Why do some women get 'bad' PMS and others don’t?

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Bloating, cramping, mood swings and food cravings are just some of the things women experience before their monthly period. Some women, however, experience bad symptoms, while others are virtually unaffected.

Mood changeability

Premenstrual syndrome (PMS) symptoms can occur as early as two weeks before one's period. It affects an average of 75% of women, although only between 20 and 40% experience extreme discomfort.

Fluctuating hormones are behind PMS, primarily oestrogen and progesterone. These can in turn affect brain chemicals, such as serotonin, which could explain mood changeability.

Other causes include:

- Inadequate intake of vitamins and minerals

- A diet high in salt, which can cause water retention and a bloated feeling

- Excessive intake of alcohol and caffeine, which can negatively affect mood and energy

Read: Is your PMS causing your food cravings?

Symptoms of PMS

The symptoms of PMS can vary from woman to woman, and up to 150 physical and behavioural symptoms are associated with PMS. The most common symptoms include:

- Irritability

- Bloating

- Mood swings

- Anxiety

- Depressed mood

- Fatigue

- Appetite changes

- Water retention

- Breast tenderness

Menstrual cramps are also experienced by many women, involving lower abdominal pain and cramps and sharp or aching back pain. However, while some pain is common, excessive pain is not, and is known as dysmenorrhoea.


Dysmenorrhoea falls into two types, primary and secondary, depending on the cause.

Primary dysmenorrhoea occurs around the time that menstruation begins, and the pain isn’t related to a specific problem with the uterus or other pelvic organs. In this case the prostaglandin hormones are involved.

Read: 12 quick PMS tips

Secondary dysmenorrhoea develops later life and is related to problems in the uterus or other pelvic organs, and is linked to:

- Endometriosis

- Fibroids

- Intrauterine device (IUD) made of copper

- Pelvic inflammatory disease

- Sexually transmitted infections

- Stress and anxiety

Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (PMDD) affects a small percentage of women and has symptoms similar to PMS, but far more severe, and usually with accompanying depression. Symptoms commonly occur during the week before your period and stop after one's period starts.

The most important criteria for a PMDD diagnosis are mood symptoms. Women with a history of depression are at risk for PMDD, and treatment generally involves antidepressants and birth control medications.  

Read: Severe PMS lasts longer than thought

You must have five or more symptoms to be diagnosed with PMDD. The most common symptoms include:

- Overwhelming feelings of sadness or despair

- Severe anxiety and panic attacks

- Mood swings and rollercoaster emotions

- Extreme irritability or anger

- Lack of concentration

- Binge eating and cravings

- Bloating

- Breast tenderness

- Headaches

- Joint or muscle pain

Easing PMS

Unless you suffer from dysmenorrhoea or PMDD, there are things you can do to alleviate the symptoms of PMS:

- Get regular exercise.

- Eat a healthy diet rich in fruits, vegetables, and whole grains.

- Avoid salt, caffeine and alcohol, especially when you're having PMS symptoms.

- Sleep at least 8 hours a night.

- Ease stress with some yoga, a massage, or relaxation therapy.

- Don’t smoke.

Read more:

Causes of PMS

Symptoms of PMS

PMS treatment


Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD); Centre for Young Womens Health; Updated 17 May 2016.; http://youngwomenshealth.org/2013/10/31/pms/

Premenstrual syndrome; HealthWomen.org; Last date updated: Tue 2016-04-12; http://www.healthywomen.org/condition/premenstrual-syndrome

Premenstrual syndrome (PMS) fact sheet’; WomensHealth.gov;  reviewed by: Songhai Barclift, M.D. Lieutenant Commander HIV/AIDS Bureau Health Resources and Services Administration U.S. Department of Health and Human Services; http://www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.html

Painful menstrual periods; US National Library of Medicine; Updated by: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team https://medlineplus.gov/ency/article/003150.htm?session=qDLjRwjjhHoPu8KqBJKmQwGGNX

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