Debunking menstrual misconceptions: What is premenstrual syndrome (PMS)?

‘It’s her time of the month’. 

A classic degrading trope that screams sexism and gender norms at their finest, premenstrual syndrome (PMS) has faced its fair share of stigma. 

The typical image of a premenstrual woman is a tearful, bloated, angry dragon—who may, or may not be, on her way home to eat an entire tub of chocolate ice cream. 

Although symptoms like high flying emotions, bloating, breast tenderness and period headaches (4), can all be typical for some people who experience PMS, it’s definitely not true of all people with cycles (some people actually experience positive shifts just before their bleed). 

There is a lot of contesting scientific evidence and research around PMS—but what is simply a (sexist) social construct and what are the actual biological facts?

As always, we’re here to answer all of these questions (and then some). But first, let’s get familiar with the scientific definitions...

What is PMS?

PMS is basically a whole loaaaad of both physical and psychological symptoms that crop up during the week before our periods and then usually clear up a few days into our bleeds (4). 

It’s thought that about 47% of people with cycles suffer with PMS regularly (2) and up to a whopping 75% will experience PMS at some point in their lives (5,6) (that’s a lot of ice cream that’s going to be flying off the shelves). 

So what are PMS symptoms? There are thought to be over 150 known PMS symptoms, from minor niggles to completely debilitating emotional and physical changes (1). 

Common PMS symptoms include:

1. Sore breasts 

2. Headaches and/or migraines 

3. Bloating 

4. Abdominal cramps (period pain)

5. Bodily aches and pains 

6. Depression and anxiety 

7. Mood swings 

8. Diarrhea and constipation

9. Nausea

10. Food cravings and appetite changes 

11. Weight gain 

12. Fatigue 

13. Acne

We could go on (and on)….

It’s important to remember here that whilst many people with cycles will suffer from a handful of symptoms before their bleeds every now and then, this doesn’t necessarily mean they fit the clinical criteria for a diagnosis of PMS. 

To be clinically diagnosed with PMS you have to experience at least one symptom 5 days before your bleeding starts, which then clears up by about day 3 of your period, and for this to happen for 3 consecutive cycles (5).

Okay, so what causes PMS?

During the week just before our periods (known as the late luteal phase of the menstrual cycle), both our estrogen and progesterone levels plummet (7). It’s this sudden lack of female sex hormones that are thought to be responsible for most PMS symptoms (7).

The specific hormonal causes vary from symptom to symptom (check out the articles linked in the list above for the deets on each), but mood changes, in particular, are thought to be linked to lower levels of estrogen and serotonin, and their hallmark feel-good factors, premenstrually (8). 

Debunking common PMS myths

Okay, so now we’re familiar with the current scientific standpoint, let’s take a look at some of the most common misconceptions about PMS:

1. Myth: Everyone with a cycle experiences PMS
   Although PMS symptoms are very common (experienced by around 47% of people with cycles)(2), definitely not everyone with a cycle will experience PMS nor fit the criteria for a clinical diagnosis of PMS.

1. Myth: PMS is just mood swings
   No, no, no and no. As we’ve seen, there are thought to be up to a whacking 150 symptoms of PMS that span the physiological and psychological. It is true that the majority of people who experience severe PMS are more likely to seek help for mood changes (9), but stigma and social constructs have created this idea of the ‘neurotic’ premenstrual woman. In fact, lots of the bad mood symptoms or feelings of being low may actually be secondary symptoms to other painful physical symptoms—because who’s in a good mood when they’ve got cramps?
   
   

2. Myth: People with cycles make PMS up to blame their bad moods on
   Yawn, do we even need to comment on this one? 

1. Myth: PMS is normal and you need to just get on with it
   A big, hefty no. Although common, being in pain is definitely not ‘normal’, nor should anyone just put up with it. There are many different treatments for the individual symptoms of PMS (again check out the detailed articles on each of the symptoms above) and these range from getting a good night's sleep to hormonal birth control. 

PMS vs PMDD

So we couldn’t write an article on PMS without mentioning it’s sinister older sister—premenstrual dysphoric disorder (PMDD). PMDD is a more severe form of PMS and tends to present in much more debilitating psychological symptoms (9). 

Only about 5% of people with cycles of childbearing age have (or have been diagnosed with) PMDD (9). It’s often commonly misdiagnosed as bipolar disorder, and there is some debate about whether PMDD should be classed as a mental health disorder or not.

In order to be diagnosed with PMDD your symptoms need to appear a week before your period, clear up a week after and meet a diagnostic criteria.  

Here for your hormonal hangups

So there you have it, everything PMSing.

Remember, we’re here to support you with any hormonally-related issues you might be experiencing and help you figure out what the four-letter-word is going on with your hormones. 

Come say hi.

Written by

Annalisa Hayes (she/her)

Copywriter at Tuune, Annalisa has worked for various pioneering health-tech startups and healthcare companies with purpose-led missions. Driven by empowering people to take control of their health, she helps make the science behind hormones accessible for our community, so they can make clued-up choices about their healthcare.

Medically reviewed by

Dr. Arushee Prasad, GP, MBBS (she/her)

Dr Arushee Prasad is a GP for NHS England with an MBBS in Medicine and Surgery, and an MRCGP from the Royal College of General Practitioners. Passionate about digital health and algorithmic medicine, Arushee was previously an Algorithmic Medical Doctor for Docly.

Written by

Hannah Durrant (she/her)

Hannah is a Biomedical Content Writer at Tuune, with a BSc in Biomedical Sciences from University College London. She is passionate about bringing together the scientific community and the general public by disseminating modern science via digestible, engaging and thought-provoking content.