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Premenstrual Syndrome

Read in Hindi

Dr. Ramakrishna Reddy


Premenstrual syndrome or PMS is a collection of symptoms that occur one or two weeks before you get your periods. PMS-related symptoms are emotional and physical in nature. Some women reportedly have such severe symptoms that they have to miss work or school; however, some women are not bothered by symptoms. The seriousness of symptoms varies between individuals. Usually, PMS occurs after the end of ovulation in your menstrual cycle and almost at the beginning of the period. Usually, as your period starts, the symptoms wear off.

As many as three out of every four menstruating women have experienced PMS symptoms, which show that women in their early and late 30s are more prone to PMS.

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Usually, symptoms are behavioural and physical in nature and depict the body’s hormonal changes. The length of how long the symptoms show up in the woman varies between a few days and two weeks. Symptoms tend to worsen six days before and usually peak at about two days before the menstrual period starts. There are two types of symptoms that you may face:

Emotional signs and symptoms include behavioural symptoms like-

  • Increased tension, overthinking, and worrying thoughts

  • Depressed mood and troublesome thoughts

  • Feeling cranky, lonely and helpless

  • Usually, mood swings are associated with irritability or anger episodes

  • Craving food high in fat, sugar or salt

  • Poor concentration in daily chores

  • Trouble falling asleep (insomnia)

  • Changes in sexual desires

Physical signs and symptoms include

  • Feeling easily fatigued

  • Headache and migraine episodes

  • Muscle and joint pains

  • Bloating

  • Weight gain because of fluid retention

  • Acne appearing on the face

  • Breast tenderness

Causes And Risk Factors


Similar to multiple unknown mechanisms that occur in the body, the mechanism of PMS is unclear. Scientists believe that it is caused by severe hormonal fluctuations that occur just before, during and, after every woman’s menstrual cycle. The fact that PMS happens after ovulation can be linked to a considerable decrease in oestrogen and progesterone levels and gets better as the hormone level starts increasing right before the start of your periods.

Risk Factors

Unfortunately, women who are obese, have a greater waist circumference, live extremely stressful lives, eat a lot of junk food or food with high salt content, drink lots of coffee or alcohol, and smoke tobacco-containing products suffer from these symptoms more often. In conclusion, women are more prone to suffering from PMS-related symptoms. Moreover, studies show that women with a family history or personal histories of depression are more prone to PMS.


The diagnosis of PMS is important and you will have to provide a detailed medical history to your physician of when the symptoms started to appear and when they start to worsen as per the menstrual history. Maintaining track of the dates of your menstrual cycle is helpful. To confirm the diagnosis, the physician will track your symptoms through one or two menstrual cycles.

The confirmation of the pattern of symptoms is performed through three criteria. A woman’s symptoms must

  • Show up in the week before her periods for more than three consecutive menstrual cycles in a row

  • Disappear within four days after her periods begin

  • Disturb the functioning or interrupt the normal daily lifestyle of the woman

Writing down or noting down the symptoms before every menstrual cycle makes it easier to confirm that diagnosis.

Moreover, PMS symptoms can be mistaken for symptoms of various diseases such as

  • Depression

  • Anxiety

  • Fatigue syndrome

  • Thyroid Disease

  • Perimenopause (Time around menopause ~45–55 years)

Hence, a proper diagnosis with a qualified physician is crucial, which leads to earlier resolving of symptoms and hence reducing the progression of PMS.


Primarily, the doctor will attempt to make certain diet- and lifestyle-related changes to check if they affect the symptoms of PMS in any way. However, in addition to implementing the changes I mention, it is important that you maintain a diary of your symptoms, which will help us understand if the changes are helping relieve your symptoms.

There are two types of treatment alternatives that the physician can suggest:

PMS symptoms can be relieved with various prescription medications, including

  1. Painkillers - These are obtained before or at the peak of your symptoms. Ibuprofen or naproxen, usually available as OTC drugs, are commonly prescribed painkillers. The medications help in managing pain related to muscle, stomach and back.

  2. Antidepressants - Drugs such as paroxetine and fluoxetine are successful in improving mood-related symptoms and are the first-line treatment for severe PMS. These drugs help in managing symptoms of despair, depression or anxiety and are prescribed in patients with severe mood swings and emotion-related symptoms during PMS.

  3. Diuretics - These drugs are used to limit the bloating of the body during PMS; they work by reversing fluid retention in the body, which decreases symptoms such as bloating, breast tenderness and weight gain.

  4. Oral contraceptive use and hormonal therapies - These medicines stop ovulation, which might help to ease symptoms; they help control the oestrogen production and release that helps in maintaining hormonal balance.

PMS symptoms can be relieved by simple diet and lifestyle modifications; these modifications tend to work in the majority of patients relieving symptoms of PMS.

  1. Swap the carbohydrates in your diet for complex carbohydrates such as whole wheat, brown rice, beans, and lentils. The intensity of mood swings and food cravings can be controlled via the intake of complex carbohydrates.

  2. Reduce the amount of salt, sugar and fatty foods in your diet.

  3. Reduce or avoid the amount of caffeine you drink.

  4. Eat six small meals in a day rather than three large meals; this helps in maintaining a stable blood sugar level. A stable blood sugar level throughout the day helps reduce PMS-related symptoms.

  5. Include foods such as green leafy vegetables (spinach and fenugreek) and yoghurt in your diet.

  6. Eat fibrous foods and food rich in vitamins such as carrots and beetroot, which get rid of any deficiencies that may enhance PMS-related symptoms.

  7. Avoid consumption of junk foods that can lead to weight gain.

  8. Drink at least eight glasses of water daily; try to keep yourself hydrated.


  1. Regular exercise such as aerobic physical activity throughout the month can help with symptoms of fatigue and depression by ensuring you are active.

  2. Getting sufficient sleep of about 8 h each night helps with mood swings because sleep is an essential factor to maintain mental health.

  3. Maintaining a journal or talking to friends can help you cope with stress. Talk your heart out in front of your beloved person, which eases the tension off you and makes you feel more comfortable and secure.

  4. Avoiding smoking and alcohol consumption is useful when it comes to managing PMS-related symptoms.

  5. Relaxation therapies such as breathing exercises, meditation and yoga help in reducing stress. Massage therapy is another form of relaxation therapy that is attempted for stress relief.

  6. Herbal preparations containing saffron, ginkgo, peppermint and turmeric are beneficial for treating PMS.

  7. Acupuncture is another therapy used for relieving stress.

Alternative Treatment

Dietary supplements help with PMS symptom relief:

  • Calcium - It helps to reduce physical and mood symptoms,

  • Magnesium – It helps to reduce water retention and bloating,

  • Vitamin E is helpful for reducing the symptoms of PMS.

Prognosis And Complications

Note that >50% of the women who suffer from PMS have other healthcare problems that may get worse right before the menstrual period. They include

  • Depression and anxiety disorders: Depression and anxiety signs are closely similar to what you experience before or during your periods.

  • Irritable bowel syndrome: Many women experience bloating, gas and cramping before periods.

  • Bladder pain syndrome: Women facing PMS might have painful camps during this time.


  1. Office on Women’s Health. Premenstrual syndrome [Internet] [Updated March 16, 2018]. Available at: Accessed on March 03, 2021. (

  2. Premenstrual syndrome [Internet]. Available at: Accessed on March 03, 2021. (

  3. Factors associated with premenstrual syndrome in Female High School Students [Internet] [Updated May 03, 2018]. Available at Accessed on March 03, 2021. (

  4. Cleveland Clinic. Premenstrual Dysphonic Disorder [Internet] [Updated Nov 23, 2020]. Available at: Accessed on Mar 03, 2021. (

  5. American College of Obstetrics and Gynaecology. Premenstrual syndrome [Internet]. Available at: Accessed on March 03, 2021. (

  6. Premenstrual syndrome and premenstrual dysphoric disorder [Internet]. Available at: Accessed on March 03, 2021. (


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