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Written by The Hormona Team
Have you ever found yourself tearing up at a commercial or craving chocolate with a sudden, intense fury right before your period? If that sounds familiar, you’re definitely not the only one. Premenstrual syndrome (PMS) affects up to 30% of women worldwide and brings a real tidal wave of physical and emotional shifts to their daily lives. But even though almost every woman is familiar with that monthly change in her body, did you know that most of these experiences aren’t actually considered PMS from a medical perspective? Doctors generally view standard premenstrual changes as a perfectly normal part of the menstrual cycle. True PMS is actually a specific clinical syndrome that goes quite a bit further than those everyday hormonal fluctuations, but for the sake of simplicity, we will use the term “PMS” in this article to cover both [1].
The concept of dividing premenstrual syndrome into five distinct types originated in the late 1970s and 1980s, primarily popularized by Dr. Guy Abraham [2]. This framework was created to help women pinpoint their most dominant symptoms and map them to targeted lifestyle and nutritional interventions. However, the modern medical community does not use or recognize these subcategories in clinical practice today [3]. Let’s discuss them in detail!
- PMS was divided into five main types: anxiety, cravings, depression, hyperhydration, and pain. However, this classification is currently outdated.
- Fluctuating levels of estrogen and progesterone during the second half of your cycle are the primary drivers behind the premenstrual changes.
- Identifying your specific PMS type may help you target your symptoms with lifestyle adjustments, nutrition, and wellness strategies.
What is PMS and why does it happen?
As we described earlier, premenstrual syndrome is a combination of physical and emotional symptoms that typically appear about five days before your period and resolve shortly after it starts. While research has defined various symptom patterns, subcategories, and even different timing variations over the years, these distinct classifications and timelines are not utilized in current medical practice. These changes occur because your body is reacting to a natural drop in estrogen and progesterone levels. These hormones interact with brain chemicals like serotonin, which directly influences your mood and energy levels.
The 5 types of PMS
Historically, the approach to premenstrual changes was broken down into five distinct symptom categories based on how they affected the body and mind. While you might still find that you relate strongly to just one specific pattern or notice a mix of symptoms across a few different areas, remember that this structured classification system is no longer used.
PMS-A: Anxiety
If you feel completely on edge before your period, you might be experiencing PMS-A. This type is characterized by nervous energy, mood swings, irritability, and a general feeling of being overwhelmed. Prioritizing calm activities can make a big difference during this phase. Practice deep breathing exercises or take a warm bath to help your muscles and mind relax.
PMS-C: Cravings
Have you ever wondered why you suddenly want to eat everything in the kitchen right before your period? PMS-C is all about increased appetite, specific food cravings, and fatigue. Women with this type typically crave sweet or salty foods, particularly carbohydrates and chocolate. While it’s fine to honor your cravings in moderation, eating complex carbohydrates like oats or sweet potatoes provides a steadier energy release. Keep your blood sugar stable by eating smaller, regular meals throughout the day.
PMS-D: Depression
If you find yourself crying over a commercial or feeling unusually sad before your period, you might have PMS-D. This type brings on low mood, tearfulness, and a strong desire to pull away from social activities. These emotional shifts may happen because serotonin levels drop sharply as your estrogen falls a few days before your period.
Serotonin is a key neurotransmitter that regulates mood, sleep, and emotional stability, acting as a chemical messenger in the brain to promote feelings of wellbeing. When its levels plunge alongside estrogen, it directly disrupts this signaling network, leaving the brain more vulnerable to sudden irritability, anxiety, and low mood. It’s completely understandable to feel overwhelmed when your mood dips so unexpectedly. Gentle movement like walking outside can help boost your endorphins naturally and lift your spirits.
PMS-H: Hyperhydration
PMS-H simply means your body is holding onto extra water. You might notice breast tenderness, abdominal bloating, or mild swelling in your hands and feet. This can happen because hormonal fluctuations often alter fluid balance. Dealing with swollen fingers or tight clothes is incredibly frustrating. Try reducing your salt intake a week before your period and drinking enough pure water to help flush out those excess fluids. A good rule of thumb is to check your urine: if it is light yellow and you are not thirsty, you are consuming enough water.
PMS-P: Pain
Women with PMS-P experience noticeable physical discomfort in the days leading up to their period. This type includes lower back aches, headaches, joint pain, and early cramping. These symptoms may be driven by prostaglandins, which are hormone-like chemicals that can cause your uterine muscles to contract. Managing your daily routine when your body aches takes a lot of resilience. Placing a hot water bottle on your lower abdomen can help soothe muscle tension and bring you some comfort. An NSAID can also help manage the pain if you need extra relief.
How to track and identify your PMS type
While identifying a specific “type” of PMS can be a fun way to better understand your body, the most important goal is finding comfort through healthy lifestyle adjustments. You might notice your symptoms lean toward a specific category or discover a unique mix of emotional and physical changes. Keeping a detailed log of how you feel each day takes the guesswork out of your cycle and helps you spot these patterns over two or three months. Using the Hormona app to track your symptoms gives you clear insights into your unique rhythm, making it easier to manage your well-being. Ultimately, the best approach is to listen to your body and seek professional guidance if your symptoms begin to interfere with your typical daily routine.
When to talk to your doctor
While premenstrual symptoms are a normal part of your cycle, they should never completely disrupt your life. If your physical or emotional symptoms are so severe that you can’t go to work or manage your daily tasks, it’s a good idea to speak with your healthcare provider. Your doctor can help you understand what is happening and rule out other underlying health conditions. Always listen to your body and seek professional support if your symptoms consistently affect your wellbeing.
FAQs
Can I have more than one type of PMS?
Absolutely. As we mentioned earlier, finding your specific “type” is just for fun to help you spot your own patterns, and it is entirely normal to experience a mixture of symptoms. You might feel the anxiety associated with PMS-A while also dealing with the water retention of PMS-H. Tracking your daily changes helps you see exactly which unique combination you experience.
Do my PMS symptoms change as I get older?
Your hormone levels naturally shift as you age, so your premenstrual symptoms can change too. Women going through perimenopause often notice new or intensified symptoms as their estrogen levels fluctuate more dramatically.
Are there natural ways to manage these symptoms?
Simple lifestyle adjustments can make a big difference in how you feel each month. Regular exercise, balanced meals, and adequate sleep all can help stabilize your energy and mood during your luteal phase.
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Dr Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the myriad of sleep.
- Baker, L. J., & O’Brien, P. M. (2012). Premenstrual syndrome (PMS): a peri-menopausal perspective. Maturitas, 72(2), 121–125. https://doi.org/10.1016/j.maturitas.2012.03.007
- Hargrove, J. T., & Abraham, G. E. (1982). The incidence of premenstrual tension in a gynecologic clinic. The Journal of reproductive medicine, 27(12), 721–724.
- Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. (2023). Obstetrics and gynecology, 142(6), 1516–1533. https://doi.org/10.1097/AOG.0000000000005426
- Baker, L. J., & O’Brien, P. M. (2012). Premenstrual syndrome (PMS): a peri-menopausal perspective. Maturitas, 72(2), 121–125. https://doi.org/10.1016/j.maturitas.2012.03.007
- Hargrove, J. T., & Abraham, G. E. (1982). The incidence of premenstrual tension in a gynecologic clinic. The Journal of reproductive medicine, 27(12), 721–724.
- Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. (2023). Obstetrics and gynecology, 142(6), 1516–1533. https://doi.org/10.1097/AOG.0000000000005426
