Premenstrual Symptoms (PMS and PMDD)
Premenstrual symptoms are common and can affect physical, emotional and psychological wellbeing in the days or weeks before a period. For some people, symptoms are mild and manageable, while for others they can be severe and disruptive.
This page explains the spectrum of premenstrual symptoms, including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). It outlines common symptoms, how they are assessed in primary care, and when further support or treatment may be needed.
These articles are intended as educational sources, not diagnostic nor taking place of a proper medical assessment. If you need help, please book an appointment with one of our GP’s.
What this page covers
This page provides GP-reviewed information on:
- what premenstrual symptoms are
- the difference between PMS and PMDD
- common emotional and physical symptoms
- how symptoms are assessed and diagnosed
- treatment options and support
- when urgent medical help is needed
This information supports understanding and does not replace personalised medical advice.
What are premenstrual symptoms?
Premenstrual symptoms occur during the luteal phase of the menstrual cycle, after ovulation and before menstruation. Symptoms typically improve or resolve once bleeding begins.
They are thought to result from an increased sensitivity to normal hormonal fluctuations, rather than abnormal hormone levels.
Symptoms can vary in severity, duration and impact from cycle to cycle.
Premenstrual syndrome (PMS)
PMS refers to a group of physical and emotional symptoms that occur before a period and are mild to moderate in severity.
Symptoms may be uncomfortable or inconvenient but usually do not cause major functional impairment.
Common PMS symptoms include:
- bloating or abdominal discomfort
- breast tenderness
- headaches
- fatigue
- mild mood changes
- irritability
- sleep disturbance
- food cravings
Many people manage PMS with reassurance, lifestyle adjustments or simple treatments.
Premenstrual dysphoric disorder (PMDD)
PMDD is a severe form of premenstrual symptoms that causes significant emotional and psychological distress. It is recognised as a distinct clinical condition.
PMDD is characterised by:
- severe mood changes
- marked irritability or anger
- anxiety or tension
- low mood or feelings of hopelessness
- reduced interest in usual activities
- difficulty concentrating
Symptoms are cyclical and improve shortly after menstruation begins, with symptom-free intervals during the rest of the cycle.
Key differences between PMS and PMDD
| Feature | PMS | PMDD |
|---|---|---|
| Severity of symptoms | Mild to moderate | Severe |
| Emotional impact | Usually manageable | Marked emotional distress |
| Effect on daily functioning | Minimal or manageable | Significant impairment |
| Impact on work or relationships | Limited | Often substantial |
| Symptom-free intervals | Yes | Yes |
| Need for medical treatment | Sometimes | Often required |
Recognising this difference is important for appropriate support and treatment.
Common symptoms of PMS and PMDD
Emotional and psychological symptoms
- mood swings
- irritability
- anxiety
- low mood
- poor concentration
- feeling overwhelmed
Physical symptoms
- bloating
- breast tenderness
- headaches or migraines
- joint or muscle pain
- fatigue
- sleep disturbance
Symptoms usually follow a predictable monthly pattern.
When to seek urgent medical help
Urgent support should be sought if premenstrual symptoms are associated with:
- thoughts of self-harm
- suicidal thoughts
- severe emotional distress
- loss of safety or control
If you are in immediate danger, emergency services should be contacted.
How PMS and PMDD are assessed
There is no single test to diagnose PMS or PMDD. Diagnosis is based on symptom timing, severity and pattern.
A GP may recommend:
- prospective symptom tracking over two or more menstrual cycles
- assessment of impact on daily life and functioning
- exclusion of other conditions such as depression, anxiety disorders, thyroid disease or perimenopause
Treatment and management options
Management depends on symptom severity and individual preference.
Lifestyle and supportive measures
These may help mild to moderate symptoms:
- regular physical activity
- balanced nutrition
- sleep routine optimisation
- stress management
- reducing caffeine and alcohol
Psychological support
Cognitive behavioural therapy (CBT) can help some people manage emotional symptoms and coping strategies.
Medication options
For moderate to severe symptoms, a GP may discuss:
- selective serotonin reuptake inhibitors (SSRIs), taken continuously or during the luteal phase
- hormonal treatments to suppress ovulation in selected cases
Treatment decisions are individualised and reviewed regularly.
When to book a GP appointment
Consider booking a GP consultation if:
- premenstrual symptoms are severe or worsening
- mood symptoms significantly affect work or relationships
- symptoms follow a clear cyclical pattern
- you want support with diagnosis or treatment options
- symptoms are being mistaken for another mental health condition
Early recognition and treatment can significantly improve quality of life.
Related articles
- Heavy or painful periods
- Menstrual cycle and period symptoms
- Perimenopause and menopause
- Polycystic ovary syndrome (PCOS)
This page provides general health information and does not replace personalised medical advice. Mental health symptoms should always be discussed with a qualified healthcare professional.
Further Reading and Hub Links
Visit our Women’s Health hub or browse more health topics in the AccessGP Knowledge Base.
If you are experiencing significant premenstrual symptoms and would like a GP review, you can book an online appointment with AccessGP.
Last reviewed by Dr Zamiel Hussain, GMC registered GP
Clinical contributor: Dr Tasnimah Miah, Women’s Health Advocate
Updated: 15 December 2025