The second half of the cycle can be very hard on us, both physically and mentally. In fact, premenstrual syndrome is one of the most common conditions associated to our menstrual cycle. But it can be hard to distinguish from other disorders –– despite more than 200 known symptoms [1], identified in the WHO's official catalogue of diseases,  the specific symptoms or severity of PMS are not mentioned [2].

Depending on which estimates are drawn from different sources, anywhere from 5 to 8 percent [3] or even up to 90 percent [4] of women of childbearing age will suffer mild to severe PMS pain. Particularly severe cases are referred to as PMDS (premenstrual dysphoric syndrome), which the WHO lists as a distinct disorder [5].

When does PMS occur?

PMS can hit any time between ovulation and menstruation –– that is, during the second phase of the cycle. This is also called the luteal phase.

Whether symptoms appear just a few days or anywhere up to 2 weeks before the start of each period will vary from person to person. In the latter case, the symptoms can intensify just before the onset of menstruation. 

PMS occurs before a period starts and usually improves right as things start flowing (pun intended). 

This is not to be confused with other similar symptoms that can occur especially during menstruation - such as colicky abdominal pain or nausea . In addition, existing mental and psychological disorders may worsen during the second half of the cycle [6]. But it’s important to determine whether it’s PMS or other conditions at work here.

To find out if your symptoms occur only in the second half of the cycle, you can run a cycle diary for 2 to 3 months. This can be done on mobile phones, for example, with Clue or Flo and for iOS devices in particular, with the preinstalled health app.

PMS: What are the symptoms?

Some of the common possible symptoms in the days (or weeks) before the period include:

Physical symptoms

• Headaches
• Sensitive and sore breasts
• Back pain
• Abdominal pain
• Stomach bloating

Mental symptoms

• Irritability
• Anger
• Dysphoria
• Crying
• Mood swings

Possible behavioural changes

• Exhaustion
• Insomnia
• Dizziness
• Change in sex drive
• Cravings

How to know it's PMS?

Generally speaking, a woman suffering from PMS has “only” some of these symptoms. 

A PMS diagnosis requires confirming that these symptoms:

1. Are  present in the last 5 days before the period for at least 3 cycles in a row
2. end within 4 days after a period starts,
3. interfere with everyday life [7].

Possible causes

The jury is still out on what actually causes PMS. Since similar levels of sex hormones were found in women with and without PMS, it’s been suggested that some women are simply more sensitive to cycle-related changes in sex hormones [3].

Since serotonin also seems to play a role here, taking serotonin reuptake inhibitors is a common treatment for more severe PMS symptoms [3].  

In addition, there is evidence that environmental factors such as stress or alcohol consumption can trigger PMS symptoms.

And last, but not least, since women today tend to have fewer children today than in the past, we’re probably simply dealing with our menstruation – and thus PMS – more often.

Pre-period mood swings: Not as clear as you thought?

A meta-analysis published in 2012 that examined 47 studies on PMS found no association of psychological impairment with the menstrual cycle [8]. This finding clearly contradicts a large body of other sources.

One possible explanation is that we may be socialised to be more aware of symptoms that arise in the second half of a menstrual cycle. The idea that we women are “unpredictable” and ill-tempered in the days before our period starts persistently continues to colour our view of things.

Yet according to a survey carried out by a menstrual cycle tracking app, many women report experiencing positive effects during the second half of their cycle [9] – which clearly doesn’t fit the societally driven image of the cranky pre-menstrual woman. 

Every woman is different

The difficult differentiation from other diseases such as depression, and possible interactions with these ensure that premenstrual syndrome is often difficult to determine.

One thing’s for sure, however: What we experience psychologically and physically during our cycle is as individual as we are. We should therefore recognize that while some women may experience the second half of their cycle in more positive or neutral terms, for others, PMS can heavily interfere with their quality of life.

How to deal with PMS?

If you experience PMS symptoms more frequently, try tracking how you feel over a period of a few months. Whether you use the notes app on your phone, a cycle app, or an old-school notebook or diary, it's best to make a ritual of jotting down how you're feeling physically and emotionally when you get up in the morning or before you go to bed. This can help your doctor with a diagnosis and, at the same time, provide information that can help determine if there’s something else causing your symptoms.

If you’re feeling discomfort in the second half of your cycle, getting a massage with The Hug can also bring relief to  the body and soul. Developed by medical professionals, the herbal formula includes hemp extract and St. John’s wort to help you take relaxation to the next level and embrace your full self. If you want to read more tips on how to deal with PMS, check out this article.

Sources:

[1] Premenstrual Syndrome

https://www.aafp.org/afp/2003/0415/p1743.html

[2] Premenstrual tension syndrome

https: //icd.who. int / browse11 / lm / s # / http: //id.who.int/icd/entity/375471908

[3] Premenstrual syndrome

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118460/

[4] The premenstrual syndrome revisited

https://pubmed.ncbi.nlm.nih.gov/16916572/

[5] Premenstrual dysphoric disorder

https: //icd.who .int / browse11 / lm / s # http% 3a% 2f% 2fid.who.int% 2ficd% 2fentity% 2f1526774088

[6] Diagnosis and treatment of premenstrual dysphoric disorder: an update

https://pubmed.ncbi.nlm.nih.gov/11195269/

[7] Premenstrual Syndrome (PMS): How is PMS diagnosed?

https://www.acog.org / womens-health / faqs / premenstrual syndrome-utm_source = redirect & amp;? utm_medium = web & amp; utm_campaign = int code

[8] Mood and the Menstrual Cycle: A Review of Prospective Data Studies

http://einsteinlab.ca/wp -content / uploads / 2016/07/7-Mood-and-the-menstrual-cycle.pdf

[9] Positive symptoms of PMS

https://helloclue.com/articles/cycle-az/positive-symptoms-pms