The vast majority of women of reproductive age say they get premenstrual symptoms, such as bloating, headaches and moodiness, about a week or two before their periods. For many women, these symptoms are mild. But for others, they can be so severe that they miss work or school.
A new study from the University of Virginia found that 29% of women worldwide experience premenstrual symptoms that disrupt their everyday lives during every menstrual cycle. Another 35% said they interfere at least some of the time.
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Researchers said PMS symptoms are so common that they should be considered a "key public health issue globally." They said they hope greater awareness can lead to better care.
"Increasing awareness of how common these symptoms are, and that if they impact functioning that there are treatments available, will help women improve their quality of life," said Dr. Jennifer Payne, director of UVA's Reproductive Psychiatry Research Program.
The researchers surveyed more than 238,000 women, ages 18-55, from 140 countries using the app Flo, which women use to track their menstrual cycle, mood and physical symptoms. About 85% of the women surveyed experience food cravings, 64% get mood swings or anxiety, and 57% feel fatigued.
"Our study demonstrates that premenstrual mood symptoms are incredibly common worldwide," Payne said. "More important, a majority of women reported that their premenstrual symptoms interfered with their everyday life at least some of the time."
Scientists are still not certain what exactly causes PMS. They theorize that changes in hormone levels during the menstrual cycle play a major role, but more studies are needed.
Premenstrual symptoms include mood swings, anxiety, insomnia, social withdrawal, poor concentration, change in libido, joint or muscle pain, headaches, weight gain due to fluid retention, abdominal bloating, breast tenderness, acne flare-ups and constipation or diarrhea, according to The Mayo Clinic.
Older women who were surveyed were more likely to report premenstrual symptoms such as absentmindedness, low libido, sleep changes, gastrointestinal symptoms, weight gain, headaches, fatigue, rashes and swelling. Many of these symptoms also are associated with perimenopause, the transitional phase into menopause.
Treatment strategies for severe premenstrual symptoms include antidepressants, nonsteroidal anti-inflammatory drugs, diuretics to reduce fluid retention and hormonal contraceptives.
Lifestyle changes including diet, exercise and stress-reducing strategies can help ease some of the symptoms. One study found that a yoga exercise intervention designed for women with premenstrual syndrome significantly decreased bodily pain, abdominal swelling and cramps, cold sweats and breast tenderness.
The UVA study did not distinguish between premenstrual syndrome and premenstrual dysphoric disorder, a rarer condition in which women experience disabling symptoms such as depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.
Reported symptoms differed significantly between the countries included in the study. Women in Congo had the lowest rate of symptoms, at 35.1% while those in Egypt had the highest, at 68.6%. The researchers said future studies are needed to better understand if these differences are due to biology or culture.