PMS or PMDD? When premenstrual symptoms need medical support

English version

Physical or emotional symptoms before a period are common. When they follow a repeated menstrual pattern, they may be described as premenstrual syndrome (PMS). Much more severe symptoms that substantially disrupt everyday functioning may represent premenstrual dysphoric disorder (PMDD).

What symptoms can occur with PMS?

Symptoms often begin during the days or one to two weeks before a period and improve after bleeding starts.

• Irritability, mood swings, anxiety or low mood
• Difficulty concentrating, tiredness or reduced energy
• Changes in sleep, appetite or food cravings
• Reduced interest in usual activities
• Bloating, breast tenderness, headache or cramps
• Joint or muscle discomfort, acne or temporary weight fluctuation

The repeated timing and effect on daily life are more informative than any single symptom.

How is PMDD different?

PMDD involves more intense emotional symptoms and greater disruption. These may include severe irritability or anger, marked anxiety, depression or hopelessness, rapid mood changes, feeling out of control, difficulty concentrating, loss of interest, major sleep or appetite changes, and thoughts of self-harm or suicide. Symptoms typically appear in the week or two before a period and improve within a few days after bleeding begins. Diagnosis requires assessment of timing, number, severity and functional impact.

Why keep a symptom diary?

Depression, anxiety, migraine, thyroid problems and perimenopausal changes can worsen before a period without necessarily being PMS or PMDD. Record symptoms daily for at least two cycles, including period dates, mood, anxiety, sleep, appetite, physical symptoms, effects on daily life, medicines and when symptoms improve.

When should you arrange a consultation?

• Symptoms repeatedly affect work, studies, relationships or daily activities
• Lifestyle measures have not provided enough relief
• Mood symptoms are severe or worsening
• Symptoms continue throughout the month
• Periods are irregular, unusually painful or very heavy
• Symptoms began after starting or changing hormonal contraception
• There is a history of depression, anxiety, bipolar disorder or another mental-health condition
• You are trying to conceive, pregnant or breastfeeding

What may help?

Management may include regular activity, consistent sleep, balanced meals, limiting excessive alcohol, relaxation techniques, cognitive behavioural therapy, appropriate pain relief, selected hormonal contraception, an SSRI antidepressant, or treatment of another medical or mental-health condition. The choice depends on medical history, symptoms, pregnancy plans and side effects. Do not start antidepressants, hormonal medication or multiple supplements without individual advice; evidence for many PMS supplements is limited.