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Premenstrual syndrome (PMS) An estimated nine out of ten women experience at least some mild premenstrual symptoms a week or two before their period.1 However, only two out of every ten women suffer from the more distressing premenstrual syndrome , or PMS.17 The symptoms of PMS can be physical, emotional, or both and may include breast swelling or tenderness, acne, bloating, headaches, joint pain, food cravings, digestive upset, irritability, mood swings, crying, and trouble sleeping.18 Similar to most of the other conditions mentioned in this guide, experts don’t know the exact cause of PMS, but it’s widely believed that the changes in hormone levels during the menstrual cycle are a factor.18 Premenstrual dysphoric disorder (PMDD) Though PMDD is technically a severe form of PMS, the condition is more complex than that implies.19 20 Considered a depressive disorder in the DSM-5,21 PMDD often comes with typical PMS signs — bloating, fatigue, sleep disturbances, and food cravings — but it also presents with symptoms that can have a profound negative impact on daily functioning, such as depression, anxiety, panic attacks, anger, mood swings, insomnia, difficulty concentrating (brain fog), or even suicidal thoughts.22 While researchers are unsure of the cause, they note that the brains of patients with PMDD react in an abnormal way to the normal hormone fluctuations of the menstrual cycle, particularly during the luteal phase right after ovulation.16 These hormone fluctuations also impact the function of neurotransmitters, namely serotonin, which is why SSRI antidepressants are the first-line treatment for PMDD.16 Polycystic ovary syndrome (PCOS) PCOS is a hormonal imbalance caused by the ovaries producing excess androgens (e.g., testosterone, androstenedione, DHEA, or DHT)

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