PMS & PMDD: Causes, Symptoms, and Treatment Options

Many people are familiar with the feeling: shortly before menstruation begins, the body changes—mood swings, abdominal pain, or a general sense of discomfort may occur. This phenomenon, known as premenstrual syndrome (PMS), affects a large number of people who menstruate, with varying degrees of intensity. While some experience only mild symptoms, others may fi nd them so severe that their daily lives are signifi cantly affected. In particularly serious cases, this condition is referred to as premenstrual dysphoric disorder (PMDD), a medically recognized subtype of PMS that involves severe psychological and physical symptoms.

But what exactly causes PMS and PMDD? What typical symptoms occur—and what forms of support are available?

What is PMS?

Premenstrual syndrome (PMS) describes a variety of symptoms that occur around 7–14 days before menstruation and subside once bleeding begins.

: • Mood swings, irritability, nervousness • Fatigue, sleep problems • Headaches, water retention, breast tenderness • Cravings or digestive issues 👉 Many women experience PMS in a mild form, but for some, the symptoms are noticeably more restrictive.

Common PMS symptoms:

• Mood swings, irritability, nervousness
• Fatigue, sleep problems
• Headaches, water retention, breast tenderness
• Cravings or digestive issues

👉 Many women experience PMS in a mild form, but for some, the symptoms are noticeably more restrictive.

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a particularly severe form of PMS and is classifi ed by professionals as a mental health condition.

Typical PMDD symptoms:

• Severe depression, lack of motivation
• Anxiety and panic attacks
• Pronounced irritability and confl icts in daily life
• Concentration diffi culties
• In severe cases: suicidal thoughts 

📌 While PMS is common, PMDD affects an estimated 3–8% of menstruating women.

Causes of PMS & PMDD

The exact causes are still not fully understood. However, it is known that hormonal fluctuations within the cycle play a key role:

• Hormonal fluctuations: Changes in progesterone and estrogen levels during the luteal phase (the time between ovulation and menstruation) can affect mood and the body.
• Neurotransmitters: The neurotransmitter serotonin appears to be linked to mood-related symptoms. An imbalance may contribute to depressive moods.
• Genetic factors: Studies show that PMS and PMDD can occur within families, indicating a genetic component.
• Lifestyle & environmental factors: Stress, lack of sleep, diet, and insufficient physical activity can intensify symptoms.

 

Symptoms of PMS

Symptoms vary in type and intensity from person to person. They can roughly be divided into two categories:

• Physical symptoms: Breast tenderness, bloating, headaches, cravings, water retention, muscle and joint pain. •
• Emotional & psychological symptoms: Irritability, mood swings, nervousness, depressive moods, concentration problems. Symptoms are usually most pronounced in the days to two weeks before menstruation and disappear once bleeding starts.

Symptoms of PMDD

Unlike PMS, the symptoms of PMDD are signifi cantly more severe and more impairing. Common symptoms include:

• Severe depressive moods or feelings of hopelessness
• Intense irritability or anger • Panic or anxiety attacks
• Significant exhaustion and sleep disturbances
• Difficulties in social and professional life

For many affected individuals, PMDD is more than an “intensified form of PMS”: it is a serious health condition requiring targeted treatment.

Treatment options

Treatment depends on individual symptom severity and may combine different approaches:

1. Lifestyle & self-care

• Regular exercise (e.g., endurance training or relaxation practices such as yoga) 
• Balanced diet with reduced sugar, caffeine, and alcohol 
• Sufficient sleep and stress management through meditation or
  mindfulness
• Symptom tracking to better identify triggers and patterns
  

2. Medical therapy

• Hormonal treatments (e.g., birth control pills or specific progestins) to regulate hormonal fluctuations
• Antidepressants (SSRIs) for severe psychological symptoms, especially effective for PMDD
• Pain medication to relieve physical discomfort
• In severe cases, other medications that suppress hormone production (under medical supervision)
  

3. Therapeutic support 

• Psychotherapy (e.g., cognitive behavioural therapy) to better manage mood swings and stress
• Group therapy or support groups for exchange and encouragement

PMS and PMDD affect millions of people worldwide—yet their symptoms are often underestimated. While PMS can often be relieved through lifestyle changes, PMDD usually requires medical treatment. It is important to take symptoms seriously and seek support early. The first step often involves tracking symptoms throughout the cycle and discussing them with a healthcare professional. With the right measures, most affected individuals can significantly improve their quality of life.

How many cycles should I track before considering a diagnosis?

For a reliable diagnosis of cycle-related conditions such as PMS or PMDD, it is recommended to carefully observe and document symptoms over at least two to three menstrual cycles. This cyclical pattern helps healthcare providers distinguish between temporary mood changes and conditions that require treatment. Symptom diaries or cycle-tracking apps can be very helpful in this process.

For cycle irregularities or lack of ovulation, it is also generally recommended to observe several cycles (at least three) to obtain a meaningful picture before considering a diagnosis or further examinations. Systematic tracking over this period is crucial for reliably identifying recurring patterns and detecting individual deviations from a normal cycle.

In summary, Before pursuing a diagnosis, symptoms should ideally be
monitored over at least two to three cycles. In cases of uncertainty or severe symptoms, medical advice should be sought regularly.