PMS and PMDD

PMS and PMDD are two related conditions involving recurring physical and emotional symptoms in the days before a period. Premenstrual syndrome (PMS) is the general name for these symptoms. Premenstrual dysphoric disorder (PMDD) is the form in which symptoms are more severe and significantly disrupt daily life. These symptoms are not an excuse or a matter of character: they can be assessed and can be eased in many people. The information below offers a general overview and does not replace an individual diagnosis or treatment advice.

What is PMS?

PMS involves recurring physical, emotional and behavioural symptoms that begin in the days before a period and ease when menstrual bleeding starts or shortly afterwards. Many people have mild symptoms and can continue their daily lives.

How do PMS and PMDD differ?

PMDD is considered the most severe end of PMS. Emotional symptoms, such as marked anger, low mood, anxiety and a feeling of losing control, are prominent and significantly affect work, school or relationships. The distinction is based on symptom severity and the effect on life, and is made by a doctor.

What symptoms occur with PMS and PMDD?

• Physical: Bloating, breast tenderness, headaches, weakness, and changes in sleep and appetite
• Emotional: Irritability, feeling tearful, low mood, anxiety and difficulty concentrating
• Behavioural: Social withdrawal and a lack of motivation for daily activities

The timing of symptoms matters: they occur in the days before a period and improve when the period starts or shortly afterwards. Early pregnancy symptoms can be similar, so a pregnancy test is useful if your period is late.

What causes PMS and PMDD?

The exact cause is unknown. Differences in how a person's brain and nervous system respond to fluctuations in hormone levels throughout the cycle are thought to play a role. The issue therefore appears to be related more to sensitivity to these fluctuations than to the amount of hormones.

How are PMS and PMDD diagnosed?

A symptom diary is the most important diagnostic tool. Recording symptoms and their severity every day over several menstrual cycles shows whether they are indeed linked to the premenstrual phase. The doctor also rules out other causes: depression or anxiety that worsens with the cycle, thyroid conditions and other medical conditions are considered as alternative diagnoses. If symptoms persist for most of the month, this may suggest a condition other than PMS and requires separate assessment.

How are PMS and PMDD treated?

Treatment depends on symptom severity, your preference and accompanying conditions.

Can lifestyle changes and supportive approaches help?

Regular sleep, a balanced diet, regular physical activity and ways of managing stress are recommended as a first step for mild symptoms. A symptom diary makes it easier to anticipate and plan for difficult days. The effects of herbal products and supplements have not been sufficiently demonstrated; consult your doctor before using them.

Can cognitive behavioural therapy help PMS and PMDD?

Cognitive behavioural therapy (CBT) is an option that may help particularly with emotional symptoms. Current medical guidance recommends it, and it may be considered for people who do not wish to take medication or want support alongside medication.

Can hormonal methods such as contraceptive pills ease PMS?

Combined oral contraceptives may ease symptoms in people with no contraindications to their use. Some preparations have been studied more extensively for this purpose. The doctor assesses licensing and suitability. Use may be unsuitable in situations such as conditions that increase the risk of blood clots, migraine with aura and pregnancy. The choice of medicine is a medical decision.

When are antidepressants (SSRIs) used?

Selective serotonin reuptake inhibitors (SSRIs) have been found effective for emotional symptoms and are considered for severe PMS or PMDD. Regimens involving use only on certain days of the menstrual cycle or continuous use have been described. Starting, monitoring and stopping these medicines must take place under medical supervision. They are not necessary for everyone, and side effects need to be assessed.

When should you seek specialist support?

You can consult an obstetrician and gynaecologist or a mental health professional if symptoms significantly disrupt work, school or relationships, lifestyle measures are insufficient, symptoms last throughout the month rather than being limited to the premenstrual phase, or you feel low and hopeless.