There are days, every month, when you feel like you're not yourself. You're more irritable than usual, you could cry over anything, you feel sad or anxious for no clear reason… and then, when your period arrives, as if by magic, everything falls back into place. If this sounds familiar, you probably know premenstrual syndrome up close.
Premenstrual syndrome (PMS) is often associated only with the physical discomfort, but for many women the hardest part to cope with is the emotional symptoms: the irritability, sadness or anxiety of the days before menstruation. In this article I focus precisely on that side, the psychological one: what it is, why it happens, when it stops being 'normal' and becomes PMDD, and above all how to manage it so it doesn't make your life impossible every month.
What premenstrual syndrome is
Premenstrual syndrome is the set of physical and emotional symptoms that appear in the days before your period —during the so-called luteal phase of the cycle— and that disappear, or improve a lot, when menstruation arrives. It's very common: most women of reproductive age notice some change before their period, though the intensity varies a lot from one person to another. The key that defines it is the cyclical pattern: always at the same point in the cycle, month after month.
The emotional symptoms of premenstrual syndrome
When people talk about premenstrual syndrome they think of bloating or stomach ache, but the symptoms that weigh most tend to be the emotional ones. They're the ones that wear you down most and the hardest to explain.
The most common emotional symptoms
- Irritability and short temper: you snap at the slightest thing and everything bothers you.
- Sadness or the urge to cry for no clear reason.
- Anxiety, restlessness or a feeling you can't cope with everything.
- Sudden mood swings: you go from laughing to crying in minutes.
- Oversensitivity: what people say to you affects you far more than usual.
- Tiredness, low motivation and the urge to withdraw.
The physical symptoms that come with it
Alongside the emotional side, premenstrual syndrome usually brings physical discomfort: abdominal bloating, swollen and tender breasts, headache, tiredness, more appetite or cravings for sweet and salty food, and trouble sleeping. When rest suffers, your mood feels it even more; if sleep is one of your weak points on those days, you can look at how to look after sleep disorders. Body and emotions go hand in hand.
PMS or PMDD: when it's far more serious
Feeling more sensitive for a few days is one thing; your life falling apart every month is another, very different one. When the emotional symptoms are so intense that they seriously affect your work, studies or relationships, we talk about premenstrual dysphoric disorder (PMDD). The American Psychological Association describes it as a severe form of premenstrual syndrome, with marked mood symptoms (intense irritability, deep sadness, anxiety) that appear before the period and ease off afterwards. PMDD isn't 'PMS but a bit worse': it's a clinical condition that deserves attention.
Why it happens: the causes
No, it isn't that you're 'too sensitive'. Premenstrual syndrome has to do with the hormonal fluctuations of the cycle (especially the drop in oestrogen and progesterone in the second half) and with how your brain —specifically systems like serotonin— responds to those changes. Some women are more sensitive to these swings than others, and that's why they experience them far more intensely. The UK's National Health Service (NHS) notes that, although the cause isn't fully understood, the hormonal changes of the cycle clearly play a part.
No, you're not 'making it up'
For a long time premenstrual symptoms have been played down or even mocked ('it's all in your head', 'always the same excuse'). And that does real harm: many women end up feeling guilty or like they're exaggerating. Let me be clear: premenstrual syndrome is real, it's common and it has a biological basis. Recognising it isn't looking for excuses; it's the first step towards being able to do something about it.
How it affects daily life and relationships
When every month there are a few days when you're at your limit, everything suffers: arguments with your partner that you can't even trace the source of, a feeling of underperforming at work, and a self-esteem that takes a hit because 'you don't recognise yourself'. Premenstrual irritability, for example, can make you take out on those closest to you things that have nothing to do with them; learning to manage anger and to warn the people around you helps a lot to avoid burning bridges on those days.
How to manage the emotional symptoms of premenstrual syndrome
The good news is there's a lot you can do to live those days better. It isn't about 'putting up with it', but about anticipating it and taking a little more care of yourself when the time comes.
Habits that help with premenstrual syndrome
- Track your cycle: knowing when the delicate phase is coming lets you anticipate it and not be caught off guard.
- Look after your sleep and keep steady routines; rest is the first thing to suffer.
- Move: gentle exercise (walking, swimming, yoga) helps regulate your mood.
- Watch caffeine, alcohol and excess sugar on those days: they amplify the restlessness.
- Lower the bar: plan fewer demanding things for the premenstrual phase, if you can.
- Treat yourself kindly: talk to yourself as you would to a friend, don't demand the same of yourself as on a good day.
The importance of tracking your cycle
If there's one piece of advice that's worth everything, it's this: note down how you feel each day for a couple of cycles. It will help with two things. First, anticipation: when you know 'those days' are coming, you face them with less fear and organise yourself better. Second, it's the way to tell premenstrual syndrome apart from a constant mood problem: if the distress is always there, and not only before your period, we may be talking about anxiety or depression, and the approach is a different one. That record is also gold for your doctor.
When to see your doctor or gynaecologist
The hormonal and physical side is medical territory. If the symptoms are strong, it's worth seeing your GP or gynaecologist, who can rule out other causes and consider treatments (from lifestyle measures to, in some cases, medication). The U.S. Office on Women's Health notes that there are effective treatments for PMS and PMDD; you don't have to resign yourself to a bad time every month. Bring your record along: it will help them get their bearings much faster.
When to seek psychological help
If the emotional symptoms overwhelm you, if every month they end in arguments or in days when you can't live normally, or if you notice that underneath there's anxiety or sadness that go beyond your period, it's worth seeking psychological help. The same goes if PMDD is really affecting you: psychological support is one of the pillars of managing it, alongside medical follow-up.
How therapy helps
In therapy we don't 'make your period or your hormones disappear', but I do give you tools to live those days differently. We work on emotional regulation so you're not hijacked by irritability or sadness, on anticipation and self-care around your cycle, and on communication with your partner or family so those days add rather than subtract. If underneath there's anxiety, low mood or excessive self-demand, we shed light on that too. I do this through emotional management therapy and, as an online psychologist for women, I accompany many women with this issue, in online therapy, in English, Spanish or Catalan.
If every month you feel you lose a few weeks of your life, get in touch for a first assessment with no obligation. Premenstrual syndrome isn't cured by willpower, but it can be managed far better: you're not exaggerating and you're not alone.