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Health Protocols

Premenstrual Syndrome (PMS)

Risk Factors

Smoking and Alcohol Consumption

A population study in over 3 000 women found that those who smoke had a more than two-fold higher risk of developing PMS, while those who began smoking before age 15 had a greater than 2.5-fold risk, compared with women who never smoked. Former smokers who smoked 25 or more cigarettes per day had a 1.8-fold higher risk of developing PMS relative to women who never smoked. Smoking more cigarettes over a longer period of time also increased PMS risk (Bertone-Johnson 2008).

A study in over 200 women found that those with PMS drank significantly more servings of alcohol per week, both pre- and postmenstrually, than did those without PMS. This same study found that women who had 10 or more alcoholic drinks per week in their postmenstrual phase were significantly more likely to have moderate to severe PMS. Other studies have also found a relationship between alcohol consumption and PMS (Rossignol 1991; Bryant 2006).


Increasing body mass index (BMI) is associated with PMS. In one study, a BMI > 27.5 conferred a significantly higher risk of PMS than a BMI < 20. Higher BMI was significantly associated with symptoms of backache, swelling of extremities, and abdominal cramping (Bertone-Johnson 2010). A survey of 874 women found that those who were obese had a 2.8-fold higher risk of PMS (Masho 2005). Higher BMI has also been associated with PMDD (Yen 2010).


Two surveys found that a diet high in fat is associated with worse PMS symptoms (Goker 2014; Nagata 2004). There is also evidence that women with PMDD have an increased desire for high-fat and high-calorie foods during the luteal phase compared to the follicular phase (Reed 2008). Another survey found that consumption of foods and beverages high in sugar was associated with PMS (Rossignol 1991).

Psychological Risk Factors

Multiple studies have found that traumatic stress or having post-traumatic stress disorder increases a woman’s odds of developing PMDD (Pilver, Levy 2011; Wittchen 2003; Perkonigg 2004). There is also evidence that women who perceive discrimination during their lifetimes, including gender and race discrimination, are more likely to experience PMDD (Pilver, Desai 2011). One study found that women with PMS were more than three times as likely to report significant trauma in childhood compared with those without PMS (Bertone-Johnson 2014).

Lastly, it is important to note that women with psychiatric illnesses may experience exacerbation of their condition during the luteal phase of their menstrual cycle (Nillni 2011; Kim 2004; Miyaoka 2011; Cirillo 2012; Rees 2014). You can learn more about psychiatric conditions that are sometimes mistaken for PMS and PMDD in Life Extension’s Anxiety and Depression protocols.