If you find yourself feeling like a completely different person in the weeks leading up to your period—more irritable, anxious, exhausted, or just not yourself—you’re not alone. Premenstrual Syndrome (PMS) and its more severe counterpart, Premenstrual Dysphoric Disorder (PMDD), affect millions of women, yet many suffer in silence, not realising that there are treatments that can help.

Let’s explore what PMS and PMDD really are, why they happen, and most importantly—what can be done about them.

What is PMS?

Premenstrual Syndrome (PMS) is an umbrella term for the physical, emotional, and psychological symptoms that occur in the second half of the menstrual cycle, known as the luteal phase. Symptoms usually start a few days to two weeks before your period and resolve once menstruation begins.

Common Symptoms of PMS:

  • Mood swings, irritability, or increased emotional sensitivity
  • Anxiety or low mood
  • Fatigue and difficulty sleeping
  • Bloating and fluid retention
  • Headaches or migraines
  • Breast tenderness
  • Food cravings or appetite changes
  • Acne breakouts
  • Digestive issues (constipation or diarrhoea)
  • Joint or muscle pain

For some, these symptoms are mild and manageable, but for others, PMS can be severe enough to interfere with daily life.

Crying woman - symptoms of PMS

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a more severe, debilitating form of PMS that can have a profound impact on mental health. While PMS can be frustrating, PMDD is life-altering, often leading to extreme mood swings, depression, and even suicidal thoughts.

  • Burning sensation when urinating
  • Frequent urination, even if little urine comes out
  • Urgency—feeling like you ‘have to go’ immediately
  • Cloudy, strong-smelling, or bloody urine
  • Pelvic pain or discomfort
  • Lower back pain or pressure
  • Fatigue or fever (if the infection spreads to the kidneys)

Symptoms of PMDD:

  • Intense mood changes, including severe irritability or rage
  • Feelings of despair, hopelessness, or severe depression
  • Panic attacks or extreme anxiety
  • Insomnia or sleeping too much
  • Severe fatigue or low energy
  • Difficulty concentrating
  • Increased sensitivity to rejection or conflict
  • Physical symptoms such as bloating, joint pain, and breast tenderness

Unlike generalised depression or anxiety, PMDD symptoms only occur in the luteal phase of the cycle and disappear once menstruation begins.

What are the treatment options?Why Does PMS and PMDD Happen?

The exact cause of PMS and PMDD isn’t fully understood, but the main culprit is thought to be hormonal fluctuations, particularly the body’s sensitivity to normal changes in oestrogen and progesterone.

Some key factors contributing to PMS and PMDD include:

1. Hormonal Sensitivity

Even though hormone levels remain within normal ranges, some women are particularly sensitive to their fluctuations. This can lead to neurotransmitter changes in the brain, particularly affecting serotonin levels, which play a key role in mood regulation.

2. Progesterone & Allopregnanolone

Progesterone, which rises in the second half of the cycle, gets converted into a neurosteroid called allopregnanolone. In some women, this has a calming effect, while in others, it can cause irritability and anxiety.

3. Serotonin Deficiency

Oestrogen helps regulate serotonin, a key mood stabiliser. When oestrogen drops before a period, serotonin levels can plummet, leading to mood swings, anxiety, and depression.

4. Inflammation & Stress

High levels of inflammation and chronic stress can make PMS and PMDD worse by increasing cortisol (the stress hormone), which disrupts hormone balance.

5. Blood Sugar Imbalances

Fluctuations in blood sugar levels can contribute to mood swings, fatigue, and food cravings. A diet high in refined carbohydrates and sugar can make PMS worse.

 

How Do PMS & PMDD Affect Daily Life?

Many women find that PMS makes them less patient, more reactive, and more emotional. This can cause tension in relationships, difficulty at work, and a general sense of feeling out of control.

For those with PMDD, the symptoms can be severe enough to disrupt careers, friendships, and even lead to misdiagnoses of bipolar disorder or depression.

 

How Do You Know if You Have PMS or PMDD?

PMDD (Premenstrual dysphoric disorder) is similar to PMS but is a more severe and serious disorder. PMDD can cause severe depression, irritability, and for some patients, even suicidal thoughts. Many patients will experience substantial impacts on their lives and it can under-recognised in the medical community. Keeping a diary can help shine a light on your symptoms and can build a picture which can help with diagnosis.

 

Treatment & Management of PMS & PMDD

1. Lifestyle Changes

  • Regular Exercise: Aerobic exercise (like running, swimming, or walking) helps regulate hormones and improves mood.
  • Balanced Diet: Focus on whole foods, lean protein, healthy fats, and fibre while reducing processed foods and sugar.
  • Reduce Alcohol & Caffeine: Both can make symptoms worse by increasing anxiety and disrupting sleep.
  • Improve Sleep: Poor sleep worsens PMS symptoms. Aim for 7-9 hours per night.

2. Nutritional Supplements

  • Magnesium: Supports muscle relaxation and mood regulation.
  • Vitamin B6: Helps with serotonin production and can reduce mood swings.
  • Omega-3 Fatty Acids: Found in fish oil, these support brain function and reduce inflammation.
  • Hormonal Treatments
  • Combined Contraceptive Pill (e.g. Yasmin): Can stabilise hormonal fluctuations and reduce symptoms.
  • Mirena Coil: Some women find that the Mirena coil helpful as in some women it switches off ovulation preventing the swings in hormones, and it is also a very useful if commencing HRT.
  • Oestrogen Therapy: e.g. a patch, can help stabilise hormone levels. This would be given with a progesterone to protect the womb lining.

4. SSRIs (Selective Serotonin Reuptake Inhibitors)

  • Medications like escitalopram, citalopram, fluoxetine and sertraline can be used just in the luteal phase to target the serotonin imbalance or continuously.

5. Cognitive Behavioural Therapy (CBT)

  • CBT can be effective for managing anxiety, depression, and emotional distress linked to PMDD.

 

PMS, PMDD & Menopause: Why Your Symptoms Are Getting Worse

If you’ve noticed your PMS becoming more intense as you get older, you’re not imagining it. Many women report worsening PMS or even developing severe premenstrual symptoms for the first time in their 40s, often as perimenopause begins.

Perimenopause is the transition phase leading up to menopause, where hormone levels become more erratic and unpredictable. This hormonal chaos can magnify symptoms of PMS and PMDD, leaving many women feeling overwhelmed, anxious, and exhausted.

Let’s dive into how menopause affects PMS, why it happens, and what you can do about it.

 

Why Does PMS Get Worse With Age?

The relationship between PMS, PMDD, and menopause is driven by fluctuating oestrogen and progesterone levels. As you approach menopause, your ovarian function becomes less stable, and your hormones begin to rise and fall more erratically than ever before.

Key Reasons PMS & PMDD Worsen in Perimenopause:

1. Wild Hormone Fluctuations

  • In your 20s and 30s, your oestrogen and progesterone follow a fairly predictable pattern each cycle.
  • In perimenopause, your ovaries start misfiring—some cycles have high oestrogen, others have too little.
  • Progesterone levels also start dropping sooner and more significantly.
  • These fluctuations destabilise serotonin and dopamine, leading to worse mood swings, anxiety, and depression.

2. Lower Progesterone = Less Calm & More Irritability

Progesterone is often called the “calming hormone” because it interacts with GABA, the brain’s natural tranquiliser. As progesterone levels decline in perimenopause:

  • Anxiety, restlessness, and poor sleep increase.
  • Mood swings become more intense, leading to irritability, rage, and emotional sensitivity.
  • Some women develop PMS for the first time in their 40s due to the change in the level of progesterone.

3. Oestrogen Drops Affect Serotonin & Brain Function

Oestrogen is key for brain function, mood regulation, and energy levels. When it drops too low before a period, women experience:

  • Lower serotonin, leading to low mood, tearfulness, and heightened anxiety.
  • Brain fog and memory lapses (often mistaken for early dementia!).
  • Worsening migraines and headaches, particularly in women already prone to them.

4. Shorter & More Erratic Cycles

  • Many perimenopausal women notice that their cycles become shorter, meaning more frequent PMS episodes.
  • Bleeding patterns can also change, with heavier, prolonged periods or skipping cycles altogether.
  • Irregular ovulation means progesterone production is inconsistent, worsening mood symptoms.

5. Higher Stress Levels & Cortisol Sensitivity

  • Women in their 40s often juggle work, family, and ageing parents, increasing stress levels.
  • Chronically high cortisol (the stress hormone) suppresses progesterone, making PMS and PMDD worse.
  • Many women also develop new sensitivities to caffeine, alcohol, and sugar, which can trigger severe PMS symptoms.

6. Poorer Sleep & Night Sweats

  • Declining progesterone disrupts sleep, making it harder to get restorative deep sleep.
  • Oestrogen withdrawal causes night sweats and hot flashes, leaving women exhausted and irritable.
  • Poor sleep increases cravings for sugar and refined carbs, which worsen PMS bloating, headaches, and mood swings.

 

How Can You Tell If It’s PMS or Perimenopause?

Since PMS and perimenopause symptoms overlap, it can be hard to tell which one is causing your symptoms, so do book an appointment if you are experiencing symptoms.

Treatments: What Can Help PMS & PMDD in Perimenopause?

Since perimenopause amplifies PMS, treatment needs to focus on stabilising hormone levels and supporting brain chemistry. Here’s what can help:

Hormone Therapy (HRT)

One of the most effective treatments for worsening PMS in perimenopause is hormone replacement therapy.

  • HRT (e.g. an oestrogen patch or gel) helps stabilise hormone fluctuations, reducing mood swings, anxiety, and fatigue. Progesterone is given alongside oestrogen if you still have a womb.
  • The Mirena coil (which releases progesterone) can be combined with oestrogen therapy to help manage heavy bleeding.

When to Seek Help

If you’re struggling with severe PMS, PMDD, or worsening perimenopausal symptoms, don’t suffer in silence. A hormone specialist can assess your symptoms and create a personalised treatment plan.

Key signs you need medical support:

  • Your PMS or PMDD symptoms are worsening with age.
  • You experience severe depression, rage, or suicidal thoughts before your period.
  • Your cycle has become irregular, shorter, or heavier.
  • You’re struggling with daily anxiety, poor sleep, or extreme fatigue.

Final Thoughts

PMS and PMDD can be incredibly difficult to navigate—and when perimenopause enters the picture, things can become even more unpredictable. But the good news is, much can be done to help. Whether it’s HRT, supplements, diet changes, or therapy, there are solutions that can get you feeling like yourself again.

Book a consultation today.