Hello Doctor, I experience severe PMS symptoms starting 10–15 days before my period (next due on 28th). It begins around the 15th–18th and includes nausea, vomiting sensation, bloating, heavy head, fatigue, and stress. My IBS also worsens — alternating constipation and diarrhea, sometimes 4 times a day.  Last cycle, I had GERD-like symptoms for 4–5 days — difficulty swallowing, burning throat and acid regurgitation after eating. I also get headaches and mood swings. These symptoms significantly affect my daily life and mental well-being. Once my period starts, I feel a sense of relief. But the premenstrual phase is extremely challenging to manage every month.  Can you please suggest what might be causing such intense PMS and if there’s any treatment or relief available, especially considering my existing IBS condition? Thank you