Pre-menstrual syndrome (PMS) and Pre-menstrual Dysphoric Disorder (PMDD)

PMS and PMDD: Understanding Hormonal Mood Changes Before Your Period

For many women, the days before their period bring more than just physical symptoms — mood swings, anxiety, fatigue, and irritability can affect work, relationships, and daily life. But when these symptoms become intense, disruptive, or feel out of control, it may be more than “just PMS.”

At Happiher, we take hormone-related mood changes seriously. Whether you’re dealing with pre-menstrual syndrome (PMS) or the more severe pre-menstrual dysphoric disorder (PMDD), support is available. As a private gynaecologist in London, I help women understand and manage their symptoms with expert, personalised care.

What is Pre Menstrual Syndrome?

Pre-Menstrual Syndrome (PMS) refers to a group of physical and emotional symptoms that occur in the second half of the menstrual cycle (typically 1–2 weeks before your period starts) and ease once menstruation begins. PMS symptoms usually begin seven to ten days before your period starts and typically intensify in the days leading up to a woman's menstrual period.

Up to 75% of women experience some PMS symptoms — but for about 20–30%, they can significantly affect daily life. About three in four women say they get PMS symptoms at some point in their lifetime.

Introduction to Premenstrual Syndrome

Premenstrual syndrome (PMS) is a common condition that affects many women of childbearing age. It is characterized by a combination of physical and emotional symptoms that occur in the premenstrual phase of the menstrual cycle. The most common symptoms of PMS include bloating, headaches, and moodiness. PMS symptoms can range from mild to severe and can include bloating, breast tenderness, mood swings, and food cravings. In some cases, PMS can be a precursor to premenstrual dysphoric disorder (PMDD), a more severe form of the condition. Understanding the causes and symptoms of PMS is essential for managing its effects and improving overall well-being.

Common PMS Symptoms

Emotional and behavioural symptoms:

• Mood swings

• Irritability or anger

• Anxiety

• Low mood

• Difficulty concentrating

• Tearfulness or sensitivity

Physical symptoms:

• Bloating

• Breast tenderness

• Headaches

• Fatigue

• Changes in appetite or sleep

• Cramps or backache

Mild PMS may be manageable with lifestyle changes, but more severe symptoms deserve proper evaluation and support. While some women experience PMS with very mild symptoms, others may have more severe symptoms that significantly impact daily activities and may indicate a condition like premenstrual dysphoric disorder (PMDD).

Physical Symptoms

The physical symptoms of PMS can be uncomfortable and debilitating. Common physical symptoms include bloating, breast tenderness, headaches, and cramps. Some women may also experience food cravings, particularly for sugary or salty foods. These symptoms are thought to be related to hormonal fluctuations during the menstrual cycle, particularly the drop in estrogen and progesterone levels after ovulation. In addition to these symptoms, some women may experience changes in appetite, sleep patterns, and energy levels. Regular exercise, a healthy diet, and relaxation techniques can help alleviate physical symptoms and improve overall health.

Emotional Symptoms

Emotional symptoms are a common aspect of PMS, and can range from mild mood swings to severe depression and anxiety. Many women experience irritability, mood swings, and feelings of sadness or hopelessness. In some cases, these symptoms can be severe enough to interfere with daily life and relationships. Selective serotonin reuptake inhibitors (SSRIs) and other medications can help regulate mood and alleviate emotional symptoms. Lifestyle changes, such as regular exercise, healthy eating, and stress management, can also help reduce the severity of emotional symptoms. It is essential to recognize that emotional symptoms are a legitimate aspect of PMS and should not be dismissed or minimized.

What Is PMDD?

Pre-Menstrual Dysphoric Disorder (PMDD) is a more severe, clinically recognised form of PMS. It involves debilitating emotional and psychological symptoms that seriously impact daily functioning and relationships. Less than 5% of women of childbearing age get a more severe form of PMS called PMDD. Recognizing PMDD symptoms is crucial as they can significantly disrupt daily life and relationships, necessitating medical assistance for effective management.

PMDD affects around 3–8% of women, but is often underdiagnosed or mislabelled as anxiety or depression. PMDD is treated differently from PMS, with treatment aiming to prevent or alleviate symptoms. Consulting a doctor for personalized testing and treatment options is essential.

Symptoms of PMDD

PMDD shares many symptoms with PMS, but they are more intense, longer-lasting, and emotionally overwhelming. Common features include:

• Severe mood swings

• Intense irritability or anger

• Panic attacks or high anxiety

• Hopelessness or depression

• Emotional outbursts

• Insomnia or sleeping too much

• Loss of interest in daily activities or relationships

• Suicidal thoughts (in extreme cases)

Mood disorders like depression and anxiety can exacerbate PMDD symptoms, making the emotional impact even more severe.

Symptoms usually improve shortly after menstruation begins, which helps distinguish PMDD from general anxiety or depression.

Managing serotonin levels is crucial for those suffering from PMDD, as imbalances can significantly impact mental health. Seeking medical assistance to regulate these levels can lead to better overall well-being.

What Causes PMS and PMDD?

The exact cause isn’t fully understood, but both PMS and PMDD are thought to be sensitive responses to normal hormonal fluctuations, particularly: The cause of PMDD isn't clear, but it has been linked to hormonal sensitivity and genetic differences.

• Oestrogen and progesterone changes after ovulation

• Interaction with brain chemicals like serotonin and GABA

Hormonal changes that occur before menstruation can exacerbate symptoms of mood disorders, suggesting a connection between these changes and the severity of emotional symptoms associated with PMDD.

Genetics, stress, trauma history, and underlying mental health conditions can also increase susceptibility.

Causes and Risk Factors

Premenstrual syndrome (PMS) is a complex condition influenced by various causes and risk factors. Hormonal fluctuations, particularly the drop in estrogen and progesterone levels after ovulation, play a significant role in the development of PMS symptoms. These hormonal changes can trigger both physical and emotional symptoms, such as breast tenderness, bloating, mood swings, and irritability.

Genetic predisposition is another important factor. Women with a family history of PMS or premenstrual dysphoric disorder (PMDD) are more likely to experience these symptoms. This suggests that genetics may influence how sensitive an individual is to hormonal changes.

Brain chemistry also plays a crucial role. Changes in serotonin levels, a neurotransmitter that regulates mood, appetite, and sleep, can contribute to PMS symptoms. Low serotonin levels are often linked to mood swings, anxiety, and depression, which are common emotional symptoms of PMS.

Lifestyle factors, such as stress, poor diet, and lack of exercise, can exacerbate PMS symptoms. High-stress levels can worsen emotional symptoms, while a diet high in sugary foods and caffeine can lead to physical symptoms like bloating and cramps. Regular exercise and a balanced diet can help mitigate these effects.

Mental health conditions, including a history of depression, anxiety, or other mental disorders, can increase susceptibility to PMS. Women with these conditions may experience more severe symptoms, making it essential to address underlying mental health issues as part of PMS management.

Understanding these causes and risk factors can help women take proactive steps to manage their PMS symptoms and improve their overall well-being.

How Are PMS and PMDD Diagnosed?

Diagnosis begins with a detailed history and symptom tracking, ideally over at least two menstrual cycles, which is about a week or two before the period starts.

At Happiher, assessment includes:

• Review of your menstrual history and symptom pattern

• Evaluation of how symptoms impact your work, relationships, and wellbeing

• Rule-out of other conditions (e.g. depression, thyroid disorders)

• Optional hormone blood tests if irregular cycles or perimenopause is suspected

Keeping a symptom diary or using a period tracking app can be extremely helpful for diagnosis and treatment planning.

Treatment Options for PMS and PMDD

At Happiher, we provide individualised treatment plans that target both physical and emotional symptoms. Various methods can ease PMS symptoms, including complementary and alternative medicines like yoga, meditation, and herbal supplements.

Managing PMS Symptoms

While there is no cure for PMS, various strategies can help manage symptoms effectively. Implementing lifestyle changes, such as regular exercise, a healthy diet, and sufficient sleep, can significantly alleviate PMS symptoms. Engaging in physical activities like walking, swimming, or yoga can reduce stress and improve mood, while a balanced diet rich in whole foods can stabilize blood sugar levels and reduce bloating.

Relaxation techniques, including yoga, meditation, and deep breathing exercises, can help reduce stress and anxiety, which are common emotional symptoms of PMS. These practices promote relaxation and mental clarity, making it easier to cope with mood swings and irritability.

Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help ease physical symptoms like cramps, headaches, and breast tenderness. These medications provide quick relief and can be an accessible option for managing pain.

Hormonal birth control is another effective option for some women. By regulating menstrual cycles and stabilizing hormone levels, birth control can reduce the severity of PMS symptoms. It’s essential to consult with a healthcare provider to determine the best type of birth control for individual needs.

Dietary supplements, such as calcium, vitamin B6, and omega-3 fatty acids, may also help relieve PMS symptoms. While more research is needed to confirm their effectiveness, these supplements can support overall health and well-being. Always consult with a healthcare provider before starting any new supplements to ensure they are safe and appropriate for your specific needs.

By combining these strategies, women can better manage their PMS symptoms and improve their quality of life.

Lifestyle Support

Incorporating regular exercise, a balanced diet, and adequate sleep can significantly improve your overall well-being. Practices like yoga and meditation can also relieve PMS symptoms by reducing stress and promoting relaxation.

Dietary Supplements and PMS

Certain dietary supplements, such as calcium and magnesium, have been shown to help alleviate PMS symptoms. Herbal supplements can relieve symptoms, but it's crucial to consult healthcare professionals to regulate herbal supplements due to potential interactions with other medications and possible side effects. Around half of women who seek relief from PMS also have another health problem that may worsen before their period.

Medical Treatments

For those who need additional support, medical treatments are available. Over-the-counter medications can be an accessible option for managing pain, such as cramps and headaches. Over-the-counter pain relievers can help lessen physical symptoms of PMS. If these remedies are ineffective, consulting a healthcare provider is essential for further guidance.

Lifestyle Support

Most women experience symptoms of premenstrual syndrome (PMS) at various points in their lives, and lifestyle changes can significantly help manage these symptoms.

• Regular exercise

• Nutritional changes (e.g., reducing sugar, caffeine, alcohol)

• Stress reduction techniques (e.g., yoga, mindfulness)

• Sleep and routine support

Lifestyle Changes for PMS Management

Making lifestyle changes can significantly reduce the severity of PMS symptoms and improve overall well-being. Here are some effective strategies:

• Eating a Balanced Diet: Focus on consuming whole foods, including plenty of fruits, vegetables, and whole grains. These foods help stabilize blood sugar and insulin levels, reducing the likelihood of mood swings and food cravings.

• Staying Hydrated: Drinking plenty of water can help reduce bloating and other physical symptoms. Aim for at least eight glasses of water a day to stay hydrated and support overall health.

• Exercising Regularly: Engage in physical activities like walking, swimming, or yoga to help reduce stress and anxiety. Regular exercise can also improve mood and energy levels, making it easier to cope with PMS symptoms.

• Practicing Stress-Reducing Techniques: Try relaxation methods like meditation, deep breathing, or progressive muscle relaxation to manage stress and anxiety. These techniques can help calm the mind and reduce the emotional impact of PMS.

• Getting Enough Sleep: Aim for 7-8 hours of sleep per night to help regulate hormones and reduce fatigue. Establishing a regular sleep routine can improve sleep quality and overall well-being.

• Avoiding Triggers: Identify and avoid triggers like sugary foods, caffeine, and alcohol, which can exacerbate PMS symptoms. Reducing or eliminating these triggers from your diet can help alleviate physical and emotional symptoms.

By incorporating these lifestyle changes and strategies, women can better manage their PMS symptoms and improve their overall quality of life. It’s essential to consult with a healthcare provider to determine the best course of treatment for individual needs.

Dietary Supplements and PMS

Some women find that dietary supplements can help alleviate PMS symptoms. Herbal supplements, such as chasteberry and evening primrose oil, may help regulate hormonal imbalances and reduce symptoms. Omega-3 fatty acids, calcium, and magnesium may also help alleviate symptoms such as bloating, breast tenderness, and mood swings. However, it is essential to consult with a healthcare provider before taking any supplements, as they can interact with other medications or have side effects. A healthy diet that includes plenty of fruits, vegetables, whole grains, and lean protein can also help reduce symptoms and improve overall health.

Medical Treatments

While mild symptoms of PMS can often be managed with lifestyle changes, more severe cases may require medical treatments.

• Hormonal contraception to suppress ovulation and stabilise hormone levels

• SSRIs (antidepressants) — often used only during the luteal phase, or continuously

• Cognitive behavioural therapy (CBT) to support mood and coping

• Oestrogen therapy (in some cases), combined with a progestogen to protect the womb

• GnRH analogues (temporary chemical menopause for severe cases)

In rare cases where symptoms are unmanageable and other treatments have failed, surgical options (such as hysterectomy with oophorectomy) may be considered. At Happiher, any such decision is always made collaboratively, with careful support and clear understanding of the risks and benefits.

Why It’s Not “All In Your Head”

The emotional impact of PMS and PMDD is real — and can be life-altering. Many women feel dismissed or told to “just ride it out,” but the hormonal and neurological changes behind these conditions are complex and legitimate.

More severe symptoms of PMS and PMDD are legitimate and require proper medical attention.

You are not being dramatic, weak, or oversensitive. You are responding to a real physiological process.

Why Choose Happiher for PMS and PMDD Care?

If you’re looking for a PMS or PMDD specialist in London, Happiher offers:

• Thoughtful, private consultations with time to talk

• Symptom tracking and diagnostic support

• Hormonal and non-hormonal treatment options

• Holistic care that addresses both physical and emotional wellbeing

• A compassionate, modern approach tailored to your needs

• Services that can effectively ease PMS symptoms

We help you feel in control of your cycle, not controlled by it.

Conclusion

Premenstrual syndrome (PMS) is a common condition that affects many women of childbearing age. Understanding the physical and emotional symptoms of PMS is essential for managing its effects and improving overall well-being. Lifestyle changes, such as regular exercise, healthy eating, and stress management, can help alleviate symptoms. In some cases, medication or dietary supplements may be necessary to regulate mood and reduce symptoms. It is essential to recognize that PMS is a legitimate medical condition that requires attention and care. By working with a healthcare provider and making informed lifestyle choices, women can reduce the severity of PMS symptoms and improve their overall quality of life. Additionally, being aware of the potential for premenstrual dysphoric disorder (PMDD) and seeking help if symptoms are severe is crucial for maintaining mental and physical health.

Final Thoughts

Whether your premenstrual symptoms are mildly frustrating or completely overwhelming, support is available — and you don’t have to manage it alone. Women in their 30s are most likely to experience PMS, making it especially important to seek help during this time if symptoms become unmanageable.

At Happiher, we offer expert, empathetic care to help you understand your hormones, manage your symptoms, and regain your sense of wellbeing — every month, and every day.