PMS vs PMDD: symptoms and getting help

PMS and PMDD both cause symptoms before a period. PMDD includes severe mood symptoms that can seriously disrupt daily life.

What you’re comparing	PMS: premenstrual syndrome	PMDD: premenstrual dysphoric disorder
Timing	Symptoms start before a period and usually get better once it starts.	Symptoms start before a period and usually get better within a few days of bleeding starting.
Typical symptoms	Sore breasts, bloating, headaches, tiredness and mood changes.	Severe irritability, low mood or anxiety. Some people also have physical symptoms, sleep problems or trouble concentrating.
Effect on daily life	Can be mild and manageable, or can get in the way a lot.	Can cause great distress or get in the way of work, school, relationships or usual activities.
How it is diagnosed	A clinician looks at your symptoms and their pattern, helped by a diary.	A clinician checks specific criteria and rules out other causes. Daily symptom notes confirm the pattern.
Treatment options	Self-care, pain relief and, if needed, talking therapy or prescribed medicines.	May include antidepressants, certain hormonal contraceptive pills and psychological support, as well as self-care.

The table is based on the symptoms and treatments in RCOG’s PMS guidance and MedlinePlus’s PMDD guidance. PMS can be hard to live with too. You don’t need a PMDD diagnosis to ask for treatment.

How PMDD is diagnosed

The Office on Women’s Health says assessment uses your health history, an examination and a symptom diary. For PMDD, you need at least five symptoms, and at least one must be about mood. A clinician also looks at when they happen and how they affect your life.

Daily notes help a clinician see if your symptoms follow the expected pattern. To confirm it, they use daily ratings during at least two cycles with symptoms. A clinician may make a provisional diagnosis before that. Keeping notes over those cycles is part of the assessment. You can still get care while you keep the diary.

There isn’t a blood test for PMDD. Tests or other checks may be used to rule out other causes. Tell the clinician about symptoms you have all through the month, including any that don’t ease after your period.

A mental health condition you already have can get worse before a period. The PMDD review treats this as different from PMDD, though you can have both. Counting symptoms or spotting a pattern in a calendar can’t diagnose PMDD. It also can’t explain why your mood changed. To learn what your notes can show, read recorded patterns and predictions.

Recording symptoms through the month

Ask your clinician if they want you to use a particular symptom-rating form. A peer-reviewed PMDD review describes structured daily recording. MedlinePlus suggests noting which symptoms you have, how bad they are and how long they last.

Next to your period dates, write what happened in everyday words. Here is a made-up example: “Felt anxious all afternoon. Found it hard to focus and left a meeting early.” On days when symptoms ease, note that too. If you miss a day, leave it as a gap. A guess would hide what’s missing.

Take both your notes and your question to the appointment. For example: “These entries seem to bunch up before my period. Could they be linked?” Write about how you actually felt that day. Don’t decide in advance what mood goes with each part of your cycle.

Help with PMS and PMDD

Book a GP appointment if symptoms affect your daily life or self-care hasn’t helped. Explain what the symptoms get in the way of, even if you haven’t kept a diary.

Everyday options for PMS

The NHS recommends regular exercise, a balanced diet and enough sleep. Relaxing activities such as yoga or meditation may also help. These changes won’t always make symptoms go away.

Pick something that fits easily into your day, such as a walk or a relaxation exercise. Jot down what you tried. You can ask for help while you try these things. You don’t have to work through a self-care checklist first.

For pain, you can take paracetamol or ibuprofen. Follow the leaflet in the pack. If you’re not sure a medicine is right for you, ask a pharmacist. Ibuprofen isn’t suitable for everyone and can interact with other medicines. Check this even for medicines you can buy without a prescription.

Be careful with claims made about supplements. The NHS says there is limited evidence for complementary therapies and supplements for PMS. It advises checking with a GP or pharmacist before you take supplements regularly alongside medicines. If cramps are your main problem, read more in period pain and when to get help.

Treatments to discuss with a GP

For PMDD, the Office on Women’s Health lists several treatments. They include antidepressants called selective serotonin reuptake inhibitors (SSRIs) and certain contraceptive pills. A clinician can talk with you about what suits you. The table above is not a prescription.

Write down your questions about treatment and take them with you. You could ask what improvement to look for, which side effects to talk about and when to check how it’s going. Preparing notes for a healthcare appointment can help you put those questions in order.

Urgent help for suicidal thoughts or self-harm

If you have thoughts of suicide or self-harm, get urgent help now. Don’t wait for your period to start or for a diary to be finished. The NHS says to call 999 or go to A&E if you have PMDD symptoms and feel suicidal.

• In the UK, call 999 or go to A&E now if you can’t keep yourself safe, you have seriously hurt yourself or someone’s life is at risk. Outside the UK, call your local emergency number or go to the nearest emergency department.
• In England, if you need urgent mental health help but it is not an emergency, call NHS 111 and choose the mental health option. You can also ask for an urgent GP appointment. Elsewhere, use your local urgent mental health service.

The NHS urgent mental health guidance explains these options.

In the UK, you can also call Samaritans on 116 123, free, day or night. In the US, call or text 988 for the Suicide & Crisis Lifeline.

If there is immediate danger, contact emergency services now. Don’t wait to talk to a listening service.