PMS Symptoms — 5 Ways to Know What’s Normal and What’s Not

May 20, 2024

woman with premenstrual syndrome

Menstruation is not a topic of casual conversation at dinner parties or children’s sporting events. But if you tell someone you’re “PMSing” (experiencing premenstrual syndrome), they know exactly what you’re talking about — and they should because nearly 90% of women in the United States feel uncomfortable before their period.

Breton Barrier, MD
Breton Barrier, MD

Somehow, though, we never dive deeper into those period-related symptoms. PMS is a broad term that can mean different things to different people. And since the symptoms usually differ from person to person, it’s easy to accept PMS as your monthly time to feel cruddy. But at what point is “feeling cruddy” not normal?

To find out, we consulted MU Health Care OB/GYN, Dr. Breton Barrier. “Premenstrual syndrome, also called premenstrual dysphoria (PMD) by medical providers, describes a cluster of symptoms,” he says. “Symptoms vary, but what is most important is how they affect your quality of life. Symptoms that disrupt your life are not normal, and there are ways we can help.”

Dr. Barrier shares five signs that your PMS is normal — and how to know if it’s not.

1. Normal: You Have Some Period-Related Symptoms

Your body undergoes many changes each month as it prepares to build up and then shed your uterine lining. “PMS is your body’s reaction to changes associated with menstruation,” Dr. Barrier says. “And it’s normal to react to those changes physically and emotionally.”

Common PMS symptoms include:

  • Bloating
  • Cramping and backache
  • Food cravings
  • Headache
  • Lethargy (feeling tired)
  • Mood swings
  • Trouble concentrating

Not Normal: Having Five or More Severe PMS Symptoms Every Month

If you are having five or more symptoms each month and they hit you hard, you may be experiencing premenstrual dysphoric disorder (PMDD). PMDD is an abnormal variation of PMS in which the symptoms meet specific criteria:

  • Timing, with symptoms that arrive and disappear perfectly in sync with your menstrual cycle
  • Severity, specifically involving intense and debilitating mental health symptoms
  • Quantity, meaning you experience five or more severe symptoms each month

“It is common to have a few different PMS symptoms,” Dr. Barrier says. “But when you have more than five, and they are severe, PMDD should be considered. PMDD symptoms are typically disruptive to your daily living.”

2. Normal: Your Menstrual Symptoms Coordinate With Your Monthly Cycle

If your menstrual cycle is somewhat regular, your symptoms should be regular, too. Period symptoms are typically caused by changes in hormone levels, particularly progesterone. Progesterone levels peak with ovulation and then drop during the second half of your cycle. The fluctuations affect you physically.

“The timing of PMS is pretty remarkable,” Dr. Barrier says. “Everything can be going well for three weeks, but as a period approaches, symptoms appear like clockwork. Once a period is over, things return to normal until it happens again next cycle.”

Not Normal: Having PMS Symptoms All Month Long

If you’re having symptoms such as bloating, irritability or pelvic pain throughout the month, you may have an underlying condition related to your:

  • Gastrointestinal (GI) function, such as irritable bowel syndrome (IBS) or reflux
  • Gynecologic health, such as endometriosis or fibroids
  • Mental health, such as anxiety or depression
  • Thyroid, such as hyperthyroidism

“When you have an underlying condition, your menstrual cycle can make those symptoms worse, so it may feel like the condition’s symptoms line up with your period,” Dr. Barrier says. “But if those symptoms never truly go away between periods, you should consult your primary care provider.”

3. Normal: You Have Mild Digestive Distress Before and During Your Period

Research shows that more than 70% of people may experience at least one GI symptom before or during their period — abdominal pain and diarrhea are the most common. Those GI symptoms make sense since changes in progesterone levels can affect digestion.

“Higher levels of progesterone — which happen midway through your cycle — can cause the bowels to slow down. As a result, you can eventually feel bloated or constipated,” Dr. Barrier says.

As you near and start your period, progesterone levels drop and the intestines reawaken, causing what’s known as “period poop” — an increase in bowel movements and possibly diarrhea. But that digestive distress should be mild and closely connected to your cycle.

Not Normal: Having Issues “Down There” All Month That Are Worse Before Your Period

If you have bowel or bladder issues all the time, and also have pain with sex, you may have underlying pelvic floor dysfunction.

“Dysfunctional pelvic floor muscles can cause a partial obstruction (among other things), which makes it hard to relieve yourself,” Dr. Barrier says. “But when you throw the slow-down effect of progesterone on top of it, severe bloating and other GI issues can trigger pelvic floor tension that worsens with your period. That tension can lead to pain with sex and to abnormal bowel and bladder function that continues throughout the cycle.”

If you have ongoing digestive issues or pelvic pain that get worse with your period, your health care provider can evaluate your symptoms and refer you to a GI specialist if needed. Treatment for pelvic floor dysfunction, such as pelvic floor therapy, can help eliminate your pain and digestive distress.

4. Normal: You Have Manageable Mood Swings During Your Period

Some emotional responses to your menstrual cycle are normal. Your physical symptoms can lead to less sleep, food cravings or skipping your workout — all of which affect mental health.

“Mild physical and emotional symptoms are generally considered normal,” Dr. Barrier says. “If you know you get agitated or weepy with your period, ask your loved ones to understand and to give you grace for a few days.”

Trying to eat well, sleep enough and move your body can help. Those proactive steps and over-the-counter pain relief should make emotional swings manageable.

Not Normal: Monthly Emotional Swings That Are Debilitating

Emotional symptoms that are unmanageable and affect your life and relationships are concerning, says Dr. Barrier. Even if your mood changes aren’t severe enough to qualify as PMDD, they can still affect your daily life.

“If you have an injury or medical issue that distracts or impairs you, you will probably seek help,” Dr. Barrier says. “Period-related mood issues shouldn’t be any different. The solution may be as simple as stabilizing your hormones with a contraceptive pill or taking a mild antidepressant.”

5. Normal: Your PMS Symptoms Change With Life Changes

Most women live with monthly periods for almost four decades. During that time, you’ll experience life changes that can affect your periods and period symptoms.
“PMS can affect someone throughout their reproductive life,” Dr. Barrier says. “When you add life stressors and age-related hormonal changes, it can worsen.”

Life changes that may affect your period and PMS include:

  • Having children: Hormonal changes associated with having children can change PMS symptoms.
  • Managing a family: Taking care of young children can lead to sleep deprivation, neglected self-care and mental health issues. These issues can make PMS symptoms feel worse.
  • Perimenopause: As you near menopause (the end of menstruation), periods can change in duration and heaviness. Those changes can alter PMS symptoms.

Not Normal: PMS Symptoms Change Suddenly With No Known Cause

Discuss any dramatic change in period symptoms with your doctor — especially if you haven’t experienced any life changes recently.

“No matter what symptoms you experience, you need to seek help from a provider if they interfere with your relationships, your occupation or your mental health,” Dr. Barrier says. “Period symptoms should never interfere with your healthy relationships or prevent you from participating in important activities.”

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