Taming the PMS beast

Most women are familiar with the emotional and physical symptoms a week before their period which define PMS (Premenstrual Syndrome). PMS is the source of many jokes, has been used as a defence in murder cases and has been discounted as hysterical nonsense.

Over 150 symptoms are attributed to PMS and include common ones such as bloating, migraines, cramping and fatigue to weird ones like smelly farts and sore throats. Emotional symptoms can range from anxiety to homicidal rage. With such a broad symptom list and variable presentation even in the same woman from month to month, PMS has been hard to classify and research.

The salient feature of PMS is its timing. PMS starts in the week before your period, greatly improves when your period starts and is gone by the time your period ends. If your symptoms last longer than the period, then it is not PMS.

Most women will experience some PMS symptoms, mostly it won’t impact too much on their lives. If there are severe symptoms medical interventions might be required. Severe cramping that does not respond to anti-inflammatories like Ponstan (mefenamic acid) might be due to endometriosis and might need surgery. Depression occurring only in the luteal phase (the week before your period) is known as PMDD (premenstrual dysphoric disorder) and might need medication. Fortunately, for the majority of us, it’s just something that needs to be ridden out.

I have come to realise that the premenstrual period is like a magnifying glass for women, highlighting all the issues in her life. As such, it can be a very useful tool to check in with one’s self, to recalibrate.

A working mom who is always on the go finds she needs to sleep for 16 hours in the days leading up to her period. A woman who carries most of the domestic load suddenly flies into a homicidal rage when her partner leaves an unwashed cup out. A mindful approach to the premenstrual time can be most illuminating.

Managing PMS:

  • Take note, but put a pin in it.

Several of my patients have described how a vague niggle in their relationships becomes a crystal clear shout when they are premenstrual. Here’s where wisdom comes in: take note of the issue but address it next week. It might be a very valid point but in your premenstrual week, this magnifying glass might distort things a bit. The last thing you want is for your voice not to be heard because it’s a bit shrill.

  • Address the imbalances

If you are exhausted, sleep more. If you have a particular craving, you probably have a deficiency in something. Chocolate cravings are common and might point to magnesium and chromium deficiencies. Magnesium deficiencies, in turn, has been linked to fatigue, insomnia, muscle cramps and bloating – common PMS symptoms. In addition, chocolate causes a brief boost of serotonin, just what’s needed premenstrually. Listening to our bodies can help us give it what it needs.

  • Exercise

PMS can weaken ones resolve to work out. Duvet and chocolates are more appealing than a brisk walk. Research has found that exercise helps for PMS symptoms, especially bloating, cramps, fatigue and depression. Belly dancing was founded in the Sheik’s harems not to please him, but to alleviate menstrual cramps.

  • Watch the alcohol

Whilst PMS can drive us to drink, it’s effect during this time is negative. Breast tenderness, headaches, mood fluctuations and cramping are more severe when alcohol is added to the hormonal mix. If we are trying to be mindful as to what our bodies need, then alcohol’s numbing effects can be confusing.

  • Drink a lot of water

It feels counterintuitive to drink water when we are bloated and puffy. Getting fluids up restores balances because although body tissues are water retentive, blood vessels are dehydrated. It then also triggers peeing.

  • Manage stress

PMS is our soul’s way of screaming at us to prioritise ourselves. Once a month we are hormonally entitled to say “No.”

PMS is normal. Occasionally it needs medical help, but mostly it is part of a healthy cycle. If we stop fighting it, then perhaps we can use the information it gives us we can use as a kind of superpower.



  1. I wonder if you recommend going onto a contraceptive pill to manage PMS. I understand that every woman is different but it appeared to shorten the duration and intensity of symptoms in one of my ex varsity sweethearts?

  2. I know there are so many different contraceptive pills, so I thought I’d better be specific and mention that it was Diane-35 ED, that seemed to do the trick.

    • Hi David. It seems as if the changes in hormone levels have more of an impact on PMS than the actual levels. PMS sufferers do best with monophasic continuous use of the Pill (i.e. no placebo days).

  3. Yes, that is consistent with what you say on your post about the “pill”. What I was referring to happened 25 years ago when off-label uses for contraceptives were less well understood. The chief benefit I think she received was to have some order imposed on her otherwise chaotic cycle including an unpredictable number of bleeding days, which is surely enough to make anyone “crazy”. Anyway in those days probing too deeply into your girlfriend’s secret cycle would have earned you a klap. Today you can be in a coffee shop and they’ll whip out a tracking app and show you. How things have changed!

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