Premenstrual syndrome

The purpose of this information leaflet is to provide patients with information about the nature of premenstrual syndrome, its diagnosis and treatment options.

What is premenstrual syndrome?

Premenstrual syndrome or PMS is a set of symptoms that occur in the second half of the menstrual cycle and affect a woman's ability to cope with everyday life. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Symptoms usually begin 1-2 weeks before menstruation and subside with the onset of menstruation. Mild PMS is very common and can occur in up to 75% of women.

Common symptoms

PMS symptoms vary widely. The following are some of the most common ones.

• Physical symptoms: fatigue, breast tenderness and/or swelling, bloating, headache, weight gain, changes in appetite, worsening of acne, joint and muscle pain

• Emotional and behavioural symptoms: irritability, anxiety or low mood, mood swings, crying easily, sleep disturbances, tension, difficulty concentrating, decreased interest in usual activities.

Causes

The exact cause of PMS is unknown. It is believed to be related to normal hormonal changes during the menstrual cycle, which affect many tissues in the body, including serotonin levels in the brain.

Diagnosis

PMS is diagnosed based on symptoms. Your doctor may ask you to keep a symptom diary for at least 2-3 menstrual cycles to see a connection between your cycle and your symptoms. If necessary, blood tests are performed to rule out other conditions (e.g. thyroid disease, anaemia). The presence of depression and anxiety disorders is also assessed.

Treatment and self-help

The goal of treatment is to reduce symptoms and improve quality of life.

Lifestyle recommendations

Lifestyle changes are often enough to improve well-being and coping.

• Consistent physical activity – regular physical activity helps reduce stress and improves mood.

• Getting enough sleep and following a regular sleep schedule.

• A varied and healthy diet – prioritise whole grains, fruits and vegetables, reduce salt, coffee and alcohol intake.

• Less stress – relaxation exercises and breathing techniques can be helpful.

Herbal preparations: chaste tree (Vitex agnus-castus) may provide relief for mild PMS. Herbal preparations can be purchased at a pharmacy without a prescription and a pharmacist can help you choose.

Medications

• Antidepressants: selective serotonin reuptake inhibitors or SSRIs are very effective for emotional symptoms.

• Hormonal contraceptives are effective in relieving PMS symptoms.

A treatment is selected on an individual basis during a consultation with a family doctor or gynaecologist, depending on the severity of the symptoms and based on the patient's preferences and needs, combining different methods.

ITK1313

Approved by the decision of the Medical and Nursing Care Quality Commission of Aktsiaselts Ida-Tallinna Keskhaigla on 22. April 2026 (Protocol No. 2.2-8/7-26)