PMDD terminology: A guide to medical terms used for PMDD diagnosis and treatment

Hormone glossary

Oestrogen

A key female sex hormone, oestrogen plays an important role in the menstrual cycle, mood regulation, bone health, and skin. It rises and falls during the menstrual cycle. In people with PMDD, these fluctuations can trigger mood swings, irritability, and anxiety. Oestrogen also interacts with neurotransmitters like serotonin and dopamine, which is why it can affect how you feel emotionally and physically.

Progesterone

Progesterone is another major hormone in the menstrual cycle. After ovulation, progesterone levels rise. For some people, this triggers fatigue, low mood, or irritability. It also affects the nervous system, specifically the GABA system, which plays a calming role. This explains why some people feel calm and sleepy in the luteal phase, and others feel tense and anxious: sensitivity to progesterone differs from person to person.

Testosterone

Often thought of as a “male hormone”, testosterone is also made by women. It’s important for libido, energy, strength, confidence, and motivation. Too little can contribute to low mood and fatigue. Too much, on the other hand, can trigger acne or excess hair. Like oestrogen and progesterone, testosterone also fluctuates across the menstrual cycle.

Relaxin

Relaxin is a hormone that increases after ovulation and peaks just before your period. It helps soften the ligaments in your body, especially in preparation for potential pregnancy. But for some people, it may also contribute to bloating, back pain, or loose joints, especially in the days before menstruation.

Cortisol

Often called the “stress hormone”, cortisol helps your body respond to stress and manage inflammation. It rises naturally in the morning and falls throughout the day. But if you’re constantly stressed, cortisol can remain high which can interfere with sleep, digestion, mood, and hormone balance. Elevated cortisol levels are linked to worsened PMS and PMDD symptoms.

Serotonin

Serotonin is one of the brain’s “happy hormones”. It regulates mood, sleep, appetite, and even gut function. It’s made from the amino acid tryptophan; 90% of which is produced in your gut. During the luteal phase (after ovulation), serotonin levels can drop, which is why many people feel low, anxious, or irritable before their period. Supporting serotonin is one of the most effective ways to manage PMDD.

Dopamine

Dopamine is another neurotransmitter, involved in motivation, pleasure, focus, and reward. It’s what helps you get out of bed in the morning, start tasks, and feel good when you achieve something. Low dopamine is associated with fatigue, apathy, or low self-worth - symptoms commonly reported by those with PMDD, particularly in the luteal phase.

Human Growth Hormone (HGH)

HGH helps repair and build tissues, including muscle and bone. It also supports metabolism and fat regulation. Most of your HGH is released during deep sleep. Disrupted sleep (which is common in PMDD) can reduce HGH levels, leading to fatigue, brain fog, and poor recovery.

Glucagon and Insulin

These two hormones work together to control your blood sugar. Insulin lowers blood sugar by helping your cells absorb glucose, while glucagon raises it when needed. If this balance is off, you might feel shaky, dizzy, tired or crave sugar - especially in the luteal phase. Supporting stable blood sugar is key in managing PMS symptoms like irritability and fatigue.

IGF-1 (Insulin-like Growth Factor 1)

IGF-1 is influenced by growth hormone and plays a role in cell growth and development. It helps regulate metabolism, supports muscle recovery, and is linked to mood and cognitive function. Emerging research suggests that IGF-1 may also influence how our brain responds to stress and inflammation – two key issues for those with PMDD.

Treatments: 

Over-the-counter treatments

• NSAIDs: if you’re experiencing pain such as cramps or headaches, one way to relieve them is by taking painkillers, for example, non-steroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen, mefenamic acid, and naproxen. 

  Although there isn’t much research on the effect of NSAIDs on PMS symptoms specifically, they are very frequently taken for pain relief (you probably already use them) and are generally well tolerated.
• Paracetamol: another popular pain relief medication is paracetamol, but research suggests that when it comes to relieving menstrual-related pain, it’s slightly less effective than NSAIDs, like ibuprofen.
• Brands such as Myoovi make small TENS machines that stick to your skin and provide in-situ pain relief. If your cramps start a few days before your period, these can be an effective pain-relief method.
  
• Evelyn's Super Regular® PMS and PMDD supplement

If you feel over-the-counter pain relief isn’t easing your symptoms, there are also other options out there, such as non-hormonal medications.

Non-hormonal therapy

• SSRIs: selective serotonin re-uptake inhibitors (SSRIs) are a type of antidepressant medication and are the primary recommended treatment for PMDD.
  
  They work by preventing serotonin from being re-absorbed, meaning there’s more of it around in the brain. As serotonin is one of the happy hormones, this helps improve our mood.
  
  Side effects - some people experience side effects when taking SSRIs such as headaches, dry mouth, tiredness, sexual dysfunction (difficulty reaching orgasm), sleep disturbances, weight changes, and worsened anxiety. 
  
  If these side effects occur, this can usually be addressed by decreasing the dose you’re taking or changing to an alternative SSRI.
  
  
• SNRIs: SNRIs (serotonin and norepinephrine reuptake inhibitors) are antidepressants similar to SSRIs, but instead of blocking serotonin uptake, they increase serotonin production. 


  
  SNRIs can also relieve nerve and muscle pain, as well as improve mood. Some people find them more effective than SSRIs, but conversely, some people find SSRIs work better; the response seems to vary from person to person.


  
  Side effects - side effects of SNRIs can include nausea, vomiting, dry mouth, constipation, fatigue, drowsiness, excess sweating, and sexual dysfunction. 
  
  Diuretics: people who experience severe bloating during PMS or PMDD may be offered a treatment called diuretics, or ‘water pills’. They work by helping your body flush more fluid through your kidneys.


  
  Side effects - although not common, some side effects of taking water pills include dizziness, headache, dehydration, muscle cramps, and joint disorders (gout).
  
  
• Reflexology and acupuncture: Reflexology and acupuncture are based on the ancient Chinese concept of energy or Qi. Qi is supposed to flow freely through the body but can be blocked by issues like stress, resulting in imbalance and illness.
  
  Reflexology is a massage technique where practitioners apply gentle pressure to specific body parts.
  
  Acupuncture involves a practitioner inserting fine needles into specific parts of the body to manage or prevent illness. Massaging, pressing, or inserting fine needles into specific parts of the body known as pressure points are meant to stimulate the nervous system, relaxing the body and having a positive effect on breathing, blood flow, the immune system, and more.
  
  A review of studies found that reflexology can help to reduce both physical and psychological symptoms of PMS/PMDD, with longer sessions (approximately 60 minutes) being the most effective
  
  
• Aromatherapy: Although aromatherapy (practices using essential oils) doesn’t have as much evidence behind its effectiveness as some other treatments, it can be effective for PMS/PMDD relief.
  
  The best thing about aromatherapy is that it can provide instant relief from certain symptoms, and can easily be practiced at home at very little cost. Essential oils can be inhaled or absorbed through the skin. It’s popular to combine aromatherapy with massage by including essential oils in the massage oil. In other cases, people might use an oil diffuser, rub diluted oil onto their skin, or even add a few drops to a warm bath. If you’re putting oils on your skin, make sure you mix them with a neutral carrier oil like coconut or extra virgin olive oil first, as concentrated essential oils can irritate the skin. 
  
  Studies have found that aromatherapy may help ease the pain experienced around the time of our period, as well as ease PMS symptoms including mood swings, depression, and fatigue.

Another treatment option for PMS and PMDD is hormone therapy. This comes in many formats. These therapies all work in a slightly different ways, but ultimately help to keep the levels of oestrogen and progesterone in our bodies steady (so they don’t rise or fall).

Hormonal therapy

• Combined oral contraceptive (COC/COCP): traditionally, the combined oral contraceptive pill has been one of the most frequently used treatments for easing symptoms of PMS. According to research, COCs containing drospirenone can significantly reduce breast pain and help reduce fluctuations in weight, appetite, mood swings, and acne. 


  
  However, while hormonal pills can relieve your PMS/PMDD symptoms, some people feel they make their PMS/PMDD symptoms worse.
  
  Oestrogen therapy: oestrogen therapy has also been put forward as a way to control PMS symptoms. Oestradiol (a specific form of oestrogen) can be absorbed into the body through a topical patch or gel, or an under-the-skin implant. 

Oestrogen therapy works by preventing ovulation and the cyclical hormone changes that usually follow. Because it’s these hormones and their metabolites which are thought to contribute to PMS/PMDD symptoms, oestrogen therapy can subsequently help reduce symptom severity.
  
  Although these treatments typically contain lower doses of oestrogen than those in COCs, they must also be taken alongside progesterone to protect your womb from excess oestrogen. However, for some people, taking this additional progesterone causes PMS symptoms to show up again, so this treatment regime doesn’t work for everyone.
  
  
• GnRH analogues: Alternatively, GnRH analogues are also an option for PMS symptom relief, but are typically reserved for people experiencing severe PMS.
  
  GnRH analogues are usually given as injections, and work by reducing the levels of oestrogen and progesterone in the body. 


  
  In a way, these injections ‘turn off’ the menstrual cycle and induce temporary menopause. This subsequently prevents the remaining sex hormones from rising and falling, leading to a reduction in PMS symptoms.


  
  Research suggests that GnRH analogies significantly reduce premenstrual depression, irritability, and headaches, and can help people feel happier.
  
  However, because oestrogen plays many important roles throughout the body, for example, in protecting bone strength, GnRH analogue injections are less suitable as a long-term solution.

Talking therapy

• Cognitive Behavioural Therapy (CBT): your healthcare professional may suggest cognitive behavioural therapy for PMS. This is a type of talking therapy that can help with a variety of mental health issues, including PMS- or PMDD-related anxiety. 


  
  CBT isn’t like other forms of therapy which typically deal with issues from your past. Instead, it deals with the ‘here and now’ and targets negative thought patterns and resultant behaviours and improving these with better coping techniques. 


  
  CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a cycle of such. It aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts.


  
  You're shown how to change these negative patterns to improve the way you feel. It looks for practical ways to improve your state of mind on a daily basis.


  
  One of the main benefits of talking therapies compared with pharmacological treatments is that the effects can be longer-lasting and are maintained when therapy comes to an end.


  
  Research indicates that CBT is generally effective in reducing the severity of psychological symptoms and can be used alongside other treatments such as SSRIs. 
  

Surgical interventions

• Surgical treatment: surgical intervention for PMS and PMDD is usually the very last option and is only offered when all other treatments aren’t working.


  
  Surgery is considered the only ‘cure’ for PMS and PMDD, and may either involve removal of the ovaries (‘bilateral oophorectomy’) or removal of the ovaries, uterus, fallopian tubes, and cervix. 


  
  As this removes the ovaries, the hormone-producing organs, it induces surgical menopause, and hormone replacement therapy (HRT) may subsequently be recommended depending on your age.

While this effectively cures PMS and PMDD, it’s important to note that this is an irreversible option, and it makes a person infertile, therefore unable to get pregnant. 
  

Diagnosis: 

• Co-morbid: medical conditions that occur at the same time. For example, a diagnosis of PMDD with co-morbid depression.  
• Diagnostic and Statistical Manual of Mental Disorders 5 (DSM): the DSM is the classification system of mental health and brain conditions published by the American Psychiatric Association. PMDD was recognised in the DSM in 2013.
• Differential diagnosis: differentiating between conditions with similar symptoms or features. 


  For example, PMDD may present with symptoms that also occur in anxiety disorders. A psychiatrist would need to investigate whether someone presenting with these symptoms has PMDD, an anxiety disorder, or possibly both. 
  
• Hormones: chemical messengers released in the body. The female sex hormones are oestrogen and progesterone. Their levels rise and fall throughout the menstrual cycle.
• International Classification of Diseases 11 (ICD): the ICD is an international medical classification of all forms of illness and is published by the World Health Organisation. PMDD was recognised by the ICD in 2019.
• Premenstrual Exacerbation (PME): when the symptoms of another disorder, such as generalised anxiety disorder, OCD, or major depressive disorder, become worse during the luteal phase of our cycle. The symptoms of PME can sometimes resemble PMDD.

Doctors and acronyms

• Endocrinologist: a medical doctor who specialises in diagnosing and treating conditions related to hormones.
• General Practitioner (GP): medical doctor who treats a wide range of common conditions and refers patients for specialist treatment.
• GPwER: stands for GP with extended role (formerly known as GP with special interest). 


  This means that a GP, while continuing to work in primary care, also performs an activity that requires them to have more specialised knowledge and training i.e. a GPwER in gynaecology. Sometimes, a GPwER will see patients who are referred from different practices.
• Gynaecologist: a medical doctor who specialises in diagnosing and treating conditions that affect the female reproductive system.
• DRCOG: when a GP includes RCOG after their name, it means they’ve trained and qualified under the Royal College of Obstetrics and Gynaecology. This indicates that they’ll have a lot of experience in this area.
• DFRSH: when a GP includes FRSH after their name, it means they’ve trained and qualified under the Faculty of Sexual ad Reproductive Health. This indicates that they’ll have a lot of experience in this area.

Mental health professionals

• Psychiatrist: a medical doctor who specialises in mental health. They can diagnose illness and prescribe medication or other forms of treatment.
• Psychologist: offers psychotherapy (talking therapy). Psychologists are not medical doctors and can’t diagnose illness or prescribe medication.
• Therapist/Counsellor: offers various forms of talk therapy. Be careful of sites selling cheap counselling, as they might not use professional therapists. Check a person’s experience, training background, and which professional bodies they're registered with. Check the Mind website for more detail.