What is PMS and PMDD?
Many people experience physical or emotional changes in the days leading up to their period. While these symptoms are often referred to as Premenstrual Syndrome (PMS), some people experience a much more severe condition known as Premenstrual Dysphoric Disorder (PMDD).
PMS is a common condition that causes a combination of physical, emotional, and behavioural symptoms during the second half of the menstrual cycle. Symptoms usually improve once a period begins.
PMDD is a more severe form of premenstrual disorder. Although it shares many of the same symptoms as PMS, PMDD has a much greater impact on mental wellbeing, relationships, work, and daily life. It can cause intense mood changes, severe anxiety, depression, and irritability that resolve after menstruation starts.
It is estimated that up to 75% of people who menstruate experience some symptoms of PMS, while around 3–8% are affected by PMDD.
What Causes PMS and PMDD?
The exact causes of PMS and PMDD are not fully understood, but they are believed to result from the body’s response to the normal hormonal changes that occur during the menstrual cycle.
Hormonal Changes
Levels of oestrogen and progesterone naturally rise and fall throughout the menstrual cycle. In some people, these hormonal fluctuations appear to trigger symptoms. Hormonal changes can affect neurotransmitters such as serotonin, which plays a key role in regulating mood, sleep, and appetite. Reduced serotonin activity is thought to contribute significantly to PMDD symptoms.
Individual Risk Factors
People may be more likely to experience PMDD if they have:
- A personal or family history of depression or anxiety
- Previous postnatal depression
- High levels of ongoing stress
- A family history of PMDD
What Are the Common Symptoms of PMS and PMDD?
Symptoms typically develop one to two weeks before a period begins and improve shortly after menstruation starts.
Common PMS Symptoms
- Bloating
- Breast tenderness
- Headaches
- Fatigue
- Food cravings
- Acne flare-ups
- Mild mood swings
- Irritability
- Difficulty sleeping
- Feeling tearful
- Mild anxiety
PMDD Symptoms
Symptoms are much more severe and can include:
- Intense mood swings
- Severe irritability or anger
- Persistent sadness or hopelessness
- Marked anxiety or panic attacks
- Feeling overwhelmed
- Difficulty concentrating
- Loss of interest in usual activities
- Sleep disturbance
- Extreme fatigue
- Changes in appetite
- Physical symptoms such headaches and joint pains
- PMDD symptoms can significantly affect work performance, relationships, education, and overall quality of life.
How Are PMS and PMDD Diagnosed?
There is no single test that diagnoses PMS or PMDD.
A GP will usually ask about:
- Your menstrual cycle
- When symptoms occur
- How symptoms affect daily life
- Your medical history
- Any history of anxiety, depression, or other mental health conditions
Many patients are asked to keep a symptom diary over at least two menstrual cycles. Recording symptoms alongside the timing of periods helps confirm whether symptoms are linked to hormonal changes.
During an online GP consultation, your doctor can discuss your symptoms, assess whether they are consistent with PMS or PMDD, and recommend appropriate treatment or referral if needed.
Occasionally, blood tests may be arranged to rule out other conditions such as thyroid disorders or anaemia if symptoms overlap.
How Long Do PMS and PMDD Last?
Symptoms usually occur during the luteal phase, which is the one to two weeks before menstruation begins.
Mild PMS
Symptoms may last a few days and have minimal impact on daily activities.
Moderate PMS
Symptoms often last five to seven days and may interfere with work or social activities.
PMDD
Symptoms commonly occur every month for one to two weeks before menstruation and usually improve within a few days of the period starting but the difference from PMS is that these symptoms are debilitating and often involve time off work or feeling like you can not cope.
Without treatment, PMDD often continues until menopause, although symptoms may fluctuate throughout reproductive life.
Factors such as stress, poor sleep, and hormonal changes may worsen symptoms.
How to Feel Better and Recover Quickly
Although PMS and PMDD cannot always be prevented, several treatments can significantly reduce symptoms.
Self-Care at Home
Many people benefit from healthy lifestyle changes, including:
- Regular exercise
- Maintaining a balanced diet
- Reducing caffeine and alcohol intake
- Getting enough sleep
- Managing stress through relaxation techniques or mindfulness
- Keeping a symptom diary
- Taking over-the-counter pain relief for headaches or cramps where appropriate
Treatment from a GP
Depending on symptom severity, a GP may recommend:
- Selective serotonin reuptake inhibitors (SSRIs), which are often the first-line treatment for PMDD these can be used just in the luteal phase or across the cycle.
- Hormonal tablets to reduce fluctuations – these are usually combined contraceptives – the newer COCP Zoely can be a good option as it uses body identical oestrogen show has emerging evidence with improvement on physical and mood related symptoms. Some progesterone only tablets can be used as well.
- Pain relief for physical symptoms
- Referral for talking therapies such as CBT if mood symptoms are significant
Treatment is individualised based on symptoms, medical history, and future pregnancy plans.
When Referral Is Needed
Referral to a gynaecologist or mental health specialist may be appropriate if:
- Symptoms are severe despite treatment
- Diagnosis is uncertain
- Symptoms significantly affect daily life
- More advanced hormonal treatments are being considered
- Surgery is being discussed in rare, treatment-resistant cases
When to Seek Urgent Medical Help
Although PMS and PMDD are not usually medical emergencies, urgent medical assessment is needed if you experience:
- Thoughts of self-harm or suicide
- Feeling unable to keep yourself or others safe
- Severe depression that rapidly worsens
- Sudden confusion or changes in consciousness
- Chest pain or severe shortness of breath
- Heavy vaginal bleeding causing dizziness or fainting
If you are experiencing suicidal thoughts or believe you are at immediate risk, attend your nearest A&E department or call 999 immediately.
How Dr.Online UK Can Help
If you’re struggling with symptoms of PMS or PMDD, our UK-registered GPs can provide fast, confidential support without the need to wait for a face-to-face appointment.
We offer:
- Same-day online GP appointments
- Assessment of PMS and PMDD symptoms
- Advice and reassurance
- Private prescriptions where clinically appropriate
- Referral letters for specialist assessment if needed
- Fit notes where appropriate
- Ongoing support to help manage recurring symptoms
Early assessment can help you access effective treatment and improve your quality of life.
