appropriate preventive measures in good time and at least adjust your daily planning a little accordingly. Observing the body's symptoms will also help you to better understand the processes and identify possible irregularities or diseases.

If you enter “sensitive” or “sad” under mood within your PMS time, a cloud in your cycle triangle will also draw your attention to the critical phase.

The smart minicomputer cyclotest myWay also shows you the PMS time. Affected women can thus better assess when the critical time is due and take preventive measures.

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What drugs help with PMS?

Pain can be treated with pain relievers. Patients can use medication to prevent water retention. Depression or depressive moods can be treated with mood-enhancing preparations such as antidepressants.

There is weak evidence that a combination pill (contains the progestin drospirenone and the low-dose hormone estrogen) can help against PMS. A doctor should of course decide after a thorough diagnosis whether the use of these hormones makes sense. But like all drugs and like every hormonal contraceptive, the pill or minipill has side effects.

And if pregnancy is desired, this method is ruled out anyway; therefore natural preparations are a welcome alternative to antidepressants, painkillers or other remedies. Herbal medications can then be used for PMS.

Chasteberry primarily relieves chest pain and can have a positive effect on the menstrual cycle. It is one of the best-researched medicinal plants and has established itself in the treatment of PMS. In one study, 79-85% of the participants were symptom-free or improved after three months of treatment with chasteberry.6

Diet in PMS

You can counteract a bad mood before your menstrual period with the right diet for PMS. You should avoid salty foods or chocolate, as these products are not only bad for your health if consumed in excess, but also because they can promote ailments. Regular meals are also thought to help reduce sweet cravings.7

Dairy products, processed foods, and red and fatty meats can also promote these ailments.

Personal experiences at PMS

Maggie from the blog We are the Ladies is an expert in contraception, cycle knowledge and many topics related to women's health. Here she has put together a few valuable tips against PMS for us:

Maggie from the blog We are the Ladies

  • Move:
    If you suffer from water retention in particular - also a common symptom before the days - physical activity will help remove the retained water more quickly. Exercise also improves blood circulation and can relieve cramps in the uterus.
  • Relax:
    Those who do not enjoy doing sports can resort to meditation and other relaxation techniques. For many, relaxation also simply means lying in the bathtub, listening to music, reading or watching a good movie.
  • Eat healthy:
    Your body now needs a lot of vitamins and minerals, so it is best to eat a lot of fruits and vegetables. Ideally, you should avoid (too much) alcohol, caffeine and sugar in the time before your bleeding. Herbal teas made from lady's mantle, lemon balm leaves and chamomile flowers can also be helpful.
  • Supplement food:
    Unfortunately, there are no scientific studies that prove which dietary supplements actually help against premenstrual syndrome. Nevertheless, a trend has emerged among women: Many swear by magnesium, St. John's wort, yam and folic acid. Vitamin B6 and calcium may also help. The best thing to do is talk to your doctor or ask at the pharmacy.
  • Sleep:
    Perhaps you are like me and you sleep worse than usual before your menstrual period. If possible, you should go to sleep again in the afternoon, if only to take a break and switch off.

Tips against PMS

Some women swear by doing moderate exercise during their PMS period. For example, you could do yoga because it combines exercise and relaxation. The body is supplied with better blood and the causes of abdominal cramps are combated.

For mood swings, upset and irritability, a. A lack of serotonin, the so-called happiness hormone, is responsible.This can be counteracted by plenty of daylight, sport, relaxation techniques or massages. It can be increased through diet with nuts, omega-3s, and even dark chocolate.

Premenstrual syndrome can be very challenging for a relationship. Some women feel their symptoms very strongly. Here it is important that your partner supports you physically, mentally and emotionally so that you both get through the days before the days.

What other women are interested in on this subject

Depending on the severity of the symptoms, the symptoms can be alleviated with hormonal agents, antidepressants, or herbal alternatives. Diet also plays an important role in combating the symptoms.
The symptoms are most severe about five days after the progesterone level peak. This is usually 4 to 10 days before the start of your menstrual period. We'll show you what you can do to alleviate the symptoms here.


  • 1 Kuhl, H. et al .: Sex Hormones and Psyche. Basics, symptoms, diseases, therapy. 1st edition. Stuttgart 2002.
  • 2 Diedrich, K. et al .: Gynecology and Obstetrics. 2nd Edition. Heidelberg 2007.
  • 3 Flemmer, A .: Treating premenstrual syndrome (PMS) naturally. Hanover 2012.
  • 4 Schuster, N .: feelings out of control. Pharmaceutical newspaper 28/2015
  • 5 Rohde, A .: PMS and PMDS - treatment options in the gynecologist's practice when psychological symptoms are in the foreground. Gyne 02/2019.
  • 6 Journal for Gynecological Endocrinology / Austria (Ed.): Monk's pepper for PMS and menstrual disorders: Pay attention to a sufficiently high dosage. o. O. 2019.
  • 7 Dean C, Steinberg SK, Sylvester WH. Medical management of premenstrual syndrome. Can Fam Physician. o.O. 1986.
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