What Is PMS?
Premenstrual syndrome (PMS) refers to a cluster of physical and emotional symptoms that occur in the luteal phase of the menstrual cycle (the 1–2 weeks before a period) and resolve with menstruation. PMS is very common — up to 75% of women experience some symptoms — but severe PMS affects approximately 20–30% of women.
PMDD — When PMS Is Severe
Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS characterised by significant mood disturbance — intense irritability, depression, anxiety, or anger — in the luteal phase that significantly impairs functioning. PMDD is a recognised medical condition that responds well to treatment.
Symptoms of PMS & PMDD
- Mood swings, irritability, or anger disproportionate to circumstances
- Anxiety, tension, or feeling on edge
- Depression, hopelessness, or low mood
- Difficulty concentrating
- Fatigue and low energy
- Bloating, breast tenderness
- Headaches
- Food cravings — particularly for sweet or salty foods
- Disturbed sleep
- Physical pain — joint or muscle aches
What Causes PMS & PMDD?
PMS and PMDD are driven by hormonal fluctuations across the menstrual cycle — specifically, abnormal sensitivity to the normal drop in progesterone and oestrogen in the luteal phase. Serotonin dysregulation plays a key role in PMDD. Nutritional deficiencies (vitamin B6, magnesium, calcium, vitamin D) and thyroid dysfunction can worsen symptoms significantly.
Treatment Options
- Lifestyle and nutritional intervention — reducing caffeine, sugar, and alcohol; regular aerobic exercise; calcium and magnesium supplementation
- Nutritional supplements — vitamin B6, evening primrose oil, chasteberry (Vitex) — evidence-based options for mild-moderate PMS
- Hormonal management — continuous or cyclical OCP, progesterone supplementation, or GnRH analogues for severe cases
- SSRIs (antidepressants) — highly effective for PMDD; can be taken continuously or only in the luteal phase
- Cognitive behavioural therapy (CBT) — effective for the psychological aspects of PMDD