What is PMS, and why does it feel different for everyone?

Many people misunderstand premenstrual syndrome (PMS) as an "emotional problem" or a psychological conflict. In reality, it is a physiological phenomenon. PMS refers to a group of physical and emotional responses that occur during the luteal phase of the menstrual cycle, rooted in dynamic changes in hormones and the nervous system [1][2].

1. PMS is not an emotional problem

PMS is not "being dramatic" or a purely psychological issue. Its symptoms can be very noticeable, including:

• Mood swings, irritability, and anxiety
• Lower energy and fatigue
• Appetite changes, breast tenderness, and abdominal discomfort

These responses are physiological effects driven by the interaction between hormones and the nervous system. They are not simply emotional conflict or personality problems [1][2].

2. Changes in hormones and the nervous system

PMS mainly involves the interaction of two systems:

1. Hormonal fluctuation

• During the luteal phase, estrogen and progesterone rise and then drop quickly. This dynamic shift is the main time window when PMS symptoms appear [1][2].
• Hormonal changes can affect neurotransmitters such as serotonin and GABA, which directly influence mood, sleep, and energy [1][2][3].

2. Autonomic nervous system response

• During the luteal phase, the balance between sympathetic and parasympathetic activity may change.
• Cyclical changes in heart rate, body temperature, and HRV also reflect dynamic adjustment in the nervous system [4][5].
• Autonomic nervous system adjustment is closely related to emotion regulation, physiological preparation, and stress response.

PMS symptoms are therefore not "overthinking" or simple moodiness. They are physiological expressions shaped by hormones and the nervous system together.

3. Why does PMS vary so much from person to person?

The intensity and specific presentation of PMS can vary widely. Main reasons include:

• Different hormonal sensitivity Some people are more sensitive to estrogen and progesterone fluctuations, with stronger neurotransmitter responses and more noticeable symptoms [1][2].

• Different nervous system regulation Each person's autonomic nervous system responds differently to hormonal changes, affecting emotional reactions and physical sensations [4][5].

• Daily rhythm and stress level Long-term stress, lack of sleep, and irregular routines can amplify both physical and emotional PMS responses [6].

• Influence of Body State People with a lower body state may have less clear rhythm signals between the luteal phase and the start of menstruation, making PMS more noticeable [1][2].

Together, these factors explain why PMS looks and feels different for everyone.

4. Summary

PMS is not an emotional problem. It is the body's natural response during the luteal phase to hormonal fluctuation and nervous system changes [1][2].

Different experiences are shaped by hormonal sensitivity, nervous system regulation, life stress, body rhythm, and other factors.

Understanding PMS and paying attention to your own body rhythm and neuroendocrine dynamics can help you manage premenstrual discomfort more scientifically and make mood, energy, and physical state feel more manageable [1][2][3][4][5][6].

References

1. Premenstrual Syndrome. In: StatPearls. PR Gudipally, 2023. Pathophysiology of PMS includes hormonal modulation of neurotransmitters such as serotonin and GABA. NCBI
2. Modzelewski S., et al. Premenstrual syndrome: new insights into etiology and clinical management. Frontiers in Psychiatry, 2024. Frontiers
3. Koifman R., et al. Cardiovascular autonomic profile in women with premenstrual syndrome. Frontiers in Physiology, 2018. Frontiers
4. Roy S. Autonomic Nervous System, cognition, and emotional valence in menstrual cycle. PMC, 2025. PMC
5. de Zambotti M., et al. Autonomic regulation across phases of the menstrual cycle. PMC, 2013. PMC
6. Liu Q., Psychological stress dysfunction in women and PMS pathways, 2024. ScienceDirect