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Background Premenstrual syndrome (PMS) is a common cyclical disorder among reproductive-aged women that adversely affects physical, psychological, and emotional well-being. It is associated with impaired daily functioning, reduced academic performance, and diminished quality of life. Despite its high prevalence, PMS often remains under-recognized and undertreated among young women. Aim This study aims to determine the prevalence of premenstrual syndrome among female medical students aged 18-25 years and to evaluate its association with lifestyle factors and its impact on academic productivity. Methods A cross-sectional questionnaire-based study was conducted among 250 female medical students aged 18-25 years at Sumandeep Vidyapeeth, Vadodara, Gujarat, India, between May and September 2024. Results Among the 250 participants, 188 (75.2%) were identified with PMS. Mood swings (76.4%), abdominal cramps (61.2%), and overthinking (56.0%) were the most frequently reported symptoms. Junk food consumption (70.8%), mental stress (59.6%), and inadequate sleep (49.2%) were common lifestyle factors. PMS was significantly associated with reduced productivity (73.4% versus 14.5%; p<0.001), increased mental stress (p<0.001), and greater analgesic use (p<0.001). Conclusion Premenstrual syndrome was highly prevalent among young female medical students and was associated with unhealthy lifestyle factors and impaired academic productivity. Early identification, appropriate counselling, and timely management may reduce symptom burden and improve academic performance and overall quality of life.