Premenstrual syndrome and symptoms? PMS is not just about lower abdominal pain

Premenstrual syndrome and symptoms? PMS is not just about lower abdominal pain
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Premenstrual syndrome is a set of symptoms that affects up to 90% of women of childbearing age. It usually appears about 2 weeks before the actual menstruation. The intensity and variability of symptoms is individual for each woman.


Premenstrual syndrome was first described 70 years ago as the so-called "hormonal causes of premenstrual tension".

The name already implies that it is a tension caused by hormonal fluctuations before the onset of menstruation.
Since 1953, the current name for this syndrome has been premenstrual syndrome or PMS.

Premenstrual Syndrome (PMS) is a set of cyclical clinical manifestations on both a somatic and psychological level. It is closely related to the menstrual cycle.

  • Up to 90% of women suffer from mild symptoms of PMS.
    Some women have a cycle with no premenstrual symptoms or only mild symptoms.
  • For others, PMS may limit their daily activities and activities.
    Severe PMS affects 10% of women.
  • The most severe form of PMS is called premenstrual dysphoric disorder (PMDP). It manifests itself in significant mood disturbances.

The actual manifestations of PMS appear in the luteal phase of the menstrual cycle, i.e. after ovulation, 1 to 2 weeks before the start of menstruation.
On the other hand, they are alleviated in the follicular phase of the following menstrual cycle.

It is between these phases that relatively large hormonal changes occur, which contribute significantly to the intensity of specific PMS symptoms.

PMS symptoms are most pronounced in women around the age of 30.
They disappear completely with the last menstrual period, i.e. with the onset of menopause.

4 types of PMS

PMS has a wide range of symptoms.
Some women may have more somatic, others psychological or vegetative symptoms.

Based on the prevalence of specific symptoms, PMS is divided into basic types according to Guy Abraham, namely PMS-A type, PMS-C type, PMS-D type and PMS-H type.

4 types of PMS:

  1. Type PMS-A - The abbreviation A comes from the English word anxiety.
    • This type of PMS manifests itself mainly through psychological problems such as anxiety, inner tension, nervousness, irritability and other mood disorders.
    • These mood disorders are associated with insomnia, fatigue, impaired concentration, memory and general difficulty in functioning normally.
  2. Type PMS-C - The abbreviation C comes from the English word cravings, which means cravings, desires.
    • The main symptom of this type of PMS is an increased craving for sweets, but also an overall increased appetite, overeating.
    • Fatigue, headaches to migraines, dizziness are associated.
  3. Type PMS-D - The abbreviation D comes from the English word depression, meaning depression.
    • Depression or also bad mood, morbid sadness and tearfulness are at the forefront of the symptomatology of this type of PMS.
    • It also includes insomnia, exhaustion, fatigue, impaired concentration and memory, and increased sensitivity to light and sound.
    • A reduced appetite for sex is typical.
  4. PMS-H type - The abbreviation H comes from the English word hydration.
    • In this type of PMS, a woman's body experiences over-hydration, i.e. water retention.
    • The swelling is most pronounced or starts in the lower parts (fingers, ankles, shins, face).
    • The accumulated water causes weight gain, weight gain and also tenderness and tightness in the breasts.


The manifestations of PMS are probably due to hormonal changes during the different phases of menstruation.
However, this cannot be stated unequivocally because the causes have not yet been fully elucidated.

It is believed that after ovulation, approximately 2 weeks before menstrual bleeding, there is an abnormal estrogen/progesterone hormone ratio.

Specifically, estrogen levels decrease and, conversely, levels of progesterone and its bioactive metabolites (deoxycorticosterone, 5βpregnenolone) and prolactin increase.

Some women are particularly sensitive to these hormonal changes and therefore experience PMS.
Why only some patients are sensitive to these changes is unknown.

PMS is also related to biochemical changes in the central nervous system.

Risk factors and presumed causes of PMS also include smoking and obesity.

PMS is 2 times more common in female smokers and the symptoms are more pronounced.
In obese women, this risk is up to three times higher!

Read also the articles:
Smoking and its effect on health. Where did it all start?
What is the difference between overweight and obesity?


Individual manifestations vary in their variability and intensity from woman to woman.

While in one patient they are only very mild, in the other they are so pronounced that they limit her in normal daily activities.

Table with categorization of PMS symptoms:

Somatic manifestations Psychiatric manifestations
  • Headaches
  • Dizziness
  • fogginess in front of the eyes
  • feeling of fainting
  • collapse
  • pressure/tingling in the abdomen
  • abdominal cramps
  • diarrhoea/constipation
  • bloating
  • increased appetite
  • nausea
  • breast tightness/pressure
  • breast tenderness
  • muscle cramps
  • feeling of heavy legs
  • swelling of the lower limbs

Premenstrual Dysphoric Disorder (PMDP) is the most severe form of premenstrual syndrome.
It affects approximately 8% of women of childbearing age.

PMDP can be characterised as a set of marked psychotic symptoms (affect disturbance) with concomitant autonomic dysfunction and somatic problems.

The vast majority of experts believe that premenstrual dysphoric disorder is related to regularly occurring PMS and is therefore an intense form of it.
However, some researchers do not consider PMS and PMDP to be interrelated conditions, but rather the result of changes in brain chemistry.

Table categorising the manifestations of PMDP

Somatic manifestations Mental manifestations
  • Headaches
  • Dizziness
  • blurred vision in front of the eyes
  • feeling of fainting
  • collapse
  • pressure/tingling in the lower abdomen
  • cramps in the abdomen
  • diarrhea/constipation
  • bloating
  • increased appetite
  • nausea
  • breast tightness/pressure
  • breast tenderness
  • muscle cramps
  • feeling of heavy legs
  • swelling of the lower limbs
  • tension
  • anxiety
  • nervousness
  • irritability
  • depressed to melancholic mood
  • thoughts about the insignificance of oneself and the world
  • thoughts of suicide
  • anger
  • aggressiveness
  • loss of interest in everyday activities
  • isolation/seeking solitude
  • insomnia
  • lack of energy
  • impaired concentration
  • memory impairment
  • motor retardation
  • inability to control behaviour


There is no test to diagnose PMS.
Diagnosis is based on recurrent symptoms in the period before menstruation.

The gynaecologist only ascertains the symptoms of PMS and their severity based on personal history from the patient.

During the gynaecological examination, the most important thing is to exclude other pathological origins of the difficulties (endometriosis, cancer, inflammatory diseases...).
Only if other diseases are excluded, it is possible to talk about PMS.

Criteria for the diagnosis of PMS

  • Symptoms typical of PMS
  • symptoms appear 7 to 10 days before menstruation
  • symptoms disappear about 4 days after the start of menstruation
  • recurrent PMS symptomatology for at least 3 months in a row


Premenstrual syndrome usually occurs in younger girls and women around the age of 30.

It affects up to 90% of women. The vast majority have only a mild form. Therefore, some women may not even know they have it.

In a particular patient, it has essentially the same course and intensity.
It varies from patient to patient, especially in the variability of the intensity of the symptoms.

PMS usually appears two weeks before the actual menstruation, probably due to hormonal imbalance.
It always disappears with the onset of menstrual bleeding.

  • The onset of PMS begins with the onset of ovulation. Ovulation occurs around day 14 of the menstrual cycle, about 2 weeks before the actual bleeding. During this period, there is a gradual fluctuation of hormones, so symptoms are initially milder. There is usually mild abdominal pain, mild abdominal pressure, irritability and nervousness of moderate intensity.
  • After the initial phase, symptoms become more intense due to a greater hormonal imbalance, and eventually other symptoms of PMS are associated. Pain is more pronounced. Often, significant mood disturbances and other somatic and psychological symptoms occur.
  • With the onset of menstruation, the symptoms gradually disappear. Their complete disappearance occurs around the 4th day of menstruation.


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Interesting resources

  • - Differential diagnosis of menstrual cycle disorders
  • - Premenstrual dysphoric disorder
  • - OVERVIEW OF THE TREATMENT OF PREMENSTRUCTIVE SYNDROME AND PREMENSTRUCTIVE DYSPHORIC DISORDER, Igor Lazar, Alexander Ostró, II. gynaecological and obstetric clinic of the Faculty of Medicine of the University of Košice and the Faculty of Medicine of the University of Košice.
  • - Hormone replacement therapy, pros and cons in 2014