PREMENSTRUAL SYNDROME & PREMENSTRUAL DYSPHORIC DISORDER

Understanding PMS and PMDD

Many women experience physical and emotional changes in the lead-up to their period. For some, these changes can be severe enough to interfere with daily life, work, and relationships. This is known as Premenstrual Syndrome (PMS). A more severe form, with significant mood symptoms, is called Premenstrual Dysphoric Disorder (PMDD).

Symptoms usually appear during the luteal phase (about one week before menstruation) and resolve with the onset of menstruation. PMDD can significantly impair social, occupational, or academic functioning, making medical intervention crucial for management.

Symptoms of PMDD

Physical

Symptoms of PMDD can also present as physical symptoms. There can include:

Fatigue or low energy
Sleep disturbances (insomnia or excessive sleep)
Joint or muscle pain
Headaches or migraines
Bloating or weight gain
Breast tenderness or swelling
Acne

Menstrual

Heavy or painful periods are often associated with PMDD

Genitourinary

Low libido is commonly associated with PMDD

Psychological

Severe mood swings
Irritability or anger
Depression or sadness
Anxiety or tension

Management

Management of Premenstrual Dysphoric Disorder (PMDD) should be individualised and evidence-based, recognising the significant impact symptoms can have on quality of life. According to the Royal College of Obstetricians and Gynaecologists (RCOG), effective treatment typically involves a multi-modal approach, including both behavioural and medical strategies.

Recommended management options include:

Prospective Symptom Tracking
Diagnosis and monitoring of PMDD should be based on daily symptom ratings for at least two consecutive menstrual cycles. Digital tools such as the PMDD & Me app can aid this process.
Lifestyle Modifications
Patients should be advised to prioritise regular exercise, balanced nutrition, and good sleep hygiene as foundational components of care.
Hormonal Therapies

Options such as continuous combined hormonal contraception, GnRH analogues with add-back therapy, or in specific cases, menopausal hormone therapy (HRT), may be considered to suppress ovulation and stabilise hormone fluctuations.

Cognitive Behavioural Therapy (CBT)
CBT is an evidence-based intervention shown to improve mood-related symptoms and functional impairment in PMDD.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are recommended as first-line pharmacological treatment, either taken continuously or intermittently during the luteal phase of the menstrual cycle.

Referral for Specialist Review
Referral to a gynaecologist, menopause specialist, or psychiatrist should be considered when symptoms are severe, diagnostic uncertainty exists, or initial treatments are ineffective.