Premenstrual Syndrome

Premenstrual syndrome (PMS) is a cluster of physical and emotional symptoms that appear in the week or so before a period and ease once the period starts. Most women have some premenstrual symptoms; a smaller proportion have PMS severe enough to affect daily life. A more severe form, PMDD (Premenstrual Dysphoric Disorder), causes severe mood changes and deserves specific treatment.

Common symptoms

• Emotional — mood swings, irritability, anxiety, low mood, tearfulness.
• Physical — breast tenderness, bloating, fatigue, headaches, joint/muscle aches, acne, cravings, sleep problems, reduced concentration.
• Symptoms in the 5-11 days before a period; ease within a few days of bleeding.

When to see a Health Expert

• Symptoms affecting work, relationships, or quality of life.
• Severe mood symptoms — especially feelings of hopelessness, self-harm, or panic — may be PMDD.
• Symptoms in PMS-like pattern but continuous — rule out depression, anxiety, thyroid issues.
• First symptoms starting after 35, or worsening suddenly.

What helps

• Track symptoms over 2-3 cycles — confirms the pattern.
• Regular aerobic exercise — best-evidenced lifestyle intervention.
• Sleep routine, stress reduction (yoga, pranayama, mindfulness).
• Balanced diet, less salt and caffeine before the period, adequate B6, calcium, magnesium.
• Limit alcohol.
• NSAIDs for pain.
• Combined oral contraceptive pills — help physical and mood symptoms in many.
• SSRIs — specifically effective for PMDD; can be taken only during premenstrual days or daily.
• Cognitive behavioural therapy (CBT) — particularly for mood symptoms.
• Severe, treatment-resistant PMDD — specialist options exist.

PMS is real, physiological, and no one's fault. Dismissive responses ("everyone gets it," "just calm down") don't help. It is treatable — don't wait years.