Premenstrual Syndrome (PMS) and premenstrual Dysphoric Dystrophia (PMDD)
Find out more below
What is PMS?
Premenstrual Syndrome (PMS) is a common group of symptoms that occurs as a result of the normal hormonal changes of the menstrual cycle. The symptoms may be physical or psychological, they typically occur in the second half of the cycle and improve with the onset of menstruation. Around 80% of women will experience PMS to some degree but the symptoms are often not very troublesome, however around 5% of women experience severe PMS which can seriously affect wellbeing.
The cause of PMS is unknown, but it is clearly related to the cycle; it does not occur before puberty, in pregnancy or after hysterectomy with removal of the ovaries. There may be a genetic basis and women with a history of pre-existing depression or anxiety tend to be at increased risk of severe PMS. The symptoms of PMS and PMDD tend to worsen with age.
Women with PMS tend to be at greater risk of postnatal depression and are more likely to suffer from depression and anxiety with the menopause.
What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a form of PMS characterised by severe emotional symptoms, which vary from woman to woman but include:
- Extreme mood swings, including feelings of sadness, anxiety, irritability, anger and in some cases suicidal thoughts
- Fatigue and difficulty concentrating
- Insomnia or hypersomnia
- A sense of being overwhelmed or out of control
How can PMS and PMDD be treated?
Proven hormonal treatment for PMS and PMDD works by suppressing the natural cycle and ovulation. This can be achieved with oestrogen gels, patches or subcutaneous hormone implants. Women receiving such treatment will also need to take additional progesterone to avoid endometrial hyperplasia and ensure a regular bleeding pattern. However, women with PMS are often progesterone intolerant and may experience PMS type symptoms when taking it. These side effects can be reduced by using natural progesterone instead of a synthetic progestogen. In some cases, a reduced dose of progesterone may be necessary, but this will require regular monitoring. A hormone releasing contraceptive device such as Mirena can also be used and is associated with fewer and less severe progesterone side effects.
The contraceptive pills suppress ovulation but are not usually helpful in the treatment of PMS because they contain synthetic progestogens which can aggravate symptoms of PMS sufferers who are often progesterone intolerant. Some of the newer contraceptive pills contain progestogens that are associated with fewer side effects and may help with mild cases of PMS.
In our experience, hormonal treatment is the most effective treatment however some women may benefit from antidepressants either alone or in addition to hormonal treatment.
Book your appointment
Book your appointment with our specialist team
Dr Neale Watson
Consultant Gynaecologist
Dr Mike Savvas
Consultant Gynaecologist
Dr Marilena Nicou
GP Menopause specialist
Frequently Asked Questions
How can I manage my PMS without medications?
There are several things you can do to manage PMDD symptoms, including:
- Practising stress-management techniques, such as yoga, meditation, or deep breathing exercises
- Engaging in regular exercise, which can help improve mood and reduce physical symptoms
- Eating a well-balanced diet and limiting caffeine and alcohol intake
At our clinic, we understand the impact that PMS/PMDD can have on your life. Our lead clinicians have a particular interest in managing patients with anxiety and depression related to hormonal changes. We can help you find the best treatment options for your individual needs and provide ongoing support and care.
Can hormonal treatments help with PMDD?
Yes, bio-identical HRT can help women who experience PMS or PMDD. This can be achieved with Transdermal Oestrogen which suppresses ovulation and provides stable hormone levels throughout the month. The progesterone used in HRT can sometimes exacerbate these symptoms and we therefore tailor our dosing and products accordingly. We will often recommend a Mirena IUS device, as this delivers Progesterone locally in the womb with the least systemic side effects and therefore, the least impact on mood.
What to Expect From Your Visit
The first visit will entail a comprehensive consultation, examination and hormone profile testing if required. Our highly qualified menopause specialists will guide you through the process of choosing the safest and most effective treatment to manage your symptoms.
A prescription will usually be issued, at the first visit if appropriate and a follow-up is arranged after 2-3 months to assess the effectiveness of the treatment and make changes as required. Our clinic allows for remote consultation for those who cannot make an in-person follow-up. This may be via a video or telephone call.
Additional services such as pelvic ultrasound scan, coil fittings, smear tests and bone density scan (DEXA) may also be performed as appropriate. We can also arrange for you to have a mammogram if you need one.