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What Causes Mood Swings During Menses: Premenstrual Syndrome and Premenstrual Dysphoric Disorder

Premenstrual syndrome

So, today we will be talking about PMS, premenstrual syndrome. What is it? Is it real? Why does it happen and what can we do to tackle it? So, you must have heard people talking that she's PMSing. 

What is a premenstrual syndrome?

Premenstrual syndrome is basically a combination of emotional, mood, physical and even behavioral discomforts and symptoms which a woman experiences just before her period and they could be severe enough to affect her quality of life or maybe even her relationship with people around her. 

Statistically it is said that almost 80% women have experienced some kind of premenstrual symptoms sometime in their lifetime. Out of these, about 50% women may just have mild symptoms

About 20-25% women may have slightly severe symptoms while about 2-5% women may actually have very severe symptoms, this is known as premenstrual dysphoric disorder or PMDD and these symptoms they typically start in the second half of the cycle typically about 5-7 days before the start of the period and surprisingly these symptoms just vanish 5-7 days after her period. 

Symptoms of Premenstrual Syndrome 

So, what are the symptoms of PMS? They could be psychological and they could be physical. 

Psychological Symptoms (Mood Swings)

The psychological or the mood symptoms could be there is anger, irritability without any reason, she's having stress, anxiety, feeling fearful all the time, restlessness, not able to sleep, depressive symptoms, crying spells, not able to concentrate and these women actually at that point of time do not want to talk to people. So, they have social withdrawal. 

Physiological Symptoms 

While the physical symptoms could be fatigue, generalized body pains, joint pains, abdominal pains, cramps, swelling all over the body, feeling of bloated feeling all over the body, breast pain, headaches and mind you all these symptoms are real. 

What Causes Premenstrual Syndrome (PMS) 

Let's understand what causes PMS. PMS is supposed to happen because of some interaction between the female sex hormones which is the estrogen and the progesterone and the chemicals at the brain which is the serotonin and the dopamine. 

These female sex hormones are also supposed to interfere at the level of kidney leading to disturbances at the water and electrolyte mechanism of the body leading to weight gain and bloating. 

Why Some Women Get Premenstrual Syndrome 

We really do not know exactly, PMS is also linked with the history of depression, anxiety, people who have a history of some kind of emotional abuse, some kind of a domestic violence or even the substance abuse. 

How do we diagnose that it is PMS and nothing else? 

It is typically based on this specific history that the symptoms appear just before the periods and they just vanish after the onset of the menstrual flow. 

So, make sure that you always give a detailed history to your doctor. Make sure that you record your symptoms, journal them nicely and as doctors obviously we also want to rule out that there is no other associated disease to cause these symptoms. So, we also like to do a test for the thyroid, maybe a blood sugar, we get a complete blood count done and an ultrasound also. 

What can be done to take care of PMS? 

Mild cases might just require simple dietary and lifestyle changes. In case somebody is having severe symptoms, you might need to talk to the doctor and take some medications. In case somebody is suffering from Premenstrual Dysphoric Disorder (PMDD) you actually might need medications and even some psychiatric intervention.

Lifestyle Changes to Treat PMS 

Let's talk about what can you do to take care of the lifestyle changes. 

1. Number one is diet. As I always say, the diet has to be simple, healthy, homemade diet with a healthy mix of cereals, grains, pulses, fruits, vegetables. 

Obviously, stay away from caffeine, alcohol, smoking. Stay away from vegetable oils, vegetable refined oils. Instead, include healthy fats in diet like coconut oil and homemade butter.

Coconut oil actually is a surprising remedy for the PMS. You could be having a lot of supplements also which could help you in PMS, like folic acid supplementation, vitamin B6 supplementation helps. 

Taking vitamin D every day, 400IU every day is very important for PMS. Calcium supplementations, you could also include natural sources of calcium in your diet which is low-fat dairy, sesame seeds, almonds, leafy green vegetables. I hope you all have heard about how magnesium helps in PMS. 

In fact, most of my patients with PMS, I always prescribe them to take one or two bananas every day in the pre-menstrual period. Bananas are actually very rich in magnesium and magnesium is something which reduces bloating, uterine cramps, body pains, joint pains. So, make sure that you take bananas, avocados, dark chocolates, I know we all love it. Grains, pulses, tofu. So, basically healthy diet.

2. Next is good exercise, when you do a good exercise, it releases serotonin. Now, serotonin is a happy hormone which helps in PMS. 

3. Good sleep. I cannot stress on this enough, a good quality sleep, the adequate hours of sleep is something which is going to help you with PMS immensely. 

4. Then, most most important is finding a time, allowing yourself to relax, finding time to do things which you like, reading, listening to music, being with the people whom you love. 

Basically, doing anything which nourishes you mentally. You know, people find relief with massage, aromatherapy, acupuncture also. So, basically anything which gives you comfort and happiness and lets the happy hormones flow in the body is perfectly fine.

How to Treat PMS with Medication 

Then, let's talk about what medicines as doctors we like to prescribe for these patients. 

Painkillers, these are simple pain relievers, they can help you with headache, body aches, joint pains, abdominal cramps. Sometimes, in case a woman is having a lot of edema, swelling, we also prescribe diuretics. 

We also prescribe antidepressants in some cases, basically, there's a class of drugs which is known as SSRIs. So, this is selective serotonin reuptake inhibitors. Little technicals, you may forget about it. But yes, in selected cases, these drugs are also prescribed. 

As gynecologists, we also like to prescribe birth control pills for PMS. So, how do they work is, they stop the ovulation and that's how they work. 

But a big word of caution, never ever buy these medications over the counter. Always buy them after getting a prescription from a doctor. So, I know it is difficult for some women. 

Closing thought 

Some women and their families too, actually find it very difficult to accept this diagnosis, let alone get it treated. But let's face it, PMS exists. PMS is real. 

But the good news is, it can be treated very well. It is definitely manageable, provided we diagnose it correctly and treat it the right way.


1. ARGONZ J, ABINZANO C. Premenstrual tension treated with vitamin A. J Clin Endocrinol Metab. 1950 Dec;10(12):1579–1590. [PubMed] [Google Scholar]

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