Premenstrual tension (PMT) also known as PMS occurs in most women but to varying degrees. Women who exercise regularly may not notice the symptoms of PMT until they have an injury where they can no longer exercise.

The symptoms of bloating, low mood, and headaches are thought to be due to the drop in estrogen and rise in progesterone after an egg is released mid cycle before one's period begins; but it is not entirely understood.

Exercise can help with symptoms as mentioned above, some people find evening primrose oil 2 grams a day can really help. While for others taking a medication to increase serotonin levels for the second half of the cycle can have a significant effect.

We ‌start with exercise, stress management and evening primrose oil and if this has no effect go straight to the oral contraceptive pill. Suppose this doesn't work after 2-3 months next step a medication to increase serotonin levels.

The effects of combined oral contraceptive pills (COCs) on premenstrual syndrome (PMS) can vary from person to person. For some individuals, COCs can help ease PMS symptoms, while for others, they may have no effect or potentially worsen symptoms.

COCs work by preventing ovulation and altering hormone levels in the body. By providing a steady level of hormones throughout the menstrual cycle, they can help regulate the menstrual cycle and reduce the fluctuations in hormone levels that contribute to PMS symptoms.

For many people, taking COCs can result in a more predictable and lighter menstrual cycle, leading to a reduction in PMS symptoms such as bloating, breast tenderness, and mood swings. Additionally, the pill can help manage symptoms related to hormonal imbalances, such as acne or heavy menstrual bleeding.

However, it's important to note that individual responses to COCs can vary. Some individuals may find that their PMS symptoms worsen or remain unchanged while taking COCs. Each person's hormonal balance and response to the specific formulation of the pill can influence how they experience PMS symptoms.

If you're considering using COCs for PMS management or experiencing changes in your symptoms after starting them, it's best to consult with a doctor. They can evaluate your specific situation, discuss potential alternatives, and provide personalized guidance based on your medical history and individual needs.