What is PMS and PMDD?

Premenstrual syndrome (PMS) is a chronic condition experienced by those who menstruate and is characterised by the presence of distressing physical and emotional symptoms that occur in the luteal phase (the days leading up to menstruation) of each cycle and which disappear or reduce significantly once a period starts.

Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS and a complex hormone-based mood disorder. As well as many of the symptoms of PMS, PMDD also includes the psychological symptoms of extreme mood changes, anxiety and sleep disturbance.

Symptoms may initially present when you start your periods and you may notice that these increase in severity at times, such as following pregnancy loss, postpartum, after stopping breastfeeding, and during perimenopause.

It’s estimated that around 25% of menstruating individuals will experience moderate or severe PMS (NAPS, 2018), and between 3–8% will be diagnosed with PMDD (Rapkin, et al., 2013). Sadly, misdiagnosis and delays in achieving a definitive diagnosis are common with both these conditions, meaning that prevalence rates are quite likely to be much higher than currently reported. In my experience, there is a societal expectation, and on occasions the same expectation from the medical profession, that the symptoms experienced with PMS are ‘part and parcel of being a woman’ and that the sufferer should just  ‘get on with it’. However, sadly this misinformation only prevents those living with PMS and PMDD from accessing the treatment and support they need. Here at Your Fertility Journey Ltd, we believe in the importance of helping individuals to advocate for themselves and providing accurate advice and support to help you feel empowered about your condition.

Common Symptoms of PMS and PMDD

There are more than 150 recognised symptoms of PMS and PMDD, and it’s important to recognise that your symptoms, both in severity and type, may differ from one cycle to another. However, below are the most commonly experienced symptoms of PMS :

Diagnosis

Documenting the variety and severity of the symptoms you are experiencing is central to achieving a diagnosis of PMS or PMDD. Therefore, it’s recommended that you keep a symptom diary for a minimum of two cycles –  an example of a symptom diary that you might like to use can be found in the resources section below.

We recommend that you keep this diary for two months and then see your GP to find out how they can help you. Your GP may refer you to a gynaecologist or PMDD specialist if necessary so that you can discuss your treatment options in more detail.

PMS and PMDD Treatment

The type of treatment you may be offered will vary depending on your individual needs. It’s common to be prescribed hormone treatment to suppress ovulation, thereby stopping any of the hormonal changes that cause the distressing symptoms. The combined oral contraceptive pill may be an option or other hormonal medication, and selective serotonin reuptake inhibitors (SSRIs) that are commonly used to treat depression and anxiety have been shown to be very effective in treating the undesirable symptoms of both severe PMS and PMDD. Cognitive Behavioural Therapy (CBT) may also be an option. In severe circumstances, and when other treatments have not been successful, individuals with a womb may be offered a total hysterectomy that also includes the removal of the ovaries.

What you can do at home

When struggling with PMS or PMDD, you may feel isolated and as if you have no control over what is happening to you. However, there are aspects of your health that you can manage at home, and these, together with medical treatments, will help you feel more empowered and in control of your diagnosis.

Lifestyle changes

Enjoying a healthy diet that is low in refined carbohydrates and sugars will benefit your general health and your PMS/PMDD symptoms. Limiting alcohol and caffeine consumption is also advisable. Add calcium-rich foods, like yoghurt and leafy green vegetables, to your diet and get a good intake of wholegrains, beans and lentils.

Where possible, reducing stress will undoubtedly help you cope better and reduce the impact of any psychological and behavioural symptoms. Relaxation methods can include meditation, breathing exercises and yoga.

Research studies have shown that exercising helps with symptom control (Stoddard, et al., 2007). Exercise regularly, not just during the days you have symptoms, and try to aim for at least 30 minutes each day of aerobic exercises, such as brisk walking, running, cycling or swimming.

A small study showed the benefits of reflexology in reducing PMS symptoms compared to placebo treatment (Oleson & Flocco, 1993). While larger studies would help our understanding of the benefits of reflexology for PMS, including some relaxation time for you can only be of benefit.

If you would like help in managing your PMS or PMDD symptoms or advice on your next steps and the treatment options open to you, book a Women’s Health Consultation with Your Fertility Journey Ltd.

Resources

• National Association for Premenstrual Syndrome (NAPS)
• International Association for Pre-menstrual Disorders
• Symptom Diary

References

• National Association for Premenstrual Syndrome (NAPS) Guidelines on PMS https://www.pms.org.uk/app/uploads/2018/06/guidelinesfinal60210.pdf
• Rapkin, A.J., &  Lewis, E. I. (2013) Treatment of Premenstrual Dysphoric Disorder, Women’s Health, pp. 537–556.
• Stoddard, J. L., Dent, C. W., Shames, L., & Bernstein, L. (2007). Exercise training effects on premenstrual distress and ovarian steroid hormones. European Journal of Applied Physiology, 99(1), pp.27–37.
• Oleson, T., & Flocco, W. (1993). Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstetrics and Gynecology, 82(6), pp.906–911.