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St. Petersburg General Hospital

Symptoms of Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is characterized by physical and emotional symptoms that occur in a regular cycle beginning 1-2 weeks before the onset of menstrual flow and improve when menstrual bleeding starts. These symptoms can be extremely distressing and may include:

  • Irritability
  • Mood swings
  • Anxiety
  • Depression
  • Low self-esteem
  • Difficulty concentrating
  • Sleep problems
  • Appetite changes (sugar and/or salt cravings; overeating)
  • Weight gain
  • Fatigue
  • Bloating
  • Headache
  • Breast swelling and tenderness
  • Palpitations
  • Lightheadedness
  • Gastrointestinal upset
  • Muscle pain

Although the symptoms of PMS may vary, the most common complaints are:

  • Irritability
  • Backache
  • Muscle pain
  • Bloating

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5 or more of the following symptoms must be present for a diagnosis of PMDD:

  • Physical symptoms, such as breast tenderness, bloating, and joint pain
  • Severe depression, possibly with suicidal thoughts
  • Anxiety, tension, or panic attacks
  • Severe irritability and anger
  • Mood swings
  • Difficulty concentrating
  • Fatigue
  • Teariness
  • Difficulty sleeping
  • Feeling out of control
  • Lack of interest in relationships, activities
  • Food cravings or binges

Revision Information

  • Reviewer: James Cornell, MD
  • Update Date: 08/18/2016 -
  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Association; 2013.

  • Premenstrual syndrome. EBSCO DynaMed website. Available at: Updated June 9, 2016. Accessed August 18, 2016.

  • Premenstrual syndrome (PMS). Family Doctor—American Academy of Family Physicians website. Available at: Updated April 2014. Accessed August 18, 2016.

  • Premenstrual syndrome (PMS) fact sheet. Office on Women's Health website. Available at: Updated December 23, 2014. Accessed August 18, 2016.