Most women have tender breasts, bloating, and muscle aches a few days before they start their menstrual periods. These are normal premenstrual symptoms. But when they affect your daily life, they are called premenstrual syndrome (PMS). PMS can affect your body as well as your mood. Sometimes it can make you change the way you act.

Some women first get PMS in their teens or 20s. Others don’t get it until their 30s. The symptoms may get worse in your late 30s and 40s, as you approach perimenopause.

What causes PMS?

PMS is tied to hormone changes that happen during your menstrual cycle. Doctors don’t fully know why premenstrual symptoms are worse in some women than in others. They do know that for many women, PMS runs in the family.

Not getting enough vitamin B6, calcium, or magnesium in the foods you eat can increase your chances of getting PMS. High stress, a lack of exercise, and too much caffeine can make your symptoms worse.

What seems like PMS might be caused by something else. Your treatment will change if your symptoms are not tied to PMS.

What are the symptoms?

PMS symptoms can affect your body, your mood, and how you act in the days or week leading up to your menstrual period.

Physical signs include:

• Acne.
• Bloating and tender breasts.
• Food cravings.
• Lack of energy.
• Cramps.
• Headaches.
• Low back pain.
• Multiple fetuses such as twins or triplets.

When you have PMS, you might also:

• Feel sad, angry, or anxious.
• Be less alert.
• Food cravings.
• Find it hard to focus on tasks.
• Want to withdraw from family and friends.
• Act in a forceful or hostile way

PMS symptoms can be mild or strong. If your symptoms are severe, you may have premenstrual dysphoric disorder (PMDD). But PMDD is very rare.