Understanding PMS and PMDD: The Role of Body, Mind, and Society

Abstract

Premenstrual Syndrome (PMS) — a condition characterized by a range of recurring physical, emotional, and behavioral symptoms that occur during the luteal phase of the menstrual cycle, just before menstruation that has gained substantial attention in recent decades, both within medical circles and broader social discourse. In more severe cases, some women experience Premenstrual Dysphoric Disorder (PMDD), a mood-related condition recognized as a clinical mental health disorder in the DSM-5. Women with PMDD often face intense emotional shifts that interfere with daily life, relationships, and work.PMS has been investigated at different levels: biological, psychological, and sociocultural. The biological basis of PMS is most closely associated with cyclical changes in hormones, particularly regarding the fluctuation of estrogen and progesterone. This study utilizes a qualitative research approach through a comprehensive literature review to explore the underlying causes of Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) using a biopsychosocial framework. This model acknowledges the complex interplay between biological, psychological, and sociocultural factors in influencing symptom expression, diagnosis, and treatment. Using a narrative synthesis approach, data from the selected studies were compared, contrasted, and synthesized to identify common patterns, theoretical perspectives, and gaps in the literature. Recent research advocates for a more comprehensive biopsychosocial approach to understanding PMS and PMDD. From a biological standpoint, fluctuations in estrogen and progesterone influence neurotransmitters such as serotonin and GABA, which are crucial for mood regulation. Women who are biologically sensitive to these hormonal shifts may experience more intense emotional and physical symptoms. Given this complex interplay of biological, psychological, and social factors, effective treatment for PMS and PMDD must be multidimensional. Pharmacological interventions such as selective serotonin reuptake inhibitors (SSRIs) and hormonal contraceptives can provide relief, but non-pharmacological strategies like cognitive behavioral therapy (CBT), regular exercise, and dietary changes have also proven beneficial. Ultimately, the most successful treatment outcomes occur when care is tailored to a woman\'s unique physiological and psychosocial background. A holistic, interdisciplinary approach that integrates clinical, psychological, and cultural considerations is essential for effectively managing PMS and PMDD, ensuring more personalized and comprehensive care for affected women.

Introduction

Overview

Premenstrual Syndrome (PMS) is a recurring set of physical, emotional, and behavioral symptoms that appear during the luteal phase of the menstrual cycle. While most menstruating women experience some form of PMS, 20–40% report significant disruption. The more severe form, Premenstrual Dysphoric Disorder (PMDD), is classified as a mental health disorder in the DSM-5, marked by intense mood shifts that affect daily functioning.

Historical and Social Context

PMS was historically trivialized or misunderstood, gaining broader recognition only in the 1980s due to cultural, legal, and media influences. Legal cases, feminist debates, and media coverage contributed to shifting PMS from a private issue to a public, medical, and legal concern. Scholars such as Rittenhouse (1989) argue that PMS should be understood as a socially constructed health condition, shaped by culture, gender norms, and medical discourse.

Biopsychosocial Framework

Modern research favors a biopsychosocial model to understand PMS and PMDD. This framework integrates:

• Biological factors: Hormonal fluctuations (e.g., estrogen, progesterone), neurotransmitter changes (e.g., serotonin), and genetic predispositions.

• Psychological factors: Mood disorders, personal coping strategies, emotional resilience, and mental health history.

• Sociocultural factors: Menstrual stigma, societal attitudes, and gender-based healthcare disparities.

Women’s perceptions of their symptoms are influenced by cultural context, social support, and stigma surrounding menstruation, particularly in urban vs. rural settings.

Research Methodology

The study conducted a qualitative literature review (2015–2024), analyzing 98 peer-reviewed articles sourced primarily from Google Scholar. Inclusion criteria focused on empirical and theoretical studies exploring biological, psychological, and social dimensions of PMS/PMDD. Themes were analyzed through narrative synthesis and organized according to diagnostic practices, assessment tools, and intervention strategies.

Findings

• PMS symptoms (e.g., irritability, fatigue, food cravings) usually last around six days per cycle, peaking just before menstruation.

• PMDD is a more debilitating form of PMS that significantly affects emotional well-being, work, and social life.

• The lack of a unified clinical definition of PMS persists, complicated by cultural assumptions and gendered stereotypes.

• Emotional and physical symptoms are often exacerbated in societies with high menstrual stigma.

• Urban women, especially in developing countries like India, may experience more severe symptoms due to increased stress and socio-economic challenges.

Treatment Implications

Effective treatment for PMS and PMDD must be multidimensional:

• Pharmacological: SSRIs, hormonal contraceptives.

• Psychological: Cognitive Behavioral Therapy (CBT), emotional regulation techniques.

• Lifestyle: Diet, exercise, stress management.
  Tailoring interventions to each woman’s biological and sociocultural context yields better outcomes.

Conclusion

In conclusion, Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are multifaceted conditions that cannot be understood through a singular lens, as they are shaped by biological, psychological, and sociocultural influences. The biopsychosocial model provides a comprehensive framework for examining these disorders, highlighting the crucial role of hormonal fluctuations, mental health factors, and societal context in both the expression and perception of symptoms. Biological factors, particularly the interplay between estrogen, progesterone, and neurotransmitters such as serotonin, play a significant role in the onset of mood and physical symptoms. Psychological factors, including pre-existing mental health conditions like anxiety and depression, can exacerbate these symptoms, making them more disruptive to daily functioning. Sociocultural influences, such as menstrual stigma and societal expectations of emotional control, further complicate the experience and reporting of PMS and PMDD. Treatment approaches must, therefore, be multidimensional and tailored to the individual. Pharmacological interventions such as SSRIs and hormonal contraceptives can provide symptom relief, but non-pharmacological strategies like cognitive-behavioral therapy (CBT), lifestyle changes, and support systems are equally important. A holistic, interdisciplinary approach that integrates clinical, psychological, and cultural considerations is essential for effectively managing PMS and PMDD, ensuring more personalized and comprehensive care for affected women.

References

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Copyright

Copyright © 2025 Shivani Yadav . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.