Hormone clinic

PMS & PMDD

Up to three in four women know premenstrual symptoms. For some they are a nuisance — for others they dismantle relationships, work and self-image for a week every month. That has a name, a diagnosis and effective treatments.

up to 75% affected

PMS

3–8% — the severe form

PMDD

cycle diary, 2 cycles

Diagnosis

luteal phase, ends with period

Pattern

PMS or PMDD — the difference

PMS covers physical and emotional symptoms in the one to two weeks before the period: breast tenderness, bloating, irritability, cravings, exhaustion. PMDD (premenstrual dysphoric disorder) is the severe, psychiatrically recognised form: pronounced irritability or rage, depressive dips, anxiety, a sense of losing control — strong enough that daily life and relationships suffer. The decisive criterion in both: symptoms disappear with or shortly after the period starts.

You co-produce the diagnosis — with a diary

There is no blood test for PMDD; hormone values are normal. Affected women react more sensitively to normal hormonal fluctuations. The diagnosis stands when a daily symptom diary over at least two cycles shows the cyclical pattern. That sounds tedious, but it is the key: it distinguishes PMDD from depression, thyroid disease or perimenopause — which can all feel similar but are treated differently.

Treatment — staged by severity

Foundation: endurance exercise, regular sleep, less alcohol; calcium is worth a try — the evidence is decent
Hormonal: certain pills (with drospirenone, possibly in extended cycle) can smooth the cyclical ups and downs
For PMDD: SSRIs are the best-evidenced therapy — continuous or luteal-phase-only; here they often work within days rather than weeks
Always: take it seriously. "Pull yourself together" is not medicine

Important: if you have thoughts of harming yourself in the days before your period, that is a PMDD warning sign and a reason for prompt help — talk to us, your GP, or a crisis line. You are not alone with this, and it is treatable.

Frequent questions about PMS & PMDD

Is PMDD "psychological" or "hormonal"?

Both fall short: hormone values are normal, but the brain reacts more sensitively to their fluctuation — a neurobiological sensitivity, not a character flaw and not imagination.

Does the pill help — or make it worse?

Both happen. Some preparations smooth the symptoms considerably, others intensify them. If a pill worsened your mood, that is important information for choosing a preparation — not a reason to discard all options.

Antidepressants for a few days a month — does that really work?

Yes, that is a peculiarity of PMDD: SSRIs act via a different mechanism here and therefore quickly. Intermittent dosing (luteal phase only) is well studied and the right strategy for many women.

Does it disappear with menopause?

With the end of cycles, PMDD ends too — but the perimenopause before can temporarily intensify it, because fluctuations increase. There are strategies for that as well.

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The same week every month?

Start the symptom diary today — and come with two documented cycles. Then we talk diagnosis and plan, not guesswork.

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