PMS and PMDD: Symptoms, Self-Help and When to Get Help

Many people notice mood changes, bloating or tiredness in the days before a period. This is known as premenstrual syndrome, or PMS. For a smaller number of people the symptoms are much stronger and are called premenstrual dysphoric disorder, or PMDD. Help is available if symptoms affect your daily life.

What is PMS?

The NHS describes PMS as the symptoms that some people have in the weeks before their period. It can affect anyone who has periods. Symptoms vary from person to person and can change from month to month, and most women have PMS at some point.

Common symptoms

According to the NHS, symptoms can include:

• mood swings, feeling depressed or irritable
• feeling upset, anxious or emotional
• tiredness or trouble sleeping
• bloating or cramping
• breast tenderness
• headaches
• spotty skin or greasy hair
• changes in appetite or food cravings

What causes it?

The exact cause is not fully understood. The NHS says it may be linked to changes in hormone levels during the menstrual cycle, and some people are more sensitive to these changes than others.

Self-help steps

The NHS suggests these steps may help:

• exercise regularly and eat a healthy, balanced diet
• try smaller, regular meals about every 2 to 3 hours, which may help some people
• get plenty of sleep
• try to reduce stress, for example with yoga or meditation
• use over-the-counter painkillers such as ibuprofen or paracetamol for pain, following the pack instructions
• avoid smoking and too much alcohol
• keep a symptom diary for at least 2 menstrual cycles and take it to your appointment

A diary is useful because there is no single test for PMS in the NHS guidance. Writing down your symptoms and the days they happen helps you and your doctor see the pattern.

Treatments a doctor may discuss

If lifestyle changes have not helped, a doctor can talk about other options. The NHS says these may include hormonal medicine such as the combined contraceptive pill, cognitive behavioural therapy (CBT), or antidepressants. If symptoms continue, you may be referred to a specialist such as a gynaecologist, psychiatrist or counsellor. A doctor decides which approach is suitable for you, so please do not start or stop medicines on your own.

The NHS also notes that complementary approaches such as acupuncture and reflexology, and supplements such as vitamin B6, calcium, vitamin D and magnesium, are sometimes used, but there is not much evidence that they work. If you take other medicines, check with a doctor or pharmacist before starting regular supplements.

What is PMDD?

PMDD is a more severe form of PMS that affects a small number of women. The symptoms are similar to PMS but much more intense and can have a bigger effect on everyday life. According to the NHS they can include headaches, joint and muscle pain, overeating, sleep problems, and feeling very anxious, angry, depressed or even suicidal. The cause is unclear, but it has been linked to sensitivity to hormone changes or to inherited genetic differences.

When to see a doctor

See a doctor if you have PMS symptoms and lifestyle changes have not helped, or if symptoms affect your daily life, work or relationships. They can look at your diary and talk through options.

If you have PMDD symptoms and are feeling suicidal, get help straight away. The NHS advises going to emergency care and not driving yourself. Ask someone to take you or call for an ambulance, and bring any medicines you take. Help lines for emotional distress exist in both India and the United States, and a doctor or a trusted person can help you reach one.

In an emergency, call your local emergency number (112 in India, 911 in the United States).

Key points

• PMS is common, and symptoms vary from month to month.
• Regular exercise, balanced meals, sleep and a symptom diary are useful first steps.
• Doctors may discuss hormonal medicine, CBT or antidepressants if self-help is not enough.
• PMDD is a more severe form, and thoughts of suicide need urgent help.