Premenstrual syndrome: What are the possible symptoms?

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PantherMedia / Craig Robinson

Premenstrual syndrome (PMS) is a set of physical and psychological symptoms that start anywhere from a few days to two weeks before a woman gets her monthly period.

PMS can have various non-specific symptoms such as abdominal (lower belly) pain, headaches, mood swings and sleep problems. "Non-specific" means that these symptoms can also be caused by other problems or diseases.

Most girls and women have mild PMS every now and then in the time leading up to their period. But it hardly affects their lives. About 20 to 40% of all girls and women have several more severe PMS-related problems that clearly affect them.

These may include:

Physical symptoms

  • Discomfort in the lower belly (abdomen)
  • Feeling bloated
  • Digestive problems
  • Swollen breasts
  • Skin blemishes, acne
  • Water retention in the legs


  • Abdominal pain
  • Sore breasts
  • Joint pain
  • Back pain
  • Muscle pain
  • Headache

Metabolism-related symptoms

Poor concentration and mood swings

  • Difficulty concentrating
  • Forgetfulness
  • Confusion
  • Feeling down, sadness
  • Emotional tension
  • Wanting to be alone
  • Anxiety
  • Mood swings
  • Being emotionally very sensitive or irritable
  • Anger, aggression
  • Feeling like you've lost control of your emotions and your body

Exhaustion or restlessness

  • Lack of energy, becoming exhausted quickly
  • Lack of motivation, listlessness
  • Lack of interest in daily activities
  • Feeling agitated or restless
  • Nervous tension

To find out whether there is actually a link between these problems and your menstrual cycle, it can be helpful to keep a diary – ideally for at least two to three months. This can also be useful when preparing for a doctor’s appointment.

Beckermann MJ. Das prämenstruelle Syndrom - ein Konstrukt? In: Beckermann MJ, Perl FM (Ed). Frauen-Heilkunde und Geburts-Hilfe. Volume 1. Basel: Schwabe; 2004. p. 502-527.

Busse JW, Montori VM, Krasnik C, Patelis-Siotis I, Guyatt GH. Psychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials. Psychother Psychosom 2009; 78(1): 6-15.

Dennerstein L, Lehert P, Heinemann K. Global epidemiological study of variation of premenstrual symptoms with age and sociodemographic factors. Menopause Int 2011; 17(3): 96-101.

Dennerstein L, Lehert P, Heinemann K. Global study of women's experiences of premenstrual symptoms and their effects on daily life. Menopause Int 2011; 17(3): 88-95.

Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid 2015: 0806.

Mooney-Somers J, Perz J, Ussher JM. A complex negotiation: women's experiences of naming and not naming premenstrual distress in couple relationships. Women Health 2008; 47(3): 57-77.

O'Brien PM, Bäckström T, Brown C, Dennerstein L, Endicott J, Epperson CN et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14(1): 13-21.

Sveinsdóttir H, Lundman B, Norberg A. Whose voice? Whose experiences? Women's qualitative accounts of general and private discussion of premenstrual syndrome. Scand J Caring Sci 2002; 16(4): 414-423.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on December 30, 2020
Next planned update: 2023


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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