Premenstrual syndrome
and PMDD

Premenstrual syndrome
and PMDD


Severe PMS

Many women experience mild premenstrual symptoms, however around 5-8% of women experience severe symptoms related to their menstrual cycle and this is known as severe PMS.  Another term for most severe end of the condition is premenstrual dysphoric disorder (PMDD) where the symptoms are debilitating and have a serious impact on your work, social life and relationships.



PMS typically causes a range of physical and emotional symptoms which occur in the 2 weeks before your period. These symptoms usually resolve fairly quickly with the onset of your period. 

Symptoms include:

  • Mood swings
  • Depression, irritability, anxiety, hopelessness, suicidal thoughts
  • Tiredness, difficulty sleeping, poor concentration, feeling overwhelmed
  • Fluid retention and bloating
  • Tender or sore breasts
  • Headaches or migraines
  • Changes in appetite, food cravings
  • Skin and hair changes

Diagnosis is usually made on your history and so it can be really helpful to keep a daily symptom diary over 2-3 cycles to help your doctor make a diagnosis. This can be combined with examination, blood tests and scans if necessary to rule out any other conditions. Very occasionally if the diagnosis is not clear from your symptom diary, a medication can be given (GnRH analogues) to supress your ovaries and menstrual cycle for 3 months which can help make the diagnosis.

An example symptom diary can be found on the NAPS website (


What causes PMS?

It is not fully understood what causes PMS and PMDD. It appears to be that some women are more sensitive to the hormonal fluctuations which occur with the menstrual cycle. Alterations in the neurotransmitters serotonin and GABA may also play a role.


What are the treatment options?

There are various lifestyle, psychological, hormonal and non-hormonal treatment options. A holistic approach to management is recommended and its about finding what works for you.

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