Physical and emotional changes before a period are very common, but their intensity varies a lot. For some women they are mild discomforts. For others, they affect work, relationships and well-being. Understanding your pattern is the first step to caring for it safely.
In short
- Symptoms appear in the phase before the period and ease soon after it starts.
- PMS can be mild, moderate to severe (premenstrual syndrome) or severe (premenstrual dysphoric disorder, PMDD).
- Food, sleep, exercise and stress management are the foundation of care.
- Supplements may help in some cases, but evidence is limited and there are risks: use them only with guidance.
01
The types of PMS
The classification considers how many symptoms appear, how intense they are and how much they interfere with daily life. Symptoms usually occur in the week before the period and go away soon after it starts.
Mild PMS
A few mild symptoms that do not disrupt daily life. It is the most common form.
Moderate to severe PMS (premenstrual syndrome)
At least five moderate to severe symptoms, including at least one mood or anxiety symptom, with impairment in some area of life, such as work, study or relationships.
Severe PMS: premenstrual dysphoric disorder (PMDD)
The most intense form, in which at least one of the core symptoms (anger or irritability, anxiety or tension, easy crying and sensitivity to rejection, depressed mood or hopelessness) is severe, with a major functional impact.
Screening tools, such as the PSST (Premenstrual Symptoms Screening Tool), help identify the pattern but do not make the diagnosis. Confirmation depends on clinical evaluation and, generally, on daily symptom tracking for at least two cycles.
02
Most common symptoms
Emotional and behavioral
Irritability, anger, anxiety, sadness, easy crying, mood swings, difficulty concentrating, tiredness, changes in sleep and appetite, and strong cravings for sweets.
Physical
Bloating and a feeling of fluid retention, breast tenderness and pain, headache, muscle and joint aches, cramps and changes in bowel function.
What defines PMS is the pattern: symptoms appear at the same time of the cycle, ease with the period and are not present throughout the month.
03
What else may be behind it
Symptoms like PMS can also have other causes. Medical evaluation is important, especially when they are intense or persist throughout the cycle:
- Depression and anxiety, which can worsen before the period but exist all month.
- Thyroid changes and iron-deficiency anemia.
- Endometriosis and adenomyosis, when there are severe cramps, pain during sex or heavier bleeding.
- Polycystic ovary syndrome and other hormonal changes.
- Perimenopause, especially after age 40.
- Use of birth control and other hormonal medicines.
Very intense cramps that disrupt daily life are not normal and should be investigated. Not all pain is just a consequence of PMS.
04
Food and habits that help
Regular meals and quality carbohydrates
Skipping meals worsens irritability and sugar cravings. Choose whole grains, fruit, legumes and protein at each meal, to keep energy and mood steadier.
Less sugar, caffeine, alcohol and salt
Reducing these in the week before the period may lower anxiety, bloating and irritability in some women.
Nutrients from food
Calcium (dairy or fortified alternatives, kale, sardines), magnesium (seeds, nuts, leafy greens, oats), vitamin B6 (meat, fish, banana, potato), omega-3 (fish) and vitamin D, through food and, when advised, sun exposure.
Movement
Regular exercise, even a walk, has good evidence for reducing physical and emotional symptoms.
Sleep and stress
Sleeping well and using relaxation techniques, such as breathing, meditation and yoga, help mood and pain. Cognitive behavioral therapy can also help.
05
Supplements: what the evidence shows
Many supplements have been studied in PMS. Results vary, and the choice depends on symptoms, tests, diet and medicines in use.
Calcium and vitamin D
Calcium is one of those with the best evidence for reducing physical and mood symptoms. Vitamin D goes with calcium, and the level should be assessed.
Magnesium and vitamin B6
They may help with some symptoms, such as bloating and mood, but evidence is modest. Vitamin B6 in high doses for a long time can cause neuropathy.
For cramps
Ginger, vitamin E, omega-3 and curcumin have studies with favorable results, generally small. Very intense cramps call for investigating causes such as endometriosis.
Vitex agnus-castus
An herbal remedy with favorable studies for PMS symptoms, but it can interfere with hormonal treatments and is not recommended in pregnancy or breastfeeding.
Breast pain and tenderness
Evening primrose and borage oil are often used, but evidence is weak, and they may interact with other medicines.
Depressed mood, anxiety and irritability
Deficiency of nutrients such as iron, zinc, magnesium and B vitamins (B6, B9 and B12) can influence mood and should be investigated with tests. L-theanine is used for relaxation, with limited evidence.
Tryptophan, 5-HTP and SAMe: caution
These are precursors or modulators of serotonin. In people taking antidepressants, they can cause dangerous interactions, such as serotonin syndrome, and should not be started without medical guidance.
Supplements do not replace treatment. Doses, combinations and duration should be individualized, based on tests and clinical evaluation, and avoided in pregnancy and when trying to conceive without guidance.
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When treatment needs to go further
In moderate to severe premenstrual syndrome and in PMDD, treatment may include cognitive behavioral therapy, antidepressants taken on certain days of the cycle or continuously, and selected hormonal contraceptives. The decision is medical, and nutrition is a support to care, never a substitute.
Understand your cycle and care for it
In the consultation, I assess your symptom pattern, tests, diet, sleep and medicines to organize an individualized plan, with supplements only when indicated, in partnership with your gynecologist or your doctor.
Dra. Daniely Catharino TooleyClinical, functional and orthomolecular nutritionist · CRN3/6794
References (4)+
- Yonkers & Simoni. Premenstrual disorders. Am J Obstet Gynecol, 2018.
- American College of Obstetricians and Gynecologists. Premenstrual Syndrome. Practice Bulletin No. 15, 2000.
- Thys-Jacobs et al. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol, 1998.
- Steiner et al. The Premenstrual Symptoms Screening Tool (PSST) for clinicians. Arch Womens Ment Health, 2003.
Educational content for adults. This guidance does not replace an individual consultation, diagnosis or treatment.