PMS, PMDD and you

For many women, the lead up to their period can be difficult. For some, it’s horrendous. The good news is that premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) can be treated.

What is PMS?

Premenstrual syndrome (PMS) refers to the symptoms you might feel in the week or 2 before your period starts. Around 90% of women experience some symptoms, while around 20% to 40% experience symptoms that impact their daily life.

The symptoms can be emotional, physical or both and include:

• cramping in the pelvic area
• bloating around the belly (abdomen)
• breast swelling and tenderness
• fluid retention (swollen fingers or ankles)
• skin problems, such as acne
• feeling grumpy (irritability)
• feeling worried or anxious (anxiety)
• lower ability to cope
• loss of confidence
• difficulty concentrating or thinking clearly
• mood changes
• sadness or depressed mood.

Symptoms can vary with each cycle. But according to Sandra Villella, a naturopath and herbalist at the Jean Hailes Clinic, “Women typically experience the same set of symptoms from one cycle to the next.”

Once your period starts, the symptoms usually go away.

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a severe condition that causes intense emotional and psychological distress before your periods. It can seem similar to PMS, but PMDD symptoms are much more intense and can significantly interfere with daily life.

Dr Karina Severin, a specialist women’s health GP at the Jean Hailes Clinic, says PMDD affects about 3% to 8% of women of reproductive age.

“It involves extreme or sudden mood changes, and women can feel depressed, anxious, angry, hopeless and sometimes suicidal.

“Typically, symptoms appear a week or 2 before your period. Once your period starts, symptoms ease and you feel more like yourself again.”

Sometimes, PMDD gets mistaken for other conditions, like bipolar disorder. There are no tests for PMDD, but the key difference between it and other mental health conditions is that symptoms of PMDD follow the menstrual cycle and get better once your period starts.

To diagnose PMDD, there needs to be a pattern of symptoms over at least 2 cycles.

Ms Villella suggests using an app or printable tracker to track your symptoms. “Tracking them under different categories will help you notice certain patterns. For example, you might ask ‘do I have generalised anxiety, or is it that I’m just anxious in the pre-menstrual phase?’”

If your periods start and your symptoms don’t ease, it’s probably not PMDD, she adds.

Learn more about diagnosing PMDD.

What causes PMS and PMDD?

It’s not known exactly what causes PMS or PMDD. But it’s believed that having an increased sensitivity to normal hormone changes during the menstrual cycle may be a reason.

Genetics, stress and inflammation may also play a role.

“The risk of PMDD is higher in those with a history of stress, trauma and mood disorders,” adds Dr Severin.

Finding relief for PMS and PMDD

The good news is that PMS and PMDD can be managed and treated successfully. But it can take trial and error to find what works for you.

Managing PMS

Healthy lifestyle habits, like staying active, eating a balanced diet, avoiding alcohol and smoking, and managing stress, can all make a difference.

Medicines, such as the Pill, some antidepressants and some anti-inflammatories, may help with PMS symptoms too.

Some people also find natural therapies useful. For example, calcium and vitamin D supplements have been shown to work well.

Chaste tree supplements, also called Vitex or Vitex agnus castus, and vitamin B6 supplements are other popular remedies, though more evidence is needed to support their use. Ms Villella adds chaste tree supplements “need to be prescribed by a health practitioner trained in herbal medicine”.

It’s a good idea to speak to your doctor before taking supplements to avoid unwanted side effects. Supplements can cause harm when taken in high doses or when they interact with other medicines.

Learn more about the different ways to manage PMS.

Treating PMDD

How PMDD is treated depends on your symptoms and how much they affect you. Dr Severin says it’s also important to understand if you have any other underlying conditions, like thyroid issues, as these can make your symptoms worse.

“Medical treatments for PMDD include hormonal treatments such as the Pill or antidepressants,” she says. “Changes to your diet, natural therapies or cognitive behavioural therapy may help too. Often, a combination of treatments is what’s needed.

“If none of these treatments work, medicines or surgery to ‘turn off’ the ovaries and cause medically induced menopause may be an option. Though this comes with risks and benefits.”

Learn more about the different treatments for PMDD.

What else you can do

Ms Villella says that being aware of your symptoms, including when they occur and how they make you feel, can help you put plans in place to make sure you don’t do too much during those times. It’s also important to educate your loved ones about the issue, so they can support you.

When to seek help

If premenstrual symptoms are impacting your quality of life, don’t suffer in silence. Speak to a doctor with an interest in women’s health.

Kira Knuckey shares her journey with PMDD.