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Everyone’s experience of PMS is different and some people experience an extreme form of PMS called PMDD.
PMS, or pre-menstrual syndrome, is the name for the symptoms people can experience in the week or so before their period starts. Many people assume that PMS is simply a highly emotional state that everyone with a period experiences each month- but that’s not true!
90% of people with periods experience PMS, but everyone’s experience is different:
This page will only focus on the the mental health side of PMS. Find out more about the physical changes that take place during the menstrual cycle.
The exact cause of PMS isn’t known. Although it’s thought to be linked to changing hormone levels during the luteal phase of the menstrual cycle, between ovulation (when the ovaries release an egg) and your period. During this time oestrogen levels are declining while progesterone levels are increasing.
Progesterone’s role is to maintain a pregnancy (whether or not one will or won’t have taken place) and can naturally make you want to take things easier and withdraw socially.
PMS can bring a variety of symptoms that affect your mood, including:
You may experience PMS at the same time as an existing mental health condition which can make your existing symptoms worse. This is known as premenstrual exacerbation. Unlike premenstrual exacerbation, PMS should disappear during your period or the week after.
If your mood is affected by PMS there are some lifestyle changes that can help ease your symptoms.
If you know when PMS is coming this can help you prepare in advance. Knowing what days you may have low energy or feel anxious can empower you to have more control over your experience of this part of your cycle. For example, you can:
You could track your cycle using a diary or there are lots of apps like Flo that can track your cycle and estimate when your period might start to save you from doing the calculations.
If you find you have low energy, exercise is a natural way of increasing your energy levels as well as helping you get a better night’s sleep. Exercise doesn’t have to mean high intensity exercise; it can be anything that moves your body. For example, gentle yoga, swimming or walking. More about exercise
Exercise if it feels good, rest if you need to. You might find you just want to sit on the sofa and do nothing and there’s nothing wrong with that. Although exercise can bring great benefits, rest and sleep are also really important at this stage of your cycle.
Stress can make PMS symptoms like anxiety and irritability worse. There is evidence that stress can also increase period pain. Exercise is a great way of reducing stress and you might find that having quiet weekends and free time can help.
The nicotine found in e-cigarettes, and cigarettes can make PMS symptoms worse by making you more affected by stress. More about the impact of vaping and smoking
A big challenge for many people is how PMS affects their relationships, their desire to interact with other people, their patience/resilience when faced with challenging conversations etc. Talking to those around you about how you are feeling can help with this.
There is a general lack of understanding about what PMS means, but talking about your personal experience can help those close to you to understand how you’re feeling and you might find that they are able to offer some support or advice, help you re-prioritise, or even cut you some slack if that’s what is needed.
It’s very easy to blame PMS for any feelings you have during this part of your cycle but the reality is that these feelings are often cropping up for a reason. This is a good time to take note of any thoughts, concerns or feelings you have. It’s likely that these are still present at other times of the month but you’re able to distract yourself or overcome them. Take note and use this time to reflect on how you can resolve any negative emotions you’re feeling. While it’s true that you might feel teary or irritable over small things, don’t belittle your feelings and explore whether there’s a deeper reason for them.
If you find that even with these changes, PMS is drastically affecting your everyday life, your work or education, relationships and mental health, you may have what’s known as premenstrual dysphoric disorder.
PMDD stands for premenstrual dysphoric disorder. It is a mental health condition that is an extreme form of PMS. Around 3-8% of people with periods suffer with PMDD and it is thought that it could be because people with PMDD are more sensitive to hormone changes.
People with PMDD often talk about feeling like a completely different person during this part of their menstrual cycle. They find their mood changes so severely that it affects all parts of their life, and they often feel unable to cope.
PMDD often has the same symptoms as PMS but symptoms with PMDD are more intense and drastically affect daily life and relationships.
Some symptoms of PMDD include:
As with PMS, PMDD can also have physical symptoms including muscle pain, breast tenderness, bloating, cramps, headaches.
PMDD symptoms usually start soon after ovulation (when the ovaries release an egg) and symptoms have normally disappeared by the week after your period.
There is a lack of awareness and understanding of PMDD which can make it hard to get support from those around you and from professionals. But you don’t have to accept feeling this way each month as a normal part of life. There are treatments and methods that can ease symptoms. So if you feel that PMS is affecting your everyday life, whether or not you think it is PMDD, it’s worth contacting your GP as there are methods that may help you.
Organisations specialising in PMDD that can help you recognise your right to support:
It’s worth keeping a diary of your symptoms, tracking your menstrual cycle and how you feel each day (you can create your own tracker or use a tracking app like Me vs PMDD). Keeping a diary can help you prepare for when your symptoms will be worse and identify changes that might help with your symptoms. You can also bring this diary to the appointment with your GP so they can better understand your symptoms.
Here are some examples of what may help with PMS/PMDD:
Making small changes to your diet, doing exercise and prioritising sleep can lessen your symptoms. More about lifestyle changes
This is a talking therapy that focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour. Through this type of therapy, you can unlearn negative thought patterns and understand how to manage symptoms of anxiety and depression. Your GP can refer you for NHS talking therapies or, if you can afford to pay, you can search online therapy directories to find a therapist specialising in PMDD.
The combined pill can help with some people’s PMDD symptoms as it stops ovulation. As ovulation doesn’t happen while taking the combined pill, you won’t experience the same increases and decreases in hormones that you would normally. However, for some people their PMDD is worse on the combined pill. Everyone’s experience is different- it’s a case of finding out what works for you. More about the combined pill
Taking Selective serotonin reuptake inhibitors (SSRIs) during the days when your symptoms are worse can help you to reduce your symptoms. These are often prescribed at the same time as therapy.
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