What is PMS, PMDD and PME?
PMS (Premenstrual Syndrome), PMDD (Premenstrual Dysphoric Disorder) and PME (Premenstrual exacerbation) are conditions that many women, and people assigned female at birth (AFAB), experience in the days or weeks leading up to their period.
These conditions involve symptoms that can affect mood, emotions, behaviour, and even physical wellbeing. PMS and PMDD are not the result of a hormone imbalance, but the brain’s negative reaction to the natural rise and fall of oestrogen and progesterone.
You might feel unusually angry, experience sudden bursts of rage, become tearful, feel like you can’t cope with daily tasks, and deal with physical discomfort like bloating, headaches and strong food cravings.
The difference between PMS and PMDD
PMS is relatively common, but PMDD is a more severe form that can significantly disrupt daily life. PMDD affects approximately 5.5% of women and AFAB people of reproductive age. Both conditions can be particularly challenging because they can affect how you feel about yourself and how you interact with others, including your relationships at home, at work and in social settings.
In PMDD, there is an increased risk of experiencing suicidal thoughts and behaviour, which is why it is very important that this condition is recognised and treated appropriately.
If you need further help, or know of someone who does, below are two resources,
NHS mental health support: NHS (www.nhs.uk)
Getting help in a mental health crisis - Mind
For more information on PMDD, please see IAPMD.org
To be classified as PMS or PMDD, symptoms should only arise following ovulation, in the second part of the menstrual cycle, and subside within a few days of menstruation. The only way to diagnose PMS or PMDD is via tracking of symptoms against your menstrual cycle across at least two cycles. This can be done via an app or a downloadable period tracker.
If symptoms are present at other times during the menstrual cycle, then this would be more suggestive of PME. Premenstrual exacerbation of underlying disorders (e.g. migraine, OCD, ADHD) can lead to worsening of symptoms during the premenstrual phase. If you are experiencing PME, then the focus of treatment should initially be on optimising treatment of the affected underlying condition. That said, hormonal approaches can often be very helpful and may be needed in addition.
Bear in mind that if you start experiencing PMS for the first time or notice that your symptoms are getting worse, it could be an early sign of perimenopause (the transition period before menopause).
This change is sometimes misdiagnosed as depression or anxiety because the symptoms can be similar. In more severe cases, where mood swings are extreme, these symptoms could be mistaken for more serious mental health conditions like bipolar disorder or psychosis.
Treatments
The good news is that there are effective treatments available to help manage these symptoms. Many of these treatments involve balancing or supporting your hormones, including:
Hormone Replacement Therapy (HRT)
This treatment helps to stabilise the hormones that are fluctuating during your menstrual cycle or during perimenopause.
The combined oral contraceptive pill (COCP)
This option can regulate your hormones by preventing ovulation and reducing the amount of prostaglandins produced, helping to reduce PMS and PMDD symptoms.
GnRH analogues
These medications temporarily stop the ovaries from working, which can help to reduce unpleasant symptoms. They are often combined with a small amount of HRT to prevent side effects from low oestrogen levels.
Remember you can talk to your GP about any of the above treatments or book a consultation with one of our specialists today
Non-hormonal options
There are also non-hormonal options for treatment, including antidepressant medication. SSRIs (Selective Serotonin Reuptake Inhibitors) can be used specifically during the second phase of the menstrual cycle when your symptoms are at their worst, or they can be taken continuously. These medications can be effective in easing the emotional and psychological symptoms of PMS and PMDD, and work differently (and more quickly) than when used to treat clinical depression.
Psychological therapy, including cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) can also be very helpful. In addition, dietary, lifestyle and supplementary approaches play an important role in management and, in milder forms of PMS, may be all that is required.
Managing PMS, PMDD and PME effectively can greatly improve your quality of life, helping you feel more in control of your emotions and better able to enjoy your personal life and relationships.
If you think you might be experiencing PMS, PMDD or PME, or if your symptoms are getting worse, it’s important to talk to your GP or one of our Menopause Care specialists who can guide you toward the right treatment options.
At Menopause Care, we have a team of menopause doctors who are experienced in helping women through perimenopause and menopause and managing their symptoms in tandem with other conditions. If you’d like evidence-based advice and an individualised treatment plan, book a consultation with a menopause doctor.
