Approach: healthy diet, exercise, relaxation, and sleep; supplements as a supplement; medication (SSRIs) only in consultation with a doctor for severe symptoms.
What is PMS and how can you reduce symptoms?
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Leesduur: 9 min
Personally, I understand the idea of the Red Tent, that old tradition where women retreated for a while to rest and shut themselves off from the outside world.
In the days before my period, I sometimes have exactly that feeling. I just want to curl up under a blanket, everyone is suddenly annoying, and I can cry over the smallest things.
That's not so strange. During this phase of your cycle, the hormones estrogen and progesterone fluctuate significantly, and you'll notice that. For most women, this is a temporary dip that disappears on its own once menstruation begins.
But for some women, the symptoms are more severe: days of sadness, tension, or irritability that truly impact daily life. This is called premenstrual syndrome (PMS) .
In this article you will read what PMS is, why it occurs and how you can reduce the symptoms in a natural way.
PMS causes physical and emotional symptoms before menstruation; with PMDD, mood symptoms are more severe and affect daily functioning.
Diagnosis: Symptoms before menstruation, disappear at the onset, and then a symptom-free week; a diary helps distinguish PMS from pregnancy or menopause.
Table of contents
What exactly is PMS? The difference between PMS and PMDD The symptoms of PMS How do you know you have PMS? PMS or pregnancy: How do you recognize the difference? PMS symptoms during menopause How does PMS develop? 1. Hormonal fluctuations 2. Lifestyle factors What you can do about PMS symptoms: 5 tips 1. Make sure you get enough tryptophan in your diet 2. Take good care of your intestines 3. Exercise every day and go outside more often 4. Make sure you relax daily and get enough sleep 5. Supplement this with a supplement In balance with your cycle When medication can be useful
What exactly is PMS?
PMS stands for premenstrual syndrome, a combination of physical and emotional symptoms that occur in the days to two weeks before menstruation . These symptoms usually disappear once menstruation begins.
The difference between PMS and PMDD
Many women notice changes in their body and mood in the days leading up to their period. This is part of the premenstrual spectrum .
PMS and PMDD fall within that spectrum. The difference lies mainly in the severity of the symptoms and how much impact they have on your daily life:
- PMS (premenstrual syndrome) - The symptoms are unpleasant and can affect your day, but you can usually still carry out your activities.
- PMDD (premenstrual dysphoric disorder) - This is the more severe variant of this spectrum. The symptoms resemble PMS, but the mood symptoms are much more intense and prominent. With PMDD, the symptoms are so severe that work, school, relationships, or self-care are significantly impaired.
Research shows that PMDD affects approximately 3% of women (worldwide). (1)
The symptoms of PMS
Symptoms of premenstrual syndrome vary from person to person, but common ones include:
- Irritability or becoming angry quickly
- Mood swings
- Tender or painful breasts
- A bloated feeling
- Headache or stomach ache
- Fatigue or insomnia
- Sadness or crying spells for no apparent reason
Irritability is one of the most characteristic symptoms of PMS, according to doctors.
How do you know you have PMS?
Many women recognize the symptoms of PMS, but that does not automatically mean that it is actually premenstrual syndrome.
According to the Dutch Journal of Medicine (NTvG), it is important to look at the pattern of your complaints , not just the symptoms themselves.
You can only speak of PMS if:
- The symptoms return in the second half of your cycle (the luteal phase),
- They disappear once your period starts, and
- At least one complaint-free week follows.
That's why doctors recommend keeping a symptom or mood diary for at least two cycles . This way, you can see if there's a recurring pattern.
See your doctor if your symptoms recur every month, are weighing heavily on your daily life, or are causing you emotional imbalance. They can help you rule out PMS, PMDD, or another cause.
Did you know that research shows that in over 40% of women who think they have PMS, the pattern ultimately does not match PMS? Self-diagnosis is therefore not always reliable. (2)
PMS or pregnancy: How do you tell the difference?
Some PMS symptoms closely resemble early pregnancy symptoms, such as breast tenderness, fatigue, and mood swings. However, there are subtle differences:
With PMS, the symptoms disappear as soon as menstruation starts, while they persist or increase during pregnancy.
Are you unsure? Then I recommend taking a pregnancy test.
PMS complaints during menopause
You may also experience symptoms that resemble PMS during menopause.
Hormonal fluctuations (particularly the declining and irregular release of estrogen and progesterone) can cause mood swings, fatigue, irritability and bloating.
During perimenopause (the years before your last menstrual period), symptoms often become more intense and less predictable, which can feel like PMS even though your cycle is already changing.
Because the distinction is not always clear, it helps to keep a complaint and cycle diary .
This is how you can see if complaints:
- Especially in the luteal phase (suitable for PMS); or
- Occurring more often or separately from your cycle (may be related to menopause)
How does PMS develop?
PMS is caused by natural hormonal fluctuations combined with certain lifestyle factors .
How sensitive your body and brain react to these fluctuations ultimately determines how much PMS you experience.
1. Hormonal fluctuations
It's mainly about the hormonal fluctuations in the second half of your menstrual cycle , also known as the luteal phase . This is the period between ovulation and menstruation.
In the latter part of this phase (the days before your period) , estrogen and progesterone levels drop , and you will notice this not only physically but also mentally.
Estrogen affects the functioning of serotonin , an important messenger substance that regulates your mood, sleep and appetite.
During PMS, the brain reacts more sensitively to these hormonal changes, which can temporarily throw serotonin activity off balance. This may explain why you tend to feel more depressed, tense, or irritable just before your period.
2. Lifestyle factors
But your lifestyle also plays a role. Consider factors such as:
- Stress
- Not enough sleep
- Little exercise
- Nutrient deficiencies
- Smoking
- Drinking a lot of coffee (more than 4–5 cups per day) (3)(4)(5)
What you can do about PMS symptoms: 5 tips
By paying attention to nutrition , exercise , sleep , and relaxation , you can support serotonin processes and help your body cope with hormonal fluctuations. This can alleviate PMS symptoms.
Small adjustments can make a noticeable difference. Here are my 5 tips for you:
1. Get enough tryptophan in your diet
Your brain produces serotonin from the amino acid tryptophan . It is converted in the brain into 5-HTP and then into serotonin .
Vitamin B6 is required as a cofactor for the final step in this process . Other nutrients (such as iron ) also play a role in this pathway.
So make sure you get enough of these nutrients.
You can also get tryptophan directly from your diet. Because it's an essential amino acid, you get it primarily from protein-rich foods, such as:
Animal sources
- Poultry (turkey, chicken)
- Fatty fish (salmon, tuna, mackerel) and shellfish
- Eggs
- Dairy (curd, yogurt, hard cheeses such as Parmesan)
- Beef and lamb
Plant sources
- Soy products (tofu, tempeh, edamame)
- Legumes (lentils, chickpeas, black beans)
- Nuts and peanuts (almonds, walnuts, peanuts)
- Seeds and kernels (pumpkin seeds, sesame/halva, chia, sunflower seeds)
- Whole grains (oats, quinoa, buckwheat, whole wheat bread/pasta)
2. Take good care of your intestines
Only 5–10% of all serotonin in your body is located in the brain. This serotonin regulates your mood, sleep, appetite, and concentration, among other things.
The remaining 90–95% of serotonin is made in the intestinal wall , by special cells (enterochromaffin cells).
This gut serotonin does not go to your brain but regulates local processes in your intestines , including the motility of your intestines and communication with your immune system.
And these processes are supported by healthy gut flora , which can indirectly influence your mood. This is partly because bacteria process fiber, creating a favorable environment for tryptophan .
Therefore, eat fiber-rich food every day:
- Vegetables
- Fruit
- Legumes
- Whole grain products
And also limit highly processed foods that can disrupt your intestinal balance.
3. Exercise every day and go outside more often
Research shows that exercise affects several processes in the brain, including the serotonin system and the release of endorphins.
Even a daily walk , a bike ride or a yoga session can help reduce tension and make you feel more energetic.
Sunlight also helps produce vitamin D, which contributes to healthy serotonin levels.
Therefore, try to be outside for at least 15 to 30 minutes every day , especially in the dark months.
4. Make sure you relax and get enough sleep every day
Long-term stress increases the stress hormone cortisol, which can suppress serotonin production. Relaxation is therefore not a luxury, but a necessity.
Small daily habits can already help. What works well for me are:
- Breathing exercises
- Meditation
- A short walk (without a phone) before bed
- A warm bath
Sleep also has a direct impact on serotonin. Poor or short nights lead to lower serotonin levels and more mood swings. Try to maintain regular bedtimes and limit screen time in the evening.
5. Supplement this with a supplement
Sometimes you don't get everything you need from your diet, especially during busy or stressful periods. A supplement can be helpful. It complements good food, sleep, and rest (not replaces them).
An example is 5-HTP , the direct precursor to serotonin .
Research on PMS/PMDD is still developing, so see what works for you and be aware of any reactions. If you're taking medication, are pregnant, or breastfeeding, consult an expert (such as your doctor).
In balance with your cycle
Your body works in cycles. By better understanding your hormones, you can adjust your diet, exercise, and rest to go with your cycle instead of fighting it. It's been a huge change for me personally.
Especially in the second half of your cycle, you can often achieve a lot by giving your body some extra attention : Healthy nutrition, exercise and relaxation form the basis for this.
Some people also consider taking a supplement, but consider this a complement to, not a replacement for, a healthy lifestyle. Whether a supplement is beneficial for you depends on your personal situation.
I therefore advise you to seek advice from an expert.
When medication can be useful
In some cases, a doctor may prescribe antidepressants (SSRIs) to help stabilize serotonin levels. This is usually done for women who experience severe PMS or PMDD , where mood swings, anxiety, or low mood significantly impact daily life.
SSRIs (selective serotonin reuptake inhibitors) ensure that more serotonin remains available in the brain, which gradually stabilizes your mood.
They are often used temporarily or around the second half of the cycle, precisely during the phase when symptoms are most severe.
Good to know : These medications aren't a one-size-fits-all solution, but they can be valuable when lifestyle changes, diet, and supplements don't provide sufficient relief. You should always make the decision together with your doctor, who will consider the severity of your symptoms, your general health, and any other medications you're taking.
Ebrina van der Bijl
Ebrina is a nutritionist with a deep commitment to healthy eating and a sustainable lifestyle, based in beautiful Portugal. Her passion for natural and organic products is at the heart of her work. With a background in Nutrition & Dietetics and experience in product development and writing, she translates complex scientific information into practical advice for a balanced lifestyle.
Sources used
- Reilly, T. J., Patel, S., Unachukwu, I. C., Knox, C., Wilson, C. A., Craig, M. C., Schmalenberger, K. M., Eisenlohr-Moul, T. A., & Cullen, A. E. (2024). The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. Journal Of Affective Disorders, 349, 534–540. https://doi.org/10.1016/j.jad.2024.01.066
- Van Der Leij, F., Schultz, W.C.W., Van de Wiel, H., & Van Leeuwen, J.H.S. (2010, July 23). The premenstrual syndrome. NTVG. https://www.ntvg.nl/artikelen/het-premenstrueel-syndroom
- Seedhom, A.E., Mohammed, E.S., & Mahfouz, E.M. (2013). Life Style Factors Associated with Premenstrual Syndrome among El-Minia University Students, Egypt. ISRN Public Health, 2013, 1–6. https://doi.org/10.1155/2013/617123
- AlQuaiz, A., Albugami, M., Kazi, A., Alshobaili, F., Habib, F., & Gold, E. B. (2022). Dietary, Psychological and Lifestyle Factors Associated with Premenstrual Symptoms. International Journal Of Women's Health, Volume 14, 1709–1722. https://doi.org/10.2147/ijwh.s387259
- Eshetu, N., Abebe, H., Fikadu, E., Getaye, S., Jemal, S., Geze, S., Mesfin, Y., Abebe, S., Tsega, D., Tefera, B., & Tesfaye, W. (2022). Premenstrual syndrome, coping mechanisms and associated factors among Wolkite university female regular students, Ethiopia, 2021. BMC Women S Health, 22(1). https://doi.org/10.1186/s12905-022-01658-5
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