Patient information · Women's health
PMS and PMDD
the timing is the diagnosis
Premenstrual symptoms affect most women to some degree. PMDD is a severe form affecting around one in twenty, with mood symptoms serious enough to damage relationships, work and wellbeing. Both are treatable, and both are routinely dismissed as something to put up with.
Please seek help promptly if you have
- thoughts of harming yourself or ending your life
- symptoms so severe you cannot function for part of every month
- rage or despair that frightens you or those around you
- symptoms that are present throughout the cycle rather than only before periods
- a history of postnatal depression or bipolar disorder alongside cyclical symptoms
PMDD carries a meaningfully raised risk of suicidal thinking, and it is under-recognised precisely because symptoms lift each month and are dismissed as ordinary. If you are struggling, call Samaritans free on 116 123 at any hour, text SHOUT to 85258, or call NHS 111 and select the mental health option.
What defines it
The specific feature is timing, not severity. Symptoms appear in the two weeks before a period, resolve within a few days of it starting, and there is a symptom-free interval afterwards. That pattern — not the symptoms themselves — is what makes it PMS.
- Mood — irritability, anger, low mood, anxiety, tearfulness, feeling out of control, sensitivity to rejection
- Physical — bloating, breast tenderness, headaches, joint aches, fatigue, sleep disturbance
- Behavioural — food cravings, poor concentration, withdrawal from people
- PMDD requires marked mood symptoms causing significant impairment, and the diagnosis needs prospective recording over two cycles
Keep a diary for two cycles — it is the diagnosis
There is no blood test. Hormone levels in PMS and PMDD are normal; the difference is sensitivity to the normal fluctuation, so testing hormones is not helpful and a normal result proves nothing. What establishes the diagnosis is a daily symptom record kept prospectively across two menstrual cycles, rated for severity. Recalling backwards is unreliable. Free validated tools exist — the DRSP is the standard one. Bringing two cycles of records to an appointment moves things faster than anything else you can do.
What helps
Reasonable evidence
- Regular aerobic exercise
- CBT, which is as effective as medication for many women
- Regular sleep and meals; reducing alcohol and caffeine
- Calcium and vitamin D supplementation
- Recording the cycle so you and those close to you can anticipate it
Weak or no evidence
- Evening primrose oil, for most symptoms
- Progesterone supplements — not recommended
- Restrictive diets and detoxes
- Hormone blood testing to make the diagnosis
- Being told it is normal and to manage it
Treatment that works
- SSRIs are first-line for moderate to severe PMS and PMDD, and are effective. They can be taken continuously, or only in the two weeks before the period — luteal-phase dosing works, which surprises people, and often at lower doses than for depression. Onset is within days rather than weeks.
- The combined pill, particularly taken continuously without a break so there is no hormone withdrawal, helps many women.
- Oestrogen patches or gel with endometrial protection, used in specialist practice.
- GnRH analogues with add-back HRT for severe resistant cases, essentially inducing a temporary menopause — used in specialist care and sometimes as a test before considering surgery.
- Treating coexisting anaemia, thyroid disease and low vitamin D, all of which amplify symptoms.
When it is not PMS
If symptoms are present throughout the cycle and simply worsen premenstrually, that is a different picture — underlying depression, anxiety, thyroid disease or the perimenopause, with premenstrual exacerbation. It matters because the treatment is different. This is another reason the two-cycle diary earns its place: it shows whether there is a genuinely symptom-free interval.
Why come to us. PMDD is frequently dismissed, and women are often told to try evening primrose oil and come back if it persists. We offer unhurried women's health appointments seven days a week, take the diary seriously as the diagnostic tool it is, check thyroid, ferritin and vitamin D in-house to exclude what mimics it, and prescribe properly — including luteal-phase SSRI regimens and continuous pill use. A female clinician is available on request, and psychology is available alongside.
Taken seriously, and treated properly
Female clinician available, bloods in-house. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.