Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Premenstrual syndrome (PMS) refers to a group of physical, emotional and behavioural symptoms that occur in the days before a period and usually improve once menstruation begins. Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that can have a significant impact on mood, relationships, work and daily life.
Commonality
PMS is very common and affects up to 75% of women of reproductive age.
PMDD is less common, affecting approximately 3–8% of women, but symptoms are often much more severe and disruptive.
Causes
The exact cause of PMS and PMDD is not fully understood, but they are thought to result from increased sensitivity to normal hormonal changes during the menstrual cycle.
Possible contributing factors include:
Fluctuations in oestrogen and progesterone after ovulation
Changes in brain neurotransmitters such as serotonin and GABA
Genetic predisposition
Stress or previous trauma
Underlying mental health conditions
For women with PMDD, the brain appears to react differently to normal hormonal changes.
Symptoms
Symptoms usually occur during the 7–14 days before a period and improve once menstruation begins.
Emotional and behavioural symptoms may include:
Mood swings
Irritability or anger
Anxiety
Low mood
Difficulty concentrating
Tearfulness or emotional sensitivity
Physical symptoms may include:
Bloating
Breast tenderness
Headaches
Fatigue
Sleep disturbance
Changes in appetite
Cramps or back pain
PMDD may cause more severe symptoms, including:
Intense mood swings
Severe irritability or anger
Anxiety or panic attacks
Depression or feelings of hopelessness
Loss of interest in daily activities
Emotional outbursts
In severe cases, PMDD may be associated with suicidal thoughts, which require urgent medical support.
Effects on Fertility
Diagnosis
Diagnosis is based on a detailed assessment of symptoms and their relationship to the menstrual cycle.
Assessment may include:
Detailed menstrual and symptom history
Review of physical and mental health
Evaluation of symptom timing throughout the cycle
Exclusion of other conditions such as thyroid disorders or depression
Symptom tracking using a diary or menstrual tracking app
Recording symptoms over two or more menstrual cycles can help confirm the diagnosis.
Because PMDD symptoms can resemble anxiety or depressive disorders, accurate diagnosis is essential.
Treatments
Treatment depends on symptom severity and how much symptoms affect daily life.
Lifestyle measures may include:
Regular physical activity
Balanced diet
Reducing caffeine and sugar intake
Adequate sleep
Stress management techniques such as mindfulness or yoga
Medical treatments may include:
Hormonal contraception to suppress ovulation
Oestrogen therapy with appropriate progesterone protection
Selective serotonin reuptake inhibitors (SSRIs)
Pain relief for headaches or pelvic discomfort
Psychological support may include:
Cognitive behavioural therapy (CBT)
In rare, severe cases, additional hormonal therapies or surgical options may be considered.
Ongoing Care
Living with the Condition
PMS and PMDD can affect many aspects of daily life, including work, relationships, confidence and emotional wellbeing. For some women, symptoms are mild and manageable, while for others they can significantly interfere with normal activities.
Understanding symptom patterns and receiving appropriate treatment can help improve quality of life. With a personalised management plan, many women achieve good symptom control and feel more in control of their menstrual cycle and overall wellbeing.
When to See a Specialist
You should consider specialist assessment if:
Premenstrual symptoms interfere with work, relationships or daily life
Mood changes feel overwhelming or unpredictable
Symptoms are becoming more severe over time
You suspect you may have PMDD
Standard treatments have not improved symptoms
If you experience severe depression or suicidal thoughts, urgent medical support should be sought immediately.