Some women experience various symptoms in the time leading up to menstruation. Premenstrual syndrome or PMS can cause severe or minor symptoms, and some women do not experience it at all. While the underlying causes of PMS and its more severe form, premenstrual dysphoric disorder (PMDD), are still not entirely understood, research has found some risk factors that exacerbate the prevalence and severity of PMS symptoms. Certain factors are unavoidable, but changes to lifestyle and diet can have a positive impact on the symptoms of PMS.

Stress Levels

The Journal of Women’s Health reports that women who experience high levels of stress in the two weeks before menstruation are two to four times more likely to experience severe PMS symptoms. These women tend to have increased levels of cortisol, the stress hormone. Research also shows that the more stressed a woman is during a month, the more severe her PMS will be. Finding strategies to help cope with stress —such as exercise, relaxation techniques, meditation, counseling, and biofeedback — may reduce stress and lessen the severity of symptoms during the premenstrual period.

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Hormone Fluctuations

Women’s bodies experience natural fluctuations in hormone levels each month. Some experts and studies suggest the sudden plummets and increases in the hormones progesterone and estrogen are the culprits behind most of the classic PMS symptoms, such as headaches, fluid retention, swollen and tender breasts, mood swings, irritability, brain fog, and acne flare-ups. The degree to which hormones fluctuate varies widely, however, which is why some women seem to get their periods relatively unscathed while others have severe symptoms.

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Experts are not certain why many women's menstruation symptoms worsen as they age. Often, a woman in her 40s will experience more significant symptoms of PMS than she did in her 20s. According to the Office on Women's Health, during perimenopause, hormones start to prepare for menopause, so women experience both PMS and early signs of menopause at the same time.

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Serotonin Levels

Besides hormones, women also experience drops in the neurotransmitter serotonin during menstruation. The chemical is responsible for mood and other physical symptoms, and a decrease may explain why some women experience depression during PMS. Doctors often prescribe hormonal birth control or selective serotonin reuptake inhibitors to women with severe PMS, to counteract this decrease. Similarly, women who discontinue taking SSRIs may experience a worsening of PMS symptoms.

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The Effects of Exercise

Research shows that women who exercise regularly experience fewer symptoms of PMS than women who rarely work out. Exercising is also one of the most commonly prescribed treatments for alleviating menstrual cramps. Furthermore, obesity correlates strongly with severe PMS symptoms, according to research in the Journal of Psychosomatic Obstetrics & Gynecology. Maintaining a healthy lifestyle that includes regular exercise can help control weight gain and therefore alleviate PMS symptoms.

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History of Mental Illness

A history of mental illness, particularly of anxiety and depression, has been linked to more severe psychological symptoms of PMS, such as irritability, mood swings, irrational anger, and excessive crying. When especially pronounced, individuals with these shared symptoms may receive a diagnosis of premenstrual dysphoric disorder (PMDD).

However, it is also possible for PMS symptoms to exacerbate underlying mood disorders. The UNC School of Medicine’s Center of Women’s Mood Disorders reports that around 40% of women who see a doctor for PMDD have a mood disorder exacerbated by PMS.

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Research notes a genetic predisposition to PMS symptoms; surveys show that nearly 70% of daughters who experience significant PMS symptoms have mothers with symptoms of similar severity. In 2007, in a study by the University of North Carolina at Chapel Hill and the National Institute of Mental Health, researchers finally discovered the genetic variation associated with menstrual cycle hormone change linked to mood disorders.

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Substance Abuse

Many substances, including alcohol, interact with hormone levels and have quite an impact on the menstrual cycle and severity of PMS. Illegal substances such as cocaine and methamphetamines can cause lighter periods, increase or decrease the length of periods, or make them stop altogether. These substances are often directly responsible for mood swings and other psychiatric symptoms that may intensify during PMS. Additionally, research shows that women who drink alcohol, especially heavy drinkers, experience more severe PMS symptoms.

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Calcium Levels

Placebo-controlled research published in Obstetrics & Gynecology Science shows that increased calcium intake can significantly reduce PMS-related depression, fatigue, swelling, and pain, indicating that deficiencies in the mineral may be responsible for the worsening of symptoms. Increased calcium intake has also been shown to lessen mood swings, sadness, and anxiety during PMS and cause fewer changes in appetite than in women who did not supplement their intake. Both diet and vitamin supplements can increase calcium.

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Caffeine and Stimulants

Studies have shown that consuming caffeinated beverages, such as soda, energy drinks, or coffee, can result in increased prevalence and severity of PMS symptoms; research also suggests women who consume greater amounts of caffeine are more like to experience PMS symptoms. The American College of Obstetricians and Gynecologists (ACOG) recommends that women who experience severe symptoms reduce or eliminate caffeine. Similarly, other stimulant drugs are linked to abnormal uterine bleeding and menstrual cycle dysregulation due to hormone interactions.

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