March 2023
Premenstrual Syndrome (PMS) is a cyclical condition characterised by physical, psychological, and behavioural symptoms in the luteal phase of the menstrual cycle. Despite affecting a large proportion of reproductive-age women, PMS remains underdiagnosed, poorly supported in educational and occupational settings, and inadequately researched. This study aimed to characterise the breadth and severity of PMS symptoms and their impact on daily functioning, relationships, and work and to describe the coping strategies women currently employ, including their rated effectiveness. The survey was conducted by DR.VEGAN®, March 2023.
A cross-sectional online survey was administered to 265 women. Individual-level response data were available for all analyses. The survey captured the dietary profile; clinical diagnoses of PMDD and PCOS; hormonal medication use; subjective emotional experience of PMS; regularly experienced physical and psychological symptoms; the most disruptive symptoms; behavioural changes during the menstrual cycle; coping strategy use and rated effectiveness (1–10 scale); period education experience; and the impact of PMS on relationships, work, and educational attendance. Respondents who did not answer a given question were excluded from the denominator for that question.
Of 265 respondents, 61.9% followed an omnivorous diet, 15.5% were vegan, 9.8% vegetarian, and 6.4% pescatarian. The majority (89.8%) had no formal diagnosis of PMDD or PCOS; 3.8% had been diagnosed with PMDD and 6.4% with PCOS. Most respondents (67.9%) were not taking any hormonal medication; 15.1% were taking HRT, and 10.9% were on hormonal contraception.
When asked to describe how PMS makes them feel, respondents overwhelmingly selected negative descriptors. Positive descriptors were almost entirely absent, with only 7.1% selecting ‘normal’. See Figure 1.
| Emotional descriptor | % selecting (n=238) |
|---|---|
| Snappy / irritable | 81.5% |
| Tired / sluggish | 80.7% |
| Anxious | 63.9% |
| Sad | 52.1% |
| Depressed | 49.6% |
| Self-conscious | 42.9% |
| Normal | 7.1% |
| Confident | 0.8% |
| Productive | 0.8% |
| Happy | 0.4% |
| Proud | 0.0% |
Of 237 respondents, 95.4% reported at least one regular PMS symptom. The mean number of symptoms per respondent was 8.3 (median 9), with 61.6% reporting seven or more and 42.6% reporting ten or more. See Figure 2 for the full symptom prevalence profile.
| Symptom | n (of 237) | Prevalence |
|---|---|---|
| Mood swings | 167 | 70.5% |
| Bloating and wind | 162 | 68.4% |
| Back pain | 142 | 59.9% |
| Less energy | 133 | 56.1% |
| Tummy pain | 132 | 55.7% |
| Poor concentration / brain fog | 122 | 51.5% |
| Breast tenderness | 118 | 49.8% |
| Depressed / mild depression | 116 | 48.9% |
| Changes in appetite or cravings | 113 | 47.7% |
| Headaches or migraines | 109 | 46.0% |
| Trouble sleeping / insomnia | 100 | 42.2% |
| Weight gain (fluid retention) | 94 | 39.7% |
| Spotty skin / breakouts | 91 | 38.4% |
| More frequent bowel movements | 80 | 33.8% |
| Joint or muscle pain | 78 | 32.9% |
| Changes in sex drive | 76 | 32.1% |
Of 217 respondents who identified their most disruptive symptoms (up to three), mood swings were by far the most frequently cited (39.6%), followed by depressed or mild depression (24.4%), trouble sleeping or insomnia (23.5%), and bloating (22.6%). Psychological and neurological symptoms were perceived as the greatest disruptors of daily life. See Figure 3.
| Most disruptive symptom | % citing as most disruptive (n=217) |
|---|---|
| Mood swings | 39.6% |
| Depressed / mild depression | 24.4% |
| Trouble sleeping / insomnia | 23.5% |
| Bloating and wind | 22.6% |
| Headaches or migraines | 19.8% |
| Poor concentration / brain fog | 18.0% |
| Tummy pain | 16.1% |
| Less energy | 16.1% |
| Back pain | 8.3% |
| Joint or muscle pain | 7.4% |
PMS was associated with significant negative changes in diet and exercise behaviour. See Figure 4 for the directional impact on these two key health behaviours.
| Behaviour affected | Worsens during PMS | Improves during PMS |
|---|---|---|
| Diet quality (n=223) | 66.4% | 4.9% |
| Ability to exercise (n=223) | 67.3% | 1.8% |
Of 221 respondents, the most widely adopted coping strategies were ibuprofen (46.2%), vitamins or supplements (44.3%), paracetamol (42.5%), and giving in to cravings (39.8%). Effectiveness was rated on a 1–10 scale. Notably, no widely used strategy achieved a mean score above 7/10, highlighting the substantial unmet need for effective PMS management. See Figure 5 for uptake and effectiveness data across all strategies.
| Coping strategy | % using (n=221) | n using | Mean score (/10) | % scoring 7+ |
|---|---|---|---|---|
| Ibuprofen | 46.2% | 102 | 6.33 | 50.5% |
| Vitamins or supplements | 44.3% | 98 | 6.24 | 46.9% |
| Paracetamol | 42.5% | 94 | 5.82 | 35.6% |
| Giving in to cravings | 39.8% | 88 | 4.68 | 18.8% |
| Hot water bottle / strap | 38.5% | 85 | 6.41 | 50.5% |
| Exercise | 21.3% | 47 | 6.91 | 58.7% |
| Drinking more water / hot drinks | 19.9% | 44 | 5.94 | 37.5% |
| Mindfulness / stress reduction | 19.9% | 44 | 6.08 | 43.2% |
| Sleeping longer | 18.1% | 40 | 5.72 | 32.5% |
| Antidepressants | 10.9% | 24 | 6.29 | 54.2% |
Giving in to cravings is highlighted as the weakest performer. No strategy achieved a mean score above 7.
Social and occupational impact. PMS had substantial consequences beyond the individual. See Figure 6 for the full social, occupational, and educational impact profile.
| Impact area | % affected |
|---|---|
| PMS impacts relationships (n=216) | 67.6% |
| Has taken time off work / education due to PMS (n=216) | 40.7% |
| Employer / school does not understand or support them (n=216) | 76.9% |
| Received no PMS / period education at school | 30.6% |
| Received some but inadequate period education | 48.1% |
| Received well-rounded period education | 21.3% |
Only 21.3% reported being well-educated on PMS / period health at school, while 48.1% received some but inadequate education and 30.6% received none at all. Respondents repeatedly called for better education for both girls and boys, greater GP awareness, and broader societal normalisation of menstrual health.
This survey of 265 women demonstrates that PMS imposes a high and multi-dimensional burden, with a mean of 8.3 symptoms per respondent and over 60% experiencing seven or more. Psychological symptoms, particularly mood swings, anxiety, low mood, and brain fog, are experienced as the most disruptive. The condition significantly affects eating habits, exercise capacity, relationships, and occupational attendance, yet institutional support is largely absent (76.9% feel unsupported). Current coping strategies provide only partial relief, and none approaches complete symptom resolution. These findings point to an urgent need for improved clinical recognition, workplace accommodation, school education, and evidence-based non-pharmacological interventions for PMS.
Keywords: PMS, premenstrual syndrome, menstrual health, mood swings, bloating, brain fog, coping strategies, occupational impact, women’s health, period education
Survey date: March 2023 | Sample size: N = 265 | Data: Individual-level responses
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