Abstract

Premenstrual syndrome (PMS) commonly includes psychological symptoms anxiety, irritability, mood swings that impair daily functioning for many women. Mind-body practices such as Hatha yoga are widely used to reduce stress and mood symptoms, but the physiological mechanisms that might explain benefits for premenstrual psychological complaints remain incompletely synthesized. This review/meta-analytic narrative examines randomized trials, controlled studies, and mechanistic research (n = 30 key papers from PubMed/Google Scholar) on (1) effects of yoga (particularly Hatha/early morning practice) on psychological PMS symptoms and (2) two candidate physiological mediators: the cortisol awakening response (CAR) and serotonergic modulation (tryptophan-serotonin pathway). Across clinical trials and systematic reviews, yoga interventions (including Hatha-format asanas combined with breathwork and brief meditative elements) were associated with moderate reductions in emotional PMS symptoms and improved quality of life compared with controls or alternative exercise (e.g., aerobic), with several randomized controlled trials reporting statistically significant improvements (Erdoğan et al., 2024; Pal et al., 2022; Ranga, 2024). Mechanistic evidence indicates that (a) mind-body interventions can modulate HPA-axis activity including alterations in diurnal cortisol patterns and CAR, and (b) exercise and yoga may influence peripheral markers and upstream metabolism of tryptophan/serotonin, potentially stabilizing mood during luteal phases. However, studies vary in methodology (intervention timing, yoga style intensity, outcome measures, saliva/plasma sampling protocols), and direct trials that concurrently measure PMS symptom changes, CAR, and serotonin metabolites during early-morning Hatha yoga interventions are scarce. We conclude that early morning Hatha yoga is a promising, low-risk intervention for psychological PMS symptoms, potentially acting via CAR normalization and serotonergic pathways, but high-quality trials with standardized CAR and neurochemical measures timed to menstrual cycle phases are needed.

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