Around 90 per cent women of reproductive age can predict the onset of their periods, even if they are irregular. The women develop typical symptoms which gives them a clue: bodies feel bloated, clothes are tight, there may be aches, muscle pains, headaches, constipation or diarrhoea, moodiness or depression. Symptoms start 5-10 days before the periods and disappear with their onset or a day or two later. They reappear with clockwork precision every month. After three such months in a row, the diagnosis of premenstrual syndrome or PMS is made.

PMS sets in 5-10 years after menarche. In 20 per cent women, the symptoms are very severe, of which five per cent find it difficult to lead a normal life during this time. Some are forced to stay away from college or work. Their academic performance and career suffer. Their families find them intolerable. Family relationships break down. This is more likely to occur in women who are already depressed, subject to a high degree of stress at home or in the workplace, lead sedentary lives and are exposed to cigarette smoke.

The exact reason for PMS is not known. One of the theories is that after ovulation (10 days before the onset of the next period) there are physiological changes in hormone levels (estrogen and progesterone). This change in ratio is responsible for the symptoms. Although the hormone variation occurs in all women, some seem to be more sensitive to it than others.

There is no diagnostic laboratory test for PMS. The diagnosis is presumptive and based on the history of the regular appearance of these symptoms. If the periods are also painful, a pelvic scan should be taken to rule out other things such as fibroids or endometriosis. These conditions can coexist with PMS. Depression, chronic fatigue and irritable bowel syndrome can worsen during this time.

Some women report relief from fatigue and depression with calcium supplements. Magnesium may help to relieve headache. Vitamin B6 (pyridoxine) helps with psychological symptoms such as irritability, bloating and forgetfulness. Muscle cramps may be relieved with omega 3 fatty acids. Evening primrose oil capsules also may relieve many symptoms.

Over-the-counter painkillers such as naproxen, paracetamol, mefenamic acid and ibuprofen can help with cramps, headaches, backaches, and breast tenderness. They should be started as soon as the symptoms appear. If the symptoms are severe, oral contraceptive pills can be started. They deliver a fixed-dose combination of synthetic estrogen and progesterone and are beneficial in some women. Some patients may require antidepressants. Diuretics can be given for a few days in the month to get rid of bloating and water retention.

Many herbal supplements are advertised for the relief of PMS symptoms. These have not been objectively evaluated, their composition is unknown and they may react with other medication being taken for co-existent ailments.

Symptoms of PMS can be reduced naturally with lifestyle modifications:

• Exercise aerobically for 40 minutes a day, such as walking, running, swimming or cycling
• Practise mindful breathing three to four times a day, 10 minutes at a time
• l Learn yoga and practise meditation
• Avoid people who smoke
• Ensure you get 7-8 hours of sleep at night
• Maintain a healthy diet with 4-6 helpings of fresh fruits and vegetables. Non-vegetarians should increase fish consumption. Do not eat too much red meat. Reduce salt and sugar intake
• Decrease caffeine intake by cutting down on tea, coffee and cola
• Avoid alcohol.