Background: Premenstrual Syndrome (PMS) affects a significant proportion of menstruating women worldwide, with symptoms ranging from physical discomfort to serious psychological disturbances. In regions like Shimla, where menstrual and mental health discussions remain socially constrained, PMS remains underrecognized and poorly addressed, impacting women's daily functioning and emotional well-being. Materials and Methods: A descriptive, cross-sectional online survey was conducted among 400 women aged 15–45 years in Shimla district from January to February 2025. A bilingual structured questionnaire explored socio-demographics, PMS awareness, symptom recognition, lifestyle impact, coping strategies, and social attitudes. Data were analyzed using SPSS 26.0, applying descriptive statistics and chi-square tests. Results: Most respondents (71.0%) acknowledged lifestyle changes as helpful in managing PMS. Common symptoms like mood swings, fatigue, and bloating were well recognized. However, fewer participants could identify psychological connections or openly discuss PMS at school or work (45.8%). Based on total scores, 14.8% showed very good awareness, 37.3% good, 33.0% fair, and 14.9% poor knowledge. Despite moderate awareness levels, stigma and emotional silencing were evident. Conclusion: While awareness of PMS is growing among women in Shimla, stigma and mental health illiteracy persist. The findings call for targeted interventions to normalize menstruation-related mental health discussions, improve health education, and enhance access to gender-sensitive, holistic care.
Premenstrual Syndrome (PMS) is a common but often misunderstood condition that affects millions of women globally, manifesting in both physical and psychological symptoms during the luteal phase of the menstrual cycle. These symptoms can range from bloating, fatigue, and breast tenderness to more severe emotional disturbances such as mood swings, irritability, anxiety, and depression. Despite its prevalence, PMS remains underrecognized and frequently trivialized, leading many women to endure its effects in silence or dismiss them as a routine part of womanhood. This lack of validation not only hinders early diagnosis and support but also perpetuates stigma surrounding menstrual health and mental well-being [1-4].
In the Indian context, especially within semi-urban and rural communities like those in Shimla district, conversations around menstruation and mental health continue to be restricted by cultural taboos and misinformation. Many women are unaware that the cyclical emotional and behavioral changes they experience may be attributed to PMS or, in severe cases, Premenstrual Dysphoric Disorder (PMDD). These conditions can significantly impact a woman’s quality of life, relationships, academic or job performance, and overall psychological health. Yet, they are rarely discussed with family members, employers, or even healthcare professionals [5-7].
Furthermore, coping mechanisms vary widely, ranging from over-the-counter painkillers and traditional remedies to behavioral adjustments and, in some cases, complete resignation. The absence of structured educational interventions and limited integration of menstrual mental health into primary healthcare services contribute to an environment where women lack the knowledge or support to manage PMS effectively. Understanding how women in Shimla perceive, experience, and respond to PMS is essential for developing context-specific health literacy strategies and psychosocial interventions [6-8].
This research was designed as a descriptive, cross-sectional online survey aimed at assessing the awareness, experiences, and coping strategies related to Premenstrual Syndrome (PMS) among women residing in Shimla. The digital approach was selected for its broad reach and ability to ensure anonymity in a culturally sensitive topic.
The study targeted female residents of Shimla district, including both urban and semi-urban areas. Women aged 15 to 45 years—the typical reproductive age range during which PMS occurs—were eligible for participation. The study embraced diversity across educational levels, marital status, and employment backgrounds.
Female participants aged 15–45 years
Permanent residents of Shimla (living in the district for at least 12 months)
Ability to understand and respond in Hindi or English
Access to an internet-enabled device (smartphone, tablet, or computer)
Willingness to provide informed digital consent
Exclusion Criteria
Women currently diagnosed with a major psychiatric illness unrelated to PMS
Healthcare professionals specializing in gynecology or psychiatry (to reduce bias)
Data were collected over a 6-week period, from January 1 to February 15, 2025, coinciding with national menstrual hygiene awareness efforts.
A non-probability convenience sampling method was used. The survey link was distributed through:
WhatsApp and Facebook groups targeting women in Shimla
Local women’s collectives and college forums
Online platforms of NGOs and community health centers
Local SHGs (Self-Help Groups) and Mahila Mandals
A target sample size of 400 responses was set based on an assumed 50% baseline awareness prevalence, with a 5% margin of error at 95% confidence.
A structured bilingual questionnaire (Hindi and English) was developed using Google Forms. The tool was reviewed by experts in gynecology, psychology, and public health. It consisted of five sections:
Demographics – Age, education, marital status, occupation, and residence type.
Knowledge and Recognition of PMS – Awareness of common physical and psychological symptoms, timing, and severity.
Impact on Daily Life – Self-reported effects on academic/work productivity, relationships, mood, and routine tasks.
Coping Mechanisms – Use of medication, rest, lifestyle modifications, home remedies, or professional consultation.
Attitudes and Barriers – Willingness to discuss PMS, perceived stigma, and openness to seeking mental health support.
The questionnaire underwent pilot testing with 30 women for validation. Their feedback was used to refine question clarity and flow.
Participants accessed a survey link that included an introductory page outlining the study's purpose, voluntary nature, anonymity assurance, and digital consent form. Each device was allowed one-time submission to prevent duplication.
Responses were exported to Microsoft Excel and analyzed using SPSS Version 26.0. Descriptive statistics (frequencies, percentages) were used to summarize responses.
Informed digital consent was obtained before participation. No personally identifiable information was collected, and data were analyzed anonymously in accordance with ethical guidelines for online health research.
A total of 400 women residing in Shimla participated in the online survey. The majority were aged between 25–34 years (38.5%), followed by those aged 15–24 years (27.0%). More than half (58.0%) of the participants were married, and 63.5% held a graduate degree or higher. Urban and semi-urban residents constituted 64.3% of the sample. The occupational status varied, with 45.5% employed and 28.5% identifying as homemakers. This diverse demographic representation provided a meaningful context for interpreting PMS awareness and its impact on daily life across different segments of the female population (Table 1).
Variable | Category | Frequency (n) | Percentage |
Age Group | 15–24 years | 108 | 27.0% |
25–34 years | 154 | 38.5% | |
35–44 years | 96 | 24.0% | |
45+ years | 42 | 10.5% | |
Marital Status | Unmarried | 168 | 42.0% |
Married | 232 | 58.0% | |
Education Level | Up to Secondary | 146 | 36.5% |
Graduate & Above | 254 | 63.5% | |
Residence Type | Urban/Semi-Urban | 257 | 64.3% |
Rural | 143 | 35.7% | |
Occupation Status | Employed | 182 | 45.5% |
Homemaker | 114 | 28.5% | |
Student | 72 | 18.0% | |
Unemployed | 32 | 8.0% |
Participants were categorized into four levels based on their total correct responses out of 20. The majority (37.3%) exhibited ‘Good’ knowledge, while 33.0% fell under the ‘Fair’ category. Only 14.8% had ‘Very Good’ knowledge, reflecting strong understanding and awareness. However, 14.9% demonstrated poor awareness, underscoring the need for better menstrual mental health education and open discussion about PMS in community and healthcare settings (Table 3).
Question | Options | Correct (n) | % |
Which phase of the menstrual cycle does PMS occur? | a) Follicular phase, b) Ovulation phase, c) Luteal phase, d) Menstrual phase | 264 | 66.0% |
Which of the following is a psychological symptom of PMS? | a) Mood swings, b) Fever, c) Head lice, d) Sore throat | 246 | 61.5% |
Is PMS a medically recognized condition? | a) Yes, b) No, c) Only in western medicine, d) Not anymore | 270 | 67.5% |
What percentage of menstruating women may experience PMS? | a) Less than 10%, b) 30–50%, c) Over 70%, d) 100% | 228 | 57.0% |
Can PMS affect concentration and work performance? | a) Yes, b) No, c) Only in teens, d) Only physically | 312 | 78.0% |
Is PMDD a more severe form of PMS? | a) Yes, b) No, c) They are the same, d) PMDD is fake | 302 | 75.5% |
Which hormone fluctuation is primarily associated with PMS? | a) Insulin, b) Estrogen & progesterone, c) Thyroxine, d) Adrenaline | 211 | 52.8% |
Is bloating a common PMS symptom? | a) Yes, b) No, c) Only in summer, d) Only if you overeat | 296 | 74.0% |
Which of the following is NOT a typical PMS symptom? | a) Breast tenderness, b) Headaches, c) Fever, d) Cramps | 248 | 61.0% |
Is PMS treatable with lifestyle changes? | a) Yes, b) No, c) Only with surgery, d) Only with hormones | 284 | 71.0% |
Can PMS cause sleep disturbances? | a) Yes, b) No, c) Only with heavy periods, d) Not proven | 278 | 69.5% |
Which profession is best suited to help with PMS-related distress? | a) Engineer, b) Teacher, c) Gynecologist or mental health expert, d) Chemist | 294 | 73.5% |
Is PMS purely psychological? | a) No, b) Yes, c) Only during stress, d) Only in urban areas | 267 | 66.8% |
Can PMS be linked to depression and anxiety? | a) Yes, b) No, c) Only if untreated, d) Not in India | 290 | 71.5% |
Do most women talk openly about PMS at work? | a) No, b) Yes, c) Depends on office, d) Only in schools | 183 | 45.8% |
Which of the following is a common coping strategy for PMS? | a) Painkillers and rest, b) Isolation, c) Skipping meals, d) Increasing caffeine | 288 | 72.0% |
Is physical activity helpful in reducing PMS symptoms? | a) Yes, b) No, c) Only yoga, d) Not if you're tired | 276 | 69.0% |
Is it normal to miss school or work due to PMS? | a) Never, b) Sometimes, c) Always, d) Only in rural areas | 198 | 49.5% |
Can stress make PMS symptoms worse? | a) Yes, b) No, c) Only if you skip meals, d) Not linked | 282 | 70.5% |
Should mental health support be included in menstrual health care? | a) Yes, b) No, c) Only in hospitals, d) Only for teens | 318 | 79.5% |
The participants responded to 20 multiple-choice questions addressing the recognition of PMS symptoms, psychological and physical impacts, coping strategies, and attitudes toward discussing menstrual health. While general awareness of PMS symptoms such as bloating, fatigue, and mood swings was relatively high, misconceptions about causes, diagnosis, and severity were still prevalent. Although 71.0% of respondents recognized lifestyle changes as an effective strategy, less than 50% felt comfortable discussing PMS at work or school. This indicates that despite awareness, stigma and underreporting continue to affect health-seeking behavior and emotional well-being (Table 2).
Knowledge Category | Score Range (%) | Frequency (n) | Percentage (%) |
Very Good | ≥ 80 | 59 | 14.8% |
Good | 60–79 | 149 | 37.3% |
Fair | 40–59 | 132 | 33.0% |
Poor | < 40 | 60 | 14.9% |
This study offers important insights into the awareness, perceptions, and impact of Premenstrual Syndrome (PMS) among women in Shimla, revealing both encouraging levels of recognition and persistent social and informational gaps. While the majority of respondents demonstrated a fair to good understanding of PMS—particularly concerning physical symptoms such as bloating, fatigue, and mood fluctuations—a significant portion of the population remains unaware of key hormonal causes and the psychosocial consequences of PMS and PMDD. Despite 71% acknowledging that PMS can be effectively managed through lifestyle changes, many still associate it primarily with physical discomfort, downplaying or overlooking its mental health implications.
The data highlight that while symptoms like mood swings and irritability are commonly reported, a lack of structured mental health literacy around PMS continues to hinder timely support-seeking. Notably, less than half of participants felt comfortable discussing PMS-related concerns at work or school, emphasizing the persistent stigma attached to menstrual health and emotional well-being. This silence is particularly concerning in a cultural context like Shimla’s, where societal expectations, familial conservatism, and gender roles often limit open conversations about reproductive and mental health.
Interestingly, a majority of participants correctly identified the luteal phase as the time when PMS occurs and recognized PMDD as a more severe form of PMS. Yet, misconceptions remain around whether PMS is purely psychological, and fewer participants could confidently link PMS to broader emotional disorders such as anxiety and depression. The lack of knowledge about non-traditional symptoms or secondary impacts—such as concentration loss and sleep disturbances—further highlights a need for community education.
This study also underscores the importance of professional healthcare guidance. Although 73.5% of participants correctly identified gynecologists or mental health experts as the right professionals for PMS support, informal remedies and silence remain common coping strategies. Such trends indicate an urgent need to integrate PMS awareness into menstrual and mental health curricula in schools, workplaces, and community health centers. Overall, these findings suggest that while awareness exists, a comprehensive, stigma-free, and mental health-inclusive approach is essential for addressing PMS in women across Shimla and similar settings.
This study reveals that while a substantial number of women in Shimla possess a foundational awareness of PMS, there are still critical knowledge gaps and significant social discomfort that hinder open dialogue and effective management. The interplay of stigma, limited understanding of psychological symptoms, and cultural silence continues to challenge efforts in promoting menstrual mental health. Strengthening education, fostering workplace and school openness, and integrating mental health support into primary reproductive care are vital steps toward empowering women to manage PMS with dignity, knowledge, and support.
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