Premenstrual syndrome symptoms: cramps and what they mean

Premenstrual syndrome cramps are period-like lower abdominal pains that can occur before bleeding and often settle when menstruation starts. They may come with bloating, breast tenderness, headache, irritability, or changes in sleep and appetite. The pattern across cycles is useful: symptoms that repeatedly appear before a period and improve soon after bleeding begins fit a premenstrual pattern more closely than pain that continues throughout the cycle.

Hormone changes before a period can affect the womb and the chemicals involved in uterine contractions. This may create aching, pressure, or waves of cramping in the lower abdomen, sometimes with pain in the lower back or thighs. PMS can include several symptoms at once, but severe, one-sided, worsening, or newly persistent pain may have another cause, such as a pelvic condition, and should not be labelled PMS without assessment.

Record the first day of pain, its location, severity, associated symptoms, and when it improves. Gentle movement, rest, warmth over the lower abdomen, regular meals, hydration, and sleep may help. A pharmacist or clinician can advise whether an anti-inflammatory or another pain reliever is suitable, particularly if you have stomach, kidney, bleeding, allergy, or pregnancy concerns. Breast tenderness can also occur with PMS; learn more about [Breast Pain](/symptoms/breast-pain/).

Arrange medical advice if cramps interfere with work, sleep, relationships, or usual activities; do not improve with self-care; become heavier or more frequent; or start outside the premenstrual window. Seek urgent help for sudden severe pain, fainting, heavy unexpected bleeding, fever, repeated vomiting, or pain during a possible pregnancy. A clinician may ask about your cycle and examine you to identify the cause.

Could my symptom pattern be PMS or another pelvic problem? Which pain medicines are appropriate for me? Should I keep a symptom diary, and for how many cycles? What symptoms would mean I should seek urgent care? If contraception is relevant, would the [Combined Pill](/treatments/contraception-and-family-planning/combined-pill/) be appropriate for my health history?