If you feel like a completely different person before and after your period, you might be experiencing PMS (Premenstrual Syndrome) or PMDD (Premenstrual Dysphoric Disorder). This blog post aims to explain PMS and PMDD, the symptoms and their impact, and the treatment options available to help you take control.
What Is PMS and PMDD?
PMS is a spectrum of physical, behavioural, and psychological symptoms which regularly recur in the luteal phase of each menstrual cycle (the two weeks leading up to your period) and which resolve or significantly improve by the end of your period. Over 150 symptoms have been recorded:
- Psychological symptoms, such as low mood, anxiety, mood swings, irritability, feeling out of control, poor concentration, change in libido, and food cravings.
- Physical symptoms, such as breast tenderness, headaches, bloating, acne, backache, weight gain, and gut disturbance.
- Behavioural symptoms, such as reduced visio-spatial and cognitive ability, aggression, and clumsiness.
PMDD is a severe form of PMS. Symptoms can be so severe that they affect your work, relationships, and overall quality of life. In fact, PMDD can make you feel like you’re not in control of your emotions and body each and every month.
PMDD is officially defined as having at least five of the following 11 symptoms, with at least one of them being mood-related:

- Mood swings or feeling suddenly sad
- Irritability, anger, or increased interpersonal conflicts
- Depressed mood, feelings of hopelessness, worthlessness, or guilt
- Anxiety, tension, or feeling on edge
- Decreased interest in usual activities (e.g., work, friends, hobbies)
- Difficulty concentrating (often referred to as “brain fog”)
- Fatigue or low energy
- Changes in appetite or food cravings
- Sleeping too much or struggling with insomnia
- Feeling overwhelmed or out of control
- Physical symptoms, such as joint pain, bloating, or breast tenderness
The impact of PMDD can be life-changing and life-threatening, with over 70% of those with PMDD experiencing suicidal thoughts every month.
How Common is PMS and PMDD?
PMS and PMDD are common, with up to 30% of women experiencing moderate to severe PMS and 5% to 8% of women experiencing PMDD. Unfortunately, many women are not diagnosed or misdiagnosed with conditions like bipolar disorder or depression.
Why Does PMS and PMDD Happen?
The cause of PMS and PMDD is not fully understood, but there are a few key contributors:
- Hormonal Fluctuations: Oestrogen and progesterone affect neurotransmitters like serotonin and GABA. Some women are more sensitive to these hormonal changes, and that’s perhaps why those with PMS and PMDD may also experience postnatal depression and mood changes at perimenopause.
- Genetics: Studies suggest that women with a specific variation in the ESR1 gene may be more likely to develop PMDD.
How Do You Know if You Have PMS or PMDD?
The best way to understand if you may have PMS or PMDD is to track your symptoms with a symptom diary. Note how you feel during each phase of your menstrual cycle and whether the symptoms are affecting your life. In particular, look for a pattern of symptoms that starts after ovulation and ends when your period starts.
How Can You Manage PMS and PMDD?
If you suspect that you’re experiencing PMS or PMDD, don’t suffer in silence. There are several treatment options available to help you. Here are some of the most common approaches:
1. Lifestyle Changes
Lifestyle changes can have a big impact on symptoms. Here are some things to consider:

- Sleep: Sleep hygiene measures like morning daylight and a consistent routine.
- Nutrition: A whole food plant-based diet that is rich in fibre has been associated with fewer PMS symptoms, and may help with PMDD too. Studies suggest that blood calcium and Vitamin D levels are lower in women with PMS and that supplements may help.
- Movement: Regular physical activity can improve mood, and help manage physical symptoms like bloating and joint pain.
- Rest: Downtime and stress management are vital.
- Connection: It’s important to have a support system in place. PMS and PMDD not only affect the woman experiencing it but also those around her. Partners, friends, and colleagues may need help to better understand what you’re going through. Consider seeking out PMDD support groups, either online or in-person, where you can share experiences and tips with others who understand what you’re facing.
2. Psychological Treatments

- CBT (Cognitive Behavioral Therapy): This type of therapy has been shown to be helpful and offers benefits into the long-term.
- SSRIs (Selective Serotonin Reuptake Inhibitors): SSRIs, often prescribed for depression, can also be effective for PMS and PMDD. They may be used continuously or just during the luteal phase (the two weeks before your period). SSRIs can show improvements in symptoms in just a few days.
3. Cycle suppression with Hormonal Treatments
- Contraception: A combined oral contraceptive (COC) pill will pause your natural cycle and stop the hormonal fluctuations that trigger symptoms. Some people with PMS and PMDD, particularly those with ADHD, find that progesterone in pills may worsen their mood. There are some newer pills that are much less likely to have this effect.
- Hormone Replacement Therapy (HRT): For women who are perimenopausal, high-dose transdermal oestrogen combined with progesterone can help suppress the cycle and alleviate symptoms.
4. Complementary Therapies
Some women find relief from symptoms through complementary treatments:
- Agnus Castus (Chasteberry): This herbal remedy is one of the most researched for PMS and PMDD, though it’s important to find standardized preparations.
- Magnesium and Vitamin B6: These may offer some benefits for managing symptoms.
- St. John’s Wort: Though limited in evidence, some women report improvement in mood and cognitive symptoms, but note it can interact with other medications including contraception and HRT.
- Red clover: This phyto-oestrogen (plant based oestrogen) has some evidence of benefit.
Final Thoughts
If you’re living with PMS or PMDD, know that you’re not alone, and help is available. From lifestyle changes to medication and psychological support, there are multiple ways to manage the symptoms. With the right support and care, you can regain control and improve your well-being. Here at Rethink, I offer advice regarding lifestyle and hormonal treatments in supporting PMS and PMDD.