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 leading up to 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 are 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) is 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 start 7-10 days before your period starts and get worse in the days leading up to a woman’s period.

Up to 75% of women experience some PMS symptoms — but for about 20–30% they can impact daily life. About 3 in 4 women 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’s a combination of physical and emotional symptoms that occur in the premenstrual phase of the menstrual cycle. The most common symptoms of PMS are bloating, headaches and moodiness. PMS symptoms can be 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 key to managing its effects and 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 severe symptoms need proper evaluation and support. Some women experience PMS with very mild symptoms, others have more severe symptoms that affect daily activities and may be a sign of premenstrual dysphoric disorder (PMDD).

Physical Symptoms

Physical symptoms of PMS can be uncomfortable and debilitating. Common physical symptoms are bloating, breast tenderness, headaches and cramps. Some women may also experience food cravings especially 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. Exercise, healthy diet and relaxation techniques can help alleviate physical symptoms and overall health.

Emotional Symptoms

Emotional symptoms are a common part 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 impact daily life and relationships. Selective serotonin reuptake inhibitors (SSRIs) and other medications can help regulate mood and emotional symptoms. Lifestyle changes such as exercise, healthy eating and stress management can also reduce the severity of emotional symptoms. It’s essential to recognise that emotional symptoms are a legitimate part of PMS and should not be dismissed or minimised.

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. Recognising PMDD symptoms is crucial as they can seriously disrupt daily life and relationships and need medical help for 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 aimed at preventing or alleviating symptoms. See a doctor for personalised testing and treatment options.

PMDD Symptoms

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 worsen PMDD symptoms making the emotional impact even more severe.

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

Managing serotonin levels is key for those with PMDD as imbalances can impact mental health. Seeing a doctor to regulate these levels can lead to overall well being.

What causes PMS and PMDD?

The exact cause is not fully understood but both PMS and PMDD are thought to be sensitive responses to normal hormonal fluctuations, particularly:

• Oestrogen and progesterone changes after ovulation

• Interaction with brain chemicals like serotonin and GABA

Hormonal changes before menstruation can worsen symptoms of mood disorders so there is a link between these changes and the severity of emotional symptoms of 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 multiple causes and risk factors. Hormonal fluctuations especially the drop in estrogen and progesterone levels after ovulation play a big role in the development of PMS symptoms. These hormonal changes can trigger both physical and emotional symptoms like breast tenderness, bloating, mood swings and irritability.

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

Brain chemistry also plays a big 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 like stress, poor diet and lack of exercise can worsen PMS symptoms. High stress 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 balanced diet can help mitigate these effects.

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

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

How are PMS and PMDD diagnosed?

Diagnosis starts 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 very helpful for diagnosis and treatment planning.

Treatment options for PMS and PMDD

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

Managing PMS symptoms

There is no cure for PMS but various strategies can help manage symptoms. Implementing lifestyle changes like regular exercise, healthy diet and enough sleep can significantly reduce 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 stabilise blood sugar levels and reduce bloating.

Relaxation techniques like 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 like ibuprofen or acetaminophen can help with physical symptoms like cramps, headaches and breast tenderness. These medications give quick relief and can be an accessible option for pain management.

Hormonal birth control is another option for some women. By regulating menstrual cycles and stabilizing hormone levels birth control can reduce PMS symptoms. Consult with a healthcare provider to determine the best type of birth control for you.

Dietary supplements like calcium, vitamin B6 and omega 3 fatty acids may also help with PMS symptoms. While more research is needed to confirm their effectiveness these supplements can support overall health and wellbeing. Always consult with a healthcare provider before starting any new supplements to ensure they are safe and suitable for you.

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

Lifestyle Support

Regular exercise, balanced diet and enough sleep can improve your overall wellbeing. Yoga and meditation can also relieve PMS symptoms by reducing stress and promoting relaxation.

Dietary Supplements and PMS

Some dietary supplements like calcium and magnesium have been shown to help with PMS symptoms. Herbal supplements can relieve symptoms but it’s essential to consult healthcare professionals to regulate herbal supplements due to potential interactions with other medications and possible side effects. Half of women who seek relief from PMS also have another health condition that worsens before their period.

Medical Treatments

For those who need extra support medical treatments are available. Over the counter medications can be an accessible option for pain management like cramps and headaches. Over the counter pain relievers can help with physical symptoms of PMS. If these don’t work consult a healthcare provider for further guidance.

Lifestyle Support

Most women experience symptoms of premenstrual syndrome (PMS) at some point in their lives and lifestyle changes can 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

Lifestyle changes can reduce PMS symptoms and improve overall wellbeing. Here are some tips:* Balanced Diet: Focus on whole foods, fruits, vegetables and whole grains. These foods stabilise blood sugar and insulin levels reducing mood swings and food cravings.

• Hydration: Drink plenty of water to reduce bloating and other physical symptoms. Aim for at least 8 glasses of water a day to stay hydrated and support overall health.

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

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

• Sleep: Aim for 7-8 hours of sleep per night to regulate hormones and reduce fatigue. Establish a regular sleep routine to improve sleep quality and overall wellbeing.

• Avoid Triggers: Identify and avoid triggers like sugary foods, caffeine and alcohol which can worsen 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 manage their PMS symptoms better and improve their quality of life. Consult with a healthcare provider to determine the best course of treatment for you.

Dietary Supplements and PMS

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

Medical Treatments

Mild PMS symptoms can often be managed with lifestyle changes but 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* 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 (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.

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.

Severe symptoms of PMS and PMDD are real and need 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 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 key to managing its effects and overall wellbeing. Lifestyle changes like exercise, healthy eating and stress management can help alleviate symptoms. In some cases medication or dietary supplements may be needed to regulate mood and reduce symptoms. Recognise that PMS is a medical condition that needs attention and care. By working with a healthcare provider and making informed lifestyle choices women can reduce PMS symptoms and improve overall quality of life. And be aware of premenstrual dysphoric disorder (PMDD) and seek help if symptoms are severe to maintain mental and physical health.

Last Word

Whether your PMS symptoms are mildly annoying or completely debilitating, help is out there — and you don’t have to do it alone. Women in their 30s are most likely to experience PMS so if symptoms become unmanageable during this decade seek help.

At Happiher we offer expert, compassionate care to help you understand your hormones, manage your symptoms and feel good every month and every day.