Everything That's Happening To Your Body During PMS — & How To Deal

Illustrated by Abbie Winters.
Women are fed a lot of platitudes during their Time Of The Month — your period is a natural sign of your womanhood, it's a beautiful reminder that you can bring life into this world, and so on. And though it's true that in some ways your period is pretty rad, there are plenty of things you probably wouldn't miss if they mysteriously disappeared — namely, all of your PMS symptoms.

PMS, or premenstrual syndrome, is a common phenomenon: roughly 15 out of every 20 women who menstruate experience at least some of the many signs of it, per the National Library of Medicine. So you're not alone if, among other things, your breasts hurt, your head hurts, you feel extra emotional, or your stomach feels like it's revolting against you in the seven to 10 days leading up to your "special time."

For the majority of women, PMS symptoms are minor. In fact, some women report feeling their best and most clearheaded during the premenstrual phase of their cycles. But for others, PMS is frustrating, and for still others, it's severe enough to interfere with activities.

While experts think cycling hormones probably have something to do with PMS, they're not sure exactly what's behind it. For example, studies show that women who experience it don't necessarily have abnormal levels of hormones. "We don’t really know what causes PMS as a general thing, so all of the theories are just that — they’re theories," Raquel B. Dardik, MD, clinical associate professor, Department of Obstetrics and Gynecology at NYU Langone’s Joan H. Tisch Center for Women’s Health, tells Refinery29. Various other factors, like stress levels, other medical conditions, even cultural influences seem to play a role. Women born into Western cultures like the U.S. tend to experience more mood swings, for example, suggesting that there's something specific to our pressures at play.
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You should never hesitate to talk to a doctor if your periods have recently become especially severe or suddenly irregular. Hiccups happen, but major shifts can be a sign of a medical issue like a pregnancy, an infection, or something else. Dr. Dardik explains that "the most important thing is for people to actually track their symptoms along with their cycle." Doing so will help you differentiate something that is premenstrual syndrome [from] something that’s a lot more chronic and should be evaluated."

But if you're wondering how to ride out those less troublesome, but still nagging, PMS symptoms, look no further. Here are some tips for solving symptoms, and more info on why they're happening to you in the first place.
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Illustrated by Abbie Winters.
Back & Joint Pain
Nebulous aches in your muscles or joints are relatively common PMS symptoms, as is the more specific symptom of low back pain.

"We’re not entirely clear why premenstrual changes would cause muscle pain," Dr. Dardik says. She goes on to explain that it can be due to a ripple effect, with pain that starts in your uterus moving out to your back: "Nerve endings are not pinpoints, so sometimes when one nerve ending is irritated, you feel pain in other places."

Low back pain, she says, can be due in part to this same effect, but it's "more common with women whose uteruses are retroverted because they’re facing backwards toward the back."

Either way, the best first response is a heating pad or hot water bottle.
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Illustrated by Abbie Winters.
Cramps
Fun fact: Medically speaking, cramps are *technically* not a symptom of PMS. "Most people have cramps immediately before their period," Dr. Dardik explains. But splitting hairs here can get a little tricky: "People who have cramps tend to have other symptoms that are related to PMS, such as irritability and mood changes, so it’s hard to tell if that’s because you’re feeling crappy because you’re having cramps or because you have concurrent PMS."

Either way, we should talk about them because, let's face it, they really suck.

Doctors refer to them by the much more sinister-sounding term dysmenorrhea (doesn't that just sound evil), but the reality is there are plenty of treatments for menstrual cramps. Common pain relievers, like ibuprofen or naproxen, can help in the moment; take the lowest dose possible at the first twinge of pain to get ahead of it.

If your cramps are severe, your doctor might prescribe a hormonal birth control method like the pill or a hormonal IUD, either of which can help painful periods. For some women other methods, like exercise or having an orgasm, may help, though the science is unclear about how well those work.
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Illustrated by Abbie Winters.
Breast Pain
Breast pain goes hand in hand with menstruation thanks to hormonal changes in your body, though experts aren't totally sure why. Dr. Dardik suggests that it can also be related to "expansion — microscopic expansion — of the breast tissue." Your breasts may feel tender or swell to be noticeably larger, and this can start as early as two weeks before your period, around ovulation.

The technical term for this kind of breast pain is "cyclical mastalgia" and severity can vary widely. While some women feel only slight tenderness, others can barely wear a bra.

How bad it is will determine what course of treatment your doctor recommends. Common methods include avoiding caffeine, keeping your breasts supported with a well-fitted bra, and eating a low-fat diet. For more severe cases or those that don't seem to be getting better, medications are available.
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Illustrated by Abbie Winters.
Headaches
Dr. Dardik once again credits this symptom to your darling hormones.

"Both the fluctuation in the hormones...as well as the drop in hormones immediately before the period, can trigger headaches for some women," she says.

Some women may also suffer from menstrual migraines, which also seem to be related to the ebb and flow of hormones, but are not necessarily a symptom of PMS. Rather they're their own specific condition, Dr. Dardik adds. Figuring out which type of pain you're experiencing will help your doctor prescribe the right treatments. Menstrual migraines, for example, tend to be more severe, and can come with nausea and light sensitivity.

Dr. Dardik says that birth control pills can be prescribed to lessen the severity if you're having a lot of regular headaches, but some women with migraines shouldn't take birth control pills. For those women, however, there are other effective pain medications.
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Illustrated by Abbie Winters.
Nausea
This can be another after effect of those cramps or the digestive issues that occur before and during your period.

There is sadly no sneaky way around it. Dr. Dardik says maintaining a healthy lifestyle — "get enough sleep, get enough exercise, don’t have too much sugar or too much caffeine" — is the best preventative measure against premenstrual nausea.

As with any kind of nausea, it's always good to err on the safe side and eat foods that are easy on the stomach — toast, rice, fish, and bananas.
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Illustrated by Abbie Winters.
Mood Swings
The idea that your period messes with your mood has been notoriously overblown. In fact, studies have yet to define a link between hormones and changes in mood.

However, Dr. Dardik says that premenstrual mood changes can still happen, and it's important to keep track of them. They should be consistent from month to month, and "if you’re having problems during your period or immediately after, that’s sort of a trigger that this isn’t PMS."

Somewhere between 5% and 10% of women do experience extreme premenstrual mood changes that could signal PMDD, or Premenstrual Dysphoric Disorder. If you're noticing more serious cyclical mood changes, like extreme sadness or major dips in your self-esteem, talk to your doctor. The important thing to know about this is that these issues are treatable, and you don't have to put up with them.
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Illustrated by Abbie Winters.
Anxiety
As a symptom, anxiety goes hand-in-hand with mood swings.

Dr. Dardik explains that the exact feelings you experience during PMS "[vary] from woman to woman." Unfortunately, she adds, it's quite common for women to feel more anxious about things around this time. But, as mentioned before, the key is to keep a log (with a period-tracking app, perhaps) to be sure these feelings are related to your menstrual cycle.

Also, you should talk to your doctor about PMDD if the feelings you're having are interfering with your life. It's estimated that 40% of women suffering PMDD may really be dealing with another mental health issue, such as anxiety or depression, that's gone under the radar.

That said, if your symptoms are more mild, reducing your stress overall can help, too.
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Illustrated by Abbie Winters.
Acne
Consider this myth busted. Dr. Dardik says flat-out that acne is not a symptom of PMS. Instead, your skin may act up during your period, due to your fluctuating hormones and how they affect your skin cells.

If that's what you're experiencing, especially if the pimples are concentrated along your jawline, you may have what's known as hormonal acne, which can be treated with birth control pills.
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Illustrated by Abbie Winters.
Bloating
As mentioned earlier, you might run into a few digestive issues as your period approaches. Fluctuating hormones can cause your bowels to contract, which can easily lead to constipation. And, unfortunately, with constipation comes a feeling of being bloated.

Dr. Dardik adds that some women just retain more water leading up to their period, and this could also contribute to the problem.

As with nausea, your best course of action is to hydrate (since drinking plenty of water can help you poop) and wait it out.
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Illustrated by Abbie Winters.
Insomnia
Insomnia isn't what Dr. Dardik calls a "classic symptom of PMS." If it shows up, you're most likely just dealing with insomnia while you happen to be approaching your period.

But, she clarifies that PMS can contribute to loss of sleep if your other symptoms are unpleasant enough to make you uncomfortable; if you don't feel well, you probably won't sleep well.

Think of it like The Perfect Storm, but for your period: Multiple weather fronts (PMS symptoms) have converged to create modern history's fiercest storm (the worst, least restful night's sleep of your life).
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