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What you should know about Period Pain - PMS and PMDD

"I have had really bad days when I have been curled up in bed crying because of abdominal period pain, associated bloating and tender breasts. Emotionally as well, it's a rollercoaster, one moment you are crying for no apparent reason and another moment you wonder why that happened. It's something I don't understand completely so you can imagine that it completely catches your partner off-guard as well. I crave sweets especially chocolate closer to my period. Experiencing period pain and these symptoms every month is really exhausting as it can and has disrupted my daily life and the symptoms are unpredictable."

This personal description of a woman's symptoms before her period is a perfect example of what is called Premenstrual syndrome (PMS). If you have experienced some or all of these symptoms, you are not alone as it is experienced by 80% of women. While the syndrome manifests in its mild form in some women, it can become intolerable in others. The severe form of PMS, called Premenstrual dysphoric disorder (PMDD) is a chronic condition that can disrupt a woman’s quality of life.

What is PMS and PMDD?

PMS is a group of behavioral, emotional, and physical symptoms that occurs one to two weeks before the onset of menstruation. Commonly described as period pain, the symptoms include cramping, breast tenderness, bloating, anxiety, depression, and headache. It can often be treated with lifestyle changes and relaxation therapies. The symptoms usually cease once the period begins.

PMDD is the severe form of PMS, most often characterized by irritability and prominent mood reactivity. Like PMS, the symptoms of PMDD also commence 7 to 14 days before the period and gradually fade once the period starts. Symptoms are similar to PMS but much worse. It occurs in less than 3% to 8% of women of childbearing age.

What causes it?

The exact cause of PMS and PMDD is not very clear. Some studies state that a rise and fall in the levels of reproductive hormones might influence a chemical called serotonin in the brain, which affects mood.

However, it is not yet clear as to why PMS and PMDD affect some women and not others. The most likely explanation for PMDD could be this: women who develop PMDD are highly sensitive to normal fluctuations in hormone levels.


Physical – Cramping, backaches, breast tenderness, headache, bloating, muscle ache, fatigue, sleep and appetite disturbance, and swelling of extremities before the period.

Psychological – Anger, depression, irritability, anxiety, and social withdrawal

Behavioral – Forgetfulness, poor concentration, and fatigue

Though the symptoms of PMS and PMDD are similar, PMDD is very severe. If the symptoms impact one’s daily activities to a large extent, it may be worth talking to your doctor about a PMDD diagnosis.

How to effectively manage them?

You can track your menstrual cycles using apps such as Clue, Maya and Flo, and input mood changes as they occur. This will help in finding ways to tackle the psychological changes.

Dietary changes such as cutting back on caffeine and limiting salty foods and incorporating complex carbohydrates such as fruits and vegetables can help. Calcium-rich foods have been shown to ease the symptoms.

Refrain from smoking - studies say that smoking escalates the severity of symptoms.

Regular exercise can definitely help manage stress and get more sleep.

Your physician may suggest pills for cramps and mood-related disorders.

Some FemTech devices available in the market help alleviate menstrual cramps without the use of drugs.

Livia is an innovative product that is designed to relieve menstrual cramps and it is popular for having an instant effect on cramping. Livia works on unique SmartWave™ technology. It is fixed to a waistband and also consists of two electrode gel pads that can be attached to the lower abdomen.

It works by sending gentle pulses to the nervous system that keep the nervous system occupied and unable to receive menstrual pain signals. Besides, Livia also activates the body’s pain-fighting endorphins. It is scientifically proven with clinical trials and carries FDA approval and CE-marking, making it a suitable alternative with no side effects.

Apart from Livia, other products also exist in the market namely Monthli, Ova+, Ovira and Beurer Menstrual Relax EM 50. All these products work with TENS technology, a transcutaneous electrical nerve stimulation (TENS) unit to treat pain. Except for Beurer which is CE-marked and specific for menstrual pain, the others are not FDA-approved or CE-marked specifically for menstrual pain relief, but rather only for pain relief in general.

We recently learned about an app that helps with period pain called Moonai. The audio app uses science-based & personalized sounds & prediction tools for period pain management. Isn't that interesting?

Let us know in the comments below if you have used any of these products and what you think of them.

Do check out our other women's health products here

About the author

Niranjana S. Rajalakshmi is a veterinary microbiologist turned science journalist, currently based in India. After her under graduation in Veterinary Medicine, she was curious to study diseases at a molecular level which led her to pursue a Master’s in Veterinary Microbiology. When the pandemic struck, she being a microbiologist felt the need to communicate about the hitherto unknown virus and its possible implications to a large audience. Subsequently, she produced several pieces on COVID-19 and other topics related to health, which are being published in leading news outlets in India.

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