PMS, also known as premenstrual syndrome, is clinically defined as a range of physical, psychological, and behavioural symptoms that occur in the luteal phase of the menstrual cycle (the two weeks before our period). There are thought to be over 150 symptoms, which disrupt the way we function and interfere with our daily lives, work, school, or relationships. Symptoms typically resolve a few days after we get our period.

Premenstrual dysphoric disorder (PMDD) is sometimes defined as ‘severe PMS’. However, it’s still very poorly understood; the Diagnostic and Statistical Manual of Mental Disorders (DSM) defines it as a "depressive disorder not otherwise specified”. As with PMS, PMDD symptoms start a week or two before our period and gradually improve or disappear within a few days of our period starting. Symptoms cause significant disruption to our daily lives; people with PMDD frequently report damage to their relationships, requiring time off work and studies, and even suicidal thoughts or ideation.

Each person’s experience of PMS and PMDD will be different. The following list covers the most common symptoms but is not exhaustive.

Physically, PMS or PMDD can manifest as:

• Hunger and food cravings
• Hot flushes
• Intensive period pains
• Headaches, dizziness and fainting
• Cramps, bloating and constipation
• Heart palpitations
• Bruising and numbness in arms and legs
• Nausea
• Acne or aggravation of existing skin problems

Psychologically, symptoms range from extreme tiredness and body dysmorphia to anger and anxiety. Here are a few of the key ones to look out for:

• Irritability
• Difficulty concentrating
• Feelings of depression
• Feelings of anxiety
• Confusion and forgetfulness

Behaviourally, symptoms range from disrupted sleep to social withdrawal, and can include:

• Lack of sleep or insomnia
• Social withdrawal
• Lack of sex drive or libido
• Appetite changes
• Emotional sensitivity and crying

The key difference between PMS and PMDD is that, with PMDD, the symptoms are more intense. Painful cramps can become debilitating, food cravings manifest as insatiable hunger, and low mood can feel like depression or extreme anxiety. 

Perhaps the most terrifying symptom of all is feeling suicidal or having suicidal thoughts or ideation. People who experience PMDD are at a 7X higher risk of suicide attempt than those without the condition.

If you or someone you know is experiencing any symptoms that are significantly affecting your/their quality of life, it’s important to seek help from a GP. If you’re having suicidal thoughts and are worried you may act on them, you should call 999, go to A&E, or contact the Samaritans.

PMS - Up to 75% of people with periods experience PMS symptoms. However, because PMS is under-researched and there’s no physical test for it, studies looking at the prevalence of PMS return different results: ranging from 32% to 90%. 

PMDD - is less common, and studies also report varying prevalence rates, ranging from 2% to 8%. Regardless of the exact numbers, it’s important to remember that you’re not alone if you’re feeling the effects of PMS or PMDD.

Currently, PMS is diagnosed by your GP after you’ve evidenced that you experience PMS symptoms one to two weeks before your period, consistently for two months, that affect your daily life and subside once you get your period.

The diagnosis for PMDD is similar, however, people must evidence a particular combination of symptoms (a minimum of five symptoms, one of which must be psychological).

If you think you have PMS or PMDD, start noting down the symptoms you experience, when they happen, and how bad they feel. Take this record to your GP who can discuss diagnosis and treatment options with you.

The good news is that treatments for PMS and PMDD are out there. However, finding the right one for you can be a trial-and-error process, so don’t be worried if it takes a little time to find what’s best for you. Treatments can vary between PMS and PMDD, that is, people with PMDD are more likely to be offered anti-depressants as a first line of treatment. For people with PMS, contraceptives or alternative therapies may initially be recommended.

Non-medical treatments include:

• Changes in diet and decreasing sugar, caffeine and alcohol intake
• Introducing regular exercise into your routine
• Practising methods of stress management, like meditation or yoga
• Taking vitamin supplements (the most frequently suggested include vitamin B6, calcium and magnesium)

Medical treatments include

• Talking therapies, such as cognitive behavioural therapy (CBT)
• Selective serotonin reuptake inhibitors (SSRIs)
• Combined oral contraceptives
• Anti-inflammatory medicines
• Water pills (diuretics)

Alternative therapies include

• Aromatherapy
• Acupuncture
• Reflexology