Here's How PMS Can Change In Your 20s, 30s, 40s

As you get older, you may notice your PMS symptoms changing. This shift is normal and often due to the way your body changes as you get closer to menopause. Dealing with PMS at any age can be uncomfortable, but knowing how your symptoms change over time may help you manage them better. 

Premenstrual syndrome (PMS) is a group of physical, emotional, and behavioral symptoms that may occur one to two weeks before your period starts.

Many menstruating people experience PMS. Most researchers believe that PMS occurs after ovulation due to a dramatic fall in estrogen and progesterone levels in people who are not pregnant. Typically, symptoms of PMS will go away a few days after your period begins and hormone levels rise.

Common PMS Symptoms 

Some people may only feel mild effects of PMS. However, others may experience severe symptoms that can interfere with daily life and keep them from going to school or work. An estimated 20% of women report having severe symptoms.

PMS can cause a variety of symptoms. You may experience physical symptoms such as:

• Cramps
• Tender or swollen breasts
• Backache
• Headache
• Sensitivity to light or noise
• Bloating
• Diarrhea
• Clumsiness
• Gas
• Constipation
• Fatigue
• Acne

In addition to physical symptoms, you may experience emotional changes, or you may skip the physical symptoms entirely and only have changes in your mood or mental health. Emotional and behavioral symptoms are common signs of PMS. Some changes you may experience include:

• Irritability
• Depressive mood, crying spells, or feeling sad
• Mood swings
• Changes in appetite or increased food cravings
• Changes in sleep patterns
• Difficulty concentrating
• Anxiety or restlessness
• Hostile behavior
• Tension
• Changes in libido

How PMS Changes With Age

Symptoms of PMS can change throughout your lifetime. Factors like pregnancy, stress, sensitivity to hormonal changes, perimenopause, and menopause can all play a role in how you experience premenstrual syndrome.

In Your 20s

PMS symptoms typically start in your 20s. Your menstrual cycle becomes more regular than what you may have experienced as a teenager. As a result, you may notice a more stable pattern with your PMS symptoms.

PMS symptoms vary from person to person. For example, some may see regular patterns of bloating and irritability, while others experience back pain and increased food cravings. Overall, PMS symptoms are thought to be milder in your 20s than in later years.

Women in their 20s may also be more likely to use hormonal contraceptives such as birth control pills, shots, or implants to stop ovulation. The two hormones that make up hormonal contraceptives are estrogen and progesterone, which are naturally found in your ovaries. Taking hormonal methods of birth control may help relieve PMS symptoms, which can contribute to mild a milder PMS experience in your 20s.

If you notice significant changes in your normal PMS symptoms in your 20s, you may want to reach out to your healthcare provider to determine the cause of these changes and rule out other health conditions. 

In Your 30s

Generally, you can expect PMS symptoms in your early 30s to resemble your 20s. PMS symptoms may begin to worsen during your late 30s, as you approach perimenopause.

PMS symptoms in your 30s may also worsen if you have:

• Given birth 
• A history of postpartum depression
• A family history of depression
• A personal history of an affective mood disorder such as depression or bipolar disorder

Some people may experience severe PMS symptoms as a result of premenstrual dysphoric disorder (PMDD), a condition that is more likely to appear in a person’s late 20s and 30s. PMDD occurs in less than 5% of people who menstruate. PMDD symptoms may appear one to two weeks before your period, and are more intense than PMS symptoms. PMDD symptoms can include:

• Intensified irritability or anger 
• Depression
• Anxiety 
• Panic attacks 
• Loss of interest in activities 
• Suicidal thoughts 

In Your 40s

You may notice your PMS symptoms worsen as you go through perimenopause. Perimenopause typically begins in your mid to late-40s and typically lasts for four years before your periods stop completely–what’s known as menopause.

Hormone levels fluctuate during perimenopause in unpredictable ways, causing periods to become irregular. These changes can affect ovulation, the length of your cycle, and the heaviness of your period. Your normal PMS symptoms may become more intense during this time and can be accompanied by hot flashes and vaginal dryness.

If you notice your mood is especially sensitive to hormonal changes during your menstrual cycle, you may find that your PMS symptoms also worsen during perimenopause.

Once your periods stop, PMS symptoms will stop too. However, some symptoms of menopause can be similar to those of PMS.

Treating PMS at Any Age

Lifestyle changes, medication, or a combination of both can be beneficial for managing PMS symptoms. 

Lifestyle Changes

For people who experience mild symptoms of PMS, lifestyle modifications are among the most effective ways to manage PMS and reduce the severity of symptoms.

This may include:

• Eating a balanced diet containing fruits, vegetables, and whole grains
• Limiting your salt and sugar intake
• Staying hydrated with water 
• Eating small meals at frequent intervals (e.g., not going longer than three hours between snacks or meals)
• Limiting soft drinks, caffeinated beverages, and alcohol
• Getting enough sleep
• Engaging in regular aerobic exercise
• Managing stress 

Medications and Supplements

In some cases, a healthcare provider may recommend medications or supplements to help manage PMS symptoms. These may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are primarily used to relieve pain and reduce inflammation. You may be prescribed Ibuprofen, Aspirin, or other NSAIDs.
• Nutritional supplements: Your healthcare provider may recommend you take calcium, vitamin B6, or magnesium. These supplements are thought to promote hormonal balance and help reduce PMS symptoms.
• Diuretics: These drugs reduce salt and water in your body and can help with severe fluid retention that can cause PMS symptoms such as bloating, tender breasts, or weight gain. 
• Birth control: Some people may benefit from birth control methods such as pills, shots, or implants to manage PMS symptoms. However, some people notice their symptoms worsen while on birth control. You may want to speak with your provider to find the option that is right for you.
• Antidepressants or anti-anxiety medications: If you experience severe emotional PMS symptoms, your provider may suggest taking selective serotonin reuptake inhibitors (SSRIs) or anti-anxiety pills to manage depressive moods and anxious thoughts.

When to See a Healthcare Provider

Managing PMS symptoms can sometimes take a team. Asking for support during your menstrual cycle is normal and encouraged. You may consider making an appointment with a healthcare provider if: 

• Your symptoms disrupt your daily life
• Your symptoms do not improve with self-treatment
• You are experiencing suicidal thoughts or wanting to self-harm

A healthcare provider can also help rule out the possibility of other conditions or refer you to other healthcare specialists that help manage symptoms. 

A Quick Review

Premenstrual syndrome can cause a variety of symptoms that range from mild to severe. The symptoms of PMS may change over the lifespan due to factors such as age, pregnancy, menopause, and stress.

In your 20s, PMS symptoms tend to be mild. In your 30s, you may begin to see PMS symptoms worsen with childbirth, postpartum depression, or the transition to perimenopause. In your 40s, PMS symptoms can worsen as you reach menopause. 

The good news is that treatment is available. Lifestyle modifications, medications, or a mix of both can help you better manage your symptoms. If you notice that PMS is starting to interfere with your daily life,  it may be a good idea to reach out to a healthcare provider for support.