Understanding PMS & PMDD: Symptoms & Treatments

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) include a range of emotional and physical symptoms that occur during the lead-up to a menstrual period.¹

In PMS or PMDD, symptoms quickly disappear after the onset of bleeding, with at least a week or two free of symptoms before they return, depending on how long your cycles are.

Researchers are still perplexed by PMS – there doesn’t seem to be one single variation of it, nor one single cause. We still don’t know what causes either PMS or PMDD but it is thought that levels of inflammation, the hormones oestrogen and progesterone, and the calming neurotransmitters GABA and serotonin, all play a role.²

Diagnosing PMS or PMDD

Diagnosis of PMS or PMDD is by symptom description and a medical check to exclude any other causes of your symptoms. Record your symptoms in a diary for at least two menstrual cycles to take to your appointment.³

What is premenstrual syndrome (PMS)?

Premenstrual syndrome is classified as symptoms, both physical and psychological, that appear up to two weeks before your period and then dissipate soon after your period starts. They range from mild to severe and can seriously affect quality of life.

Premenstrual dysphoric disorder is considered a severe form of PMS and can be very disruptive to work, relationships and life in general, if left untreated.

Symptoms of PMS/PMDD⁴

Bloating
Fluid retention
Pimples or acne breakouts
Anxiety
Feeling confused
Being clumsy
Depression, low mood
Suicidal thoughts
Concentration problems
Memory problems
Lowered self-esteem and self-confidence
Changes in libido (increase, decrease)
Digestive problems – diarrhoea, constipation, upset tummy
Lonely
Paranoid
Weepy
Sweats
Insomnia or sleeping too much
Fatigue
Headache/migraine
Hungry/appetite increase
Sensitive to light, sounds, touch
Irritable
Mood swings
Angry outbursts
Tender breasts

What is premenstrual dysphoric disorder (PMDD?)

PMDD is a severe form of PMS, affecting three to five per cent of women. PMS is the milder version of PMDD, so where PMS might result in bloating, food cravings and mood swings, PMDD can result in depression or suicidal thoughts. This is not to say that PMS sufferers don’t get symptoms that are very difficult to deal with.

Hormonal imbalances could possibly cause PMDD symptoms, so being properly diagnosed is necessary to rule out any underlying conditions such as endometriosis, ovarian conditions or fibroids, and to exclude depression and panic disorder if appropriate.⁵

PMDD symptoms are debilitating and recurrent.⁶

Symptoms of PMDD – you need five of these for a diagnosis⁷

Mood swings
Feeling hopeless
Depression
Intense anger
Conflict with others
Feeling tense, anxious and irritable
Loss of interest in usual activities
Concentration loss/lack of focus
Fatigue
Appetite changes
Feeling out of control
Sleep issues
Cramping and bloating
Tender breasts
Headaches
Joint/muscle pain
Hot flushes

Treatments for PMS and PMDD

Many of the same treatments for PMS are useful in treating PMDD but PMDD treatment should be under the guidance of a doctor or naturopath.^8,9

Vitex agnus-castus (Premular – a scientifically proven herbal formula for treating PMS)
Antidepressants (typically SSRIs)
St John’s Wort (Hypericum perforatum) – supports serotonin and can relieve both physical and psychological symptoms but is not safe to take with SSRIs and reduces the affect of oral contraceptive pill and other medications so check with your doctor or naturopath if you are taking these.
Curcumin supplements – this high-strength extract of turmeric has shown excellent results in reducing PMS symptoms in research, thought to be due to its effects on inflammation and neurotransmitters
Other herbs – see a naturopath for a personalised prescription
Calcium supplements
Vitamin B6 supplements
Hormone therapy, including the pill
Cutting down alcohol consumption
Quit smoking – smokers are twice as likely to have PMS symptoms
Exercise – research has shown solid improvements with 60 minutes, 3x weekly
Weight loss – those with BMIs over 30 are three times more likely to have PMS
Managing stress – stress can mess with hormones, inflammation and neurotransmitters so you may notice your PMS is worse when you are stressed; however, this isn’t the case for everyone
Anti-inflammatory drugs – aspirin, ibuprofen, for physically uncomfortable symptoms
Diuretics for water retention – try dandelion leaf tea, roasted dandelion root tea/latte, or nettle leaf tea
Counselling
Meditation
Reflexology
Yoga
Ensure enough sleep
Ensure a regular bowel movement – this helps with the clearance and detoxification of hormones
Managing relative oestrogen excess and or progesterone deficiency – see a naturopath
Eat a well-balanced diet with minimally processed foods
Testing for MTHFR genetic mutations and being treated by a gene-savvy practitioner

Predicting when PMS or PMDD symptoms will arrive

How often you experience these symptoms depends entirely on how long your menstrual cycle is (the number of days from period to period).

A period tracker app or diary is very useful to record your symptoms and understand when to expect symptoms and what you should expect. This is essential for diagnosis and can help you track changes over time so that you know how much treatments are helping.^10,11

Premenstrual syndrome and premenstrual dysphoric disorder can take us by surprise every cycle, which is unnecessary because these symptoms tend to be predictable and occur at about the same time each cycle.¹² Some women may only occasionally get mild PMS, while others get severe PMS/PMDD every cycle.

Both PMS and PMDD can be debilitating and very destructive to relationships and careers. Keeping it together when you are losing it is spectacularly difficult.

Moderate and severe PMS/PMDD is common, but this doesn’t mean it’s normal. It might run in your family, but this doesn’t make it ok. Having symptoms so severe that you wreak havoc in your life, as a pattern, is not normal or healthy and requires your attention.

Luckily, many tools are at your disposal to relieve PMS and its drivers – inflammation, hormone levels and neurotransmitters.

References

1.
Yonkers KA, O’Brien PS, Eriksson E. Premenstrual syndrome. The Lancet. Published online April 2008:1200-1210. doi:10.1016/s0140-6736(08)60527-9
2.
Tiranini L, Nappi RE. Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome. Fac Rev. Published online April 28, 2022. doi:10.12703/r/11-11
3.
Henz A, Ferreira CF, Oderich CL, et al. Premenstrual Syndrome Diagnosis: A Comparative Study between the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST). Rev Bras Ginecol Obstet. Published online November 13, 2017:020-025. doi:10.1055/s-0037-1608672
4.
Yi SJ, Kim M, Park I. Investigating influencing factors on premenstrual syndrome (PMS) among female college students. BMC Women’s Health. Published online November 10, 2023. doi:10.1186/s12905-023-02752-y
5.
Schroll JB, Lauritsen MP. Premenstrual dysphoric disorder: A controversial new diagnosis. Acta Obstet Gynecol Scand. Published online April 21, 2022:482-483. doi:10.1111/aogs.14360
6.
Thakrar P, Bhukar K, Oswal R. Premenstrual dysphoric disorder: Prevalence, quality of life and disability due to illness among medical and paramedical students. Journal of Affective Disorders Reports. Published online April 2021:100112. doi:10.1016/j.jadr.2021.100112
7.
Hantsoo L, Rangaswamy S, Voegtline K, Salimgaraev R, Zhaunova L, Payne JL. Premenstrual symptoms across the lifespan in an international sample: data from a mobile application. Arch Womens Ment Health. Published online August 26, 2022:903-910. doi:10.1007/s00737-022-01261-5
8.
Carlini SV, Deligiannidis KM. Evidence-Based Treatment of Premenstrual Dysphoric Disorder. J Clin Psychiatry. Published online February 4, 2020. doi:10.4088/jcp.19ac13071
9.
Management of Premenstrual Syndrome. BJOG. Published online November 30, 2016. doi:10.1111/1471-0528.14260
10.
Hou L, Chen L, Zhang W. The longitudinal predictive effect of self-reported frequency of premenstrual syndrome on depression: Findings from the Australian Longitudinal Study on Women’s Health. Front Public Health. Published online March 23, 2023. doi:10.3389/fpubh.2023.1126190
11.
Broad A, Biswakarma R, Harper JC. A survey of women’s experiences of using period tracker applications: Attitudes, ovulation prediction and how the accuracy of the app in predicting period start dates affects their feelings and behaviours. Womens Health (Lond Engl). Published online January 2022. doi:10.1177/17455057221095246
12.
Li L, Lv X, Li Y, Zhang X, Li M, Cao Y. Development and validation of risk prediction model for premenstrual syndrome in nurses: results from the nurses-based the TARGET cohort study. Front Public Health. Published online October 3, 2023. doi:10.3389/fpubh.2023.1203280