Contraceptive Pearl: Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms that begin after ovulation and resolve within the first 4 days of menstruation. Over 90% of women experience PMS at some point during their reproductive years, and approximately 5% of women experience the more severe premenstrual dysphoric disorder (PMDD). PMS symptoms include irritability, fatigue, insomnia, depression, anxiety, crying spells, mood swings, poor concentration, social withdrawal, decreased libido, tender breasts, bloating, constipation, diarrhea, and headache.

PMS is diagnosed when the following criteria are met: symptoms are present 5 days prior to menstruation for 3 menstrual cycles in a row; symptoms resolve within 4 days after menstruation starts; and symptoms interfere with daily activities. PMS can imitate or overlap with depression, anxiety, chronic fatigue syndrome, irritable bowel syndrome, and thyroid disease.

Mild-to-moderate PMS can be relieved with aerobic exercise, meditation, yoga, adequate sleep, and dietary changes. Calcium, Vitamin B6, omega 3 fatty acids, chasteberry, and acupuncture may help to relieve PMS symptoms.

Hormonal contraceptives may improve PMS symptoms, possibly by preventing ovulation. SSRIs and cognitive behavioral therapy may improve mood symptoms for patients with premenstrual dysphoric disorder.



Skipping Periods on Birth Control



American College of Obstetricians & Gynecologists. (2015). Premenstrual Syndrome. Retrieved from 

Hofmeister S, Bodden S. Premenstrual Syndrom and Premenstrual Dysphoric Disorder. American Family Physician. 2016;94(3):236-240.

Lanza di Scalea T, Pearlstein T. Premenstrual Dysphoric Disorder. Med Clin North Am. 2019;103(4):613-628. doi: 10.1016/j.mcna.2019.02.007.

U.S. Department of Health & Human Services Office on Women’s Health. (2018). Premenstrual Syndrome. Retrieved from



The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.

Contraceptive Pearls

This monthly clinical e-newsletter highlights evidence-based best practice for contraceptive care

Latest Blog Post

View More Posts on Topic