The absence of reports of premenstrual syndrome (PMS) in contexts such as China, Hong Kong, and India has led to the conclusion that PMS is a culture-bound syndrome. This qualitative study examines whether is it possible for women in a Western cultural context to negotiate negative premenstrual change in order to effectively avoid or reduce premenstrual distress. Sixty women who self-defined as a 'PMS sufferer' took part in one-to-one interviews, which were analysed using theoretical thematic analysis from a material-discursive-intrapsychic (MDI) perspective. Three major themes were consistently identified across relationship type and context, reflecting women's strategies of premenstrual self-regulation and coping: 'Self-monitoring and awareness: recognition and acceptance of premenstrual change'; 'Coping through self-regulation of premenstrual distress', including: 'avoidance of stress and conflict', 'escaping relational demands and responsibilities', and 'care of the self'; and 'Coping as an inter-subjective experience'. These findings challenge the view of PMS as a fixed unitary syndrome, suggesting that premenstrual change is an ongoing process of negotiation, in which women are agentic subjects, not passive 'PMS sufferers'. This has implications for therapists working with women reporting moderate-severe PMS, suggesting that the reframing of 'symptoms' as normal change, behavioural coping strategies, and self-monitoring, can effectively reduce premenstrual distress.