For many women, the lead‑up to a period is more than a date on the calendar — it’s a fortnight of emotional turbulence, mood shifts, cravings and physical discomfort, and a sense that life becomes just a little harder to navigate. This cluster of symptoms is known as Premenstrual Syndrome (PMS), and while it’s often joked about or brushed aside, its impact is very real.
PMS is common; it can reshape work, relationships and daily life, but it doesn’t have to be endured in silence. If the days before your period feel harder than they should, you’re not alone. This column explores why it happens — and what helps.
What PMS actually feels like
PMS refers to the physical and emotional symptoms that appear in the two weeks before a period and usually ease once bleeding begins. The pattern tends to repeat each cycle, though the intensity can vary from month to month.
The symptoms are wide‑ranging, but the most common include:
• Mood swings
• Irritability, low mood, or feeling unusually emotional
• Anxiety or feeling overwhelmed
• Tiredness or difficulty sleeping
• Headaches
• Food cravings or changes in appetite
• Bloating or fluid retention
• Breast tenderness
• Skin or hair changes
• Feeling clumsy or 'not quite yourself'
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For most women, these symptoms are manageable. For 2–4 per cent, symptoms are severe enough to interfere with daily life. An even smaller number develop Premenstrual Dysphoric Disorder (PMDD) — a more intense form marked by significant mood symptoms.
Why does PMS happen?
Despite how common PMS is, its exact cause remains unclear. It’s linked to the natural hormonal fluctuations of the menstrual cycle. Some women are simply more sensitive to these changes, particularly shifts in oestrogen and progesterone.
These hormonal shifts also influence brain chemicals such as serotonin and GABA, which help regulate mood, sleep, and emotional balance— and symptoms follow.
How do you know if it’s PMS?
One of the most useful tools is surprisingly simple: a symptom diary. Tracking symptoms over at least two menstrual cycles helps reveal whether they follow a predictable premenstrual pattern.
Your doctor may review this diary with you to confirm the diagnosis. In rare cases where the pattern is unclear, ‘switching off the ovaries’ hormone production using medications can clarify.
What can help?
Understanding it is the first step to taking back control. There is no single 'best' treatment for PMS — the right approach depends on your symptoms, lifestyle, and preferences.
Lifestyle changes
Small adjustments can make a meaningful difference:
• Regular exercise
• A balanced diet
• Stress‑reduction techniques such as yoga, meditation, or mindfulness
Psychological support
Cognitive Behavioural Therapy (CBT) is an effective treatment for PMS. It helps develop practical strategies to reduce their impact.
Complementary therapies/supplements
• Calcium
• Vitamin D
• Evening primrose oil (particularly for breast tenderness)
Medical Treatments
Non‑Hormonal options
• Antidepressants (SSRIs or SNRIs) can significantly reduce PMS symptoms, especially mood‑related ones. They are considered first‑line treatment for severe PMS.
• Diuretics may help with bloating and fluid retention.
Hormonal options
• Interestingly, women using certain hormonal contraceptives often experience fewer PMS symptoms, suggesting that stabilising hormone levels can help. Pills containing drospirenone as progesterone component (such as Yaz, Yasmin, Nikki, Zarah, Syeda, Loryna) can improve both physical and emotional symptoms. Continuous use — skipping the pill‑free week — often provides better control.
• Oestrogen patches or gel
• GnRH analogues or danazol may be used when symptoms are severe
Surgical treatment
Surgery is extremely rare and considered only when all other options have failed. It involves removing the ovaries and uterus, which induces menopause and permanently stops hormonal cycling.
A team‑based approach
For women with severe PMS or PMDD, the best results often come from a multidisciplinary team — a combination of a gynaecologist, mental health professional, dietitian, and exercise specialist. This approach recognises that PMS affects the whole person, not just their hormones.
PMS is common and can significantly affect daily life, but effective treatments exist. A wide range of lifestyle, psychological, complementary, and medical options can help — and many women need a combination.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
