Premenstrual Syndrome (PMS) affects an estimated up to 80-90% of menstruating women at some point in their lives, making it one of the most common cyclical health conditions globally1. Yet despite its prevalence, PMS is often trivialised, misunderstood, or dismissed as an inevitable inconvenience of being a woman. PMS is not simply “a bad mood before a period”; it is a collection of physical, emotional, and cognitive symptoms that can significantly interfere with daily functioning, wellbeing, and quality of life.
Symptoms typically arise during the luteal phase of the menstrual cycle, the stage following ovulation and preceding menstruation, during which fluctuating levels of oestrogen and progesterone influence multiple physiological and neurological pathways. The menstrual cycle itself is broadly divided into the follicular phase, ovulation, and the luteal phase, each characterised by distinct hormonal patterns. In PMS, symptoms emerge predominantly during the late luteal phase, usually one to two weeks before menstruation, and resolve shortly after the onset of bleeding. For many women, this predictable monthly pattern shapes work performance, relationships, self-confidence, and mental resilience. While PMS exists on a spectrum of severity, even moderate forms can become significantly disruptive when experienced repeatedly over years or decades2.
The impact of PMS is often cumulative rather than acute. A few difficult days each month can quietly add up to missed opportunities, strained relationships, and chronic self-doubt, particularly when symptoms are minimised or normalised by those around them.
The Lived Experience: More than “Just Hormones”
PMS can manifest in over 150 recognised symptoms, varying widely between individuals. Common emotional and cognitive symptoms include irritability, low mood, anxiety, reduced concentration, and emotional sensitivity. Physically, women may experience bloating, breast tenderness, headaches, fatigue, joint pain, sleep disturbance, and changes in appetite3.
Importantly, pain is a central and often under-recognised component of PMS. This may include persistent abdominal pain, headaches, musculoskeletal pain, and fatigue severe enough to limit physical activity, social engagement, and overall quality of life.
For some women, symptoms begin up to 10 days before menstruation and persist into the menstrual phase itself, resulting in nearly half the month being affected by discomfort or pain. Everyday activities such as exercise, work, or maintaining usual routines can become significantly more difficult, yet this burden often remains invisible.
What makes PMS particularly challenging is not only the symptoms themselves, but the way they interact with everyday demands. Women may feel less capable, less patient, or less mentally sharp, yet are still expected to perform at the same level at work, care for others, and maintain emotional composure. Many internalise these monthly changes as personal shortcomings rather than recognising them as cyclical, biologically driven experiences4,5.
The Social Challenge: Normalisation and Dismissal
PMS suffers from a paradox: it is so common that it is not taken seriously. Cultural narratives frequently portray PMS as an excuse, or a stereotype, reinforcing the idea that women are irrational or unreliable around their periods. This normalisation masks genuine suffering and discourages women from seeking help.
In healthcare settings, women reporting PMS symptoms are often reassured rather than assessed. While reassurance may be well-intentioned, it can cross into dismissal when symptoms meaningfully impair daily life. The absence of clear diagnostic pathways for PMS, compared with Premenstrual Dysphoric Disorder (PMDD), further contributes to under-recognition and inconsistent management.
This dismissal has consequences. When women are taught that PMS is simply something to “put up with,” they may not realise that effective interventions exist, or that their experience is valid and treatable. The result is unnecessary suffering framed as biological destiny6.
The scientific challenge: understanding hormonal sensitivity
Unlike conditions caused by abnormal hormone levels, PMS, like PMDD which will be discussed in the next article, is thought to arise from an individual sensitivity to normal hormonal fluctuations, particularly changes in oestrogen and progesterone during the luteal phase. These hormonal shifts influence neurotransmitter systems such as serotonin and GABA, which play key roles in mood regulation, stress response, and pain perception7.
Importantly, PMS is distinct from PMDD in severity and diagnostic criteria, but the two exist on a continuum rather than as entirely separate entities. PMS does not require the presence of severe mood symptoms, yet it can still significantly affect wellbeing. Because symptoms overlap with anxiety, depression, and stress-related disorders, PMS is often misattributed to lifestyle or psychological factors alone.
This is further compounded by the normalisation of menstrual-related symptoms within society and healthcare systems, despite the fact that PMS affects a significant proportion of menstruating women worldwide. As a result, many individuals experience ongoing symptoms without formal recognition, adequate support, or evidence-based management strategies8.
The way forward: recognition, support, and care
Improving outcomes for women with PMS requires a shift in both perception and practice:
- Validation and education are fundamental. Women should be supported to recognise cyclical symptom patterns and understand that PMS is a legitimate health concern, not a personal failing.
- Routine clinical enquiry about menstrual-related symptoms should be embedded into primary care, mental health assessments, and workplace wellbeing discussions.
- Individualised management strategies, including lifestyle interventions, such as nutritional support, stress reduction can meaningfully reduce symptom burden.
- Ongoing research into neuroendocrine mechanisms, biomarkers, and long-term impacts is essential to move PMS care beyond generalised advice toward precision women’s health.
PMS should not be invisible simply because it is common. Normalisation must not become neglect. By taking PMS seriously, socially, clinically, and scientifically, we can reduce unnecessary suffering and empower women to understand and advocate for their own health. Open conversations in clinics, workplaces, schools, and homes can challenge stigma and reshape expectations. Healthcare professionals must listen, assess, and act, rather than reassure and dismiss. And women’s lived experiences must inform research priorities and healthcare design.
PMS is a real, cyclical health condition that deserves recognition, respect, and evidence-based care. Only then can we ensure that women are supported, not just during one phase of the month, but across their entire lives.
References
- Gudipally, P. R., & Sharma, G. K. (2023, July 17). Premenstrual Syndrome. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560698/
- NHS. (2019). PMS (premenstrual syndrome). NHS. https://www.nhs.uk/conditions/pre-menstrual-syndrome/
- What is PMS? (n.d.). NAPS – National Association for Premenstrual Syndromes. https://www.pms.org.uk/about-pms-2/what-is-pms/
- Schoep, M. E., Nieboer, T. E., van der Zanden, M., Braat, D. D. M., & Nap, A. W. (2019). The impact of menstrual symptoms on everyday life: a survey among 42,879 women. American Journal of Obstetrics and Gynecology, 220(6), 569.e1–569.e7. https://doi.org/10.1016/j.ajog.2019.02.048
- Hantsoo, L., Rangaswamy, S., Voegtline, K., Salimgaraev, R., Zhaunova, L., & Payne, J. L. (2022). Premenstrual symptoms across the lifespan in an international sample: data from a mobile application. Archives of Women’s Mental Health, 25(5), 903–910. https://doi.org/10.1007/s00737-022-01261-5
- UK Parliament. (2018). “Medical misogyny” is leaving women in unnecessary pain and undiagnosed for years – Committees – UK Parliament. Parliament.uk. https://committees.parliament.uk/committee/328/women-and-equalities-committee/news/204316/medical-misogyny-is-leaving-women-in-unnecessary-pain-and-undiagnosed-for-years/
- Hantsoo, L., & Payne, J. L. (2023). Towards understanding the biology of premenstrual dysphoric disorder: From genes to GABA. Neuroscience & Biobehavioral Reviews, 149, 105168. https://doi.org/10.1016/j.neubiorev.2023.105168
- McKinsey Health Institute. (2024). Closing the women’s health gap: A $1 trillion opportunity to improve lives and economies | McKinsey. Www.mckinsey.com. https://www.mckinsey.com/mhi/our-insights/closing-the-womens-health-gap-a-1-trillion-dollar-opportunity-to-improve-lives-and-economies