Most women get some symptoms before their period. This is called premenstrual syndrome (PMS). For a small number of women, the mood changes are so severe they affect work, relationships and daily life. This is premenstrual dysphoric disorder (PMDD). It is a recognised medical condition, and treatment can help.
Emergency
Call triple zero (000) or go to your nearest emergency department if:
- you are thinking about suicide and have a plan, or feel you cannot keep yourself safe
- you have harmed yourself
For 24-hour crisis support, call Lifeline on 13 11 14 or the Suicide Call Back Service on 1300 659 467.
Key points
- PMS is very common. Most women have at least one symptom before their period, but for most it is mild.
- PMDD is a severe form of premenstrual disorder. It affects about 3 in 100 women when confirmed with symptom tracking.
- The main difference is severity. PMDD causes mood symptoms that seriously affect your life.
- Both follow the same pattern. Symptoms start after ovulation and ease within a few days of your period starting.
- Treatment includes lifestyle changes, talking therapy, antidepressant medicines and hormonal treatments.
- A Doccy consultation can help with medical certificates, contraception, and continuing your usual medicine.
What is PMS?
Premenstrual syndrome (PMS) is a group of physical and emotional symptoms in the 1 to 2 weeks before your period. Symptoms can include:
- bloating and breast tenderness
- headaches
- tiredness
- irritability and mood swings
- food cravings
- trouble sleeping
For most women, PMS is mild and manageable. Some women have moderate symptoms that are uncomfortable but do not stop them doing things. Symptoms ease within a day or two of your period starting.
If your symptoms do not follow this pattern, something else may be going on.
What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a severe mood condition linked to the menstrual cycle. It has the same timing as PMS, but the emotional symptoms are much stronger.
PMDD is not "just bad PMS". It is listed as a medical condition in the main diagnostic manual for mental health (DSM-5). Women with PMDD have normal hormone levels. Their brain is more sensitive to the normal rise and fall of hormones each month.
A 2024 review found PMDD affects about 3 in 100 women when diagnosed by tracking symptoms over 2 cycles. Rates are higher (about 8 in 100) when it is not confirmed with tracking.
How to tell the difference
PMS often looks like: feeling more emotional or teary, food cravings, mild bloating, tiredness, and some irritability you can mostly manage. It is annoying, but it does not stop you working, caring for your family or keeping up relationships.
PMDD often looks like: feeling hopeless, very sad or very anxious for days before your period. You may feel anger that damages relationships, lose interest in things you enjoy, feel overwhelmed, or find it hard to concentrate at work. Some women have thoughts of self-harm or suicide.
The key sign of PMDD is that symptoms almost completely go away once your period starts. If you feel fine for 2 weeks of the month and then struggle for the next 2, PMDD may be the cause.
Symptoms of PMDD
To diagnose PMDD, doctors look for at least 5 of these symptoms in the week before your period. They must improve within a few days of your period starting and be mostly gone the week after.
At least one must be from this group:
- sudden mood swings, or feeling tearful or very sensitive
- strong irritability or anger, or more arguments with others
- low mood, hopelessness or feeling bad about yourself
- anxiety or tension, or feeling "on edge"
Other symptoms include:
- less interest in usual activities
- trouble concentrating
- tiredness or low energy
- changes in appetite or food cravings
- sleeping too much or too little
- feeling overwhelmed or out of control
- physical symptoms, such as breast tenderness, bloating, joint or muscle pain, or headaches
The symptoms must cause real distress or affect your work, social life or relationships. PMDD can happen alongside depression or anxiety.
Some women also get headaches around their periods. Read more about menstrual migraine.
When to see a doctor
If you have any of the signs in the emergency box at the top of this page, call triple zero (000) or go to your nearest emergency department.
Get an urgent GP appointment, or call healthdirect on 1800 022 222 for advice, if:
- you are having thoughts of self-harm or suicide, even if they pass when your period starts
- your low mood or anxiety is severe and lasting more than a few days
See a GP if:
- premenstrual symptoms affect your work, study or relationships
- you feel like a different person in the week or two before your period
- lifestyle changes have not helped enough
- your mood symptoms do not ease after your period starts (this may be another condition)
Many women live with difficult periods for years before getting help. If your symptoms feel like more than PMS, it is worth talking to your doctor.
Causes and risk factors
PMS and PMDD are linked to the rise and fall of oestrogen and progesterone after ovulation. In PMDD, the brain reacts differently to these normal changes. This affects brain chemicals such as serotonin and GABA, which help control mood. This may explain why antidepressant medicines work well for PMDD.
You may be more likely to have PMDD if you:
- have had depression, anxiety or postnatal depression
- have a family history of PMDD or mood conditions
- have a history of trauma or high stress
- have had mood changes with hormonal contraception or during pregnancy
How PMS and PMDD are diagnosed
There is no blood test for PMS or PMDD. The diagnosis is based on the pattern of your symptoms.
Your doctor will ask you to track your symptoms every day for at least 2 cycles. You can use a symptom diary or an app. Tracking is important because it is hard to remember past cycles accurately.
Other conditions can get worse before a period, including depression, anxiety, bipolar disorder and thyroid problems. If your symptoms are there all month, the cause is likely to be something else. Your doctor may arrange blood tests to check for thyroid problems or low iron.
Treatment for PMS
Lifestyle changes are often enough for mild to moderate PMS.
- Exercise regularly. Aerobic exercise most days can help mood, tiredness and bloating.
- Cut back on caffeine, alcohol and salt in the week before your period.
- Try calcium. Some studies suggest calcium supplements help. Ask your pharmacist or doctor.
- Talking therapy. Cognitive behavioural therapy (CBT) can help you manage mood changes.
For physical symptoms, anti-inflammatory medicines can help with pain. Some types of the combined contraceptive pill can also help.
Read more about period pain and heavy periods.
Treatment for PMDD
Antidepressant medicines (SSRIs). These are the main medicine treatment for PMDD. A 2024 Cochrane review found they probably reduce premenstrual symptoms. In PMDD, they can start to work within days, much faster than for depression. They can be taken every day, or only in the 2 weeks before your period. Both approaches work. The Cochrane review found daily use is probably a little more effective. Your doctor can talk to you about side effects, such as nausea and tiredness.
Hormonal treatments. Stopping ovulation can prevent the hormone changes that trigger PMDD. Some combined contraceptive pills, taken without a break, can help. For severe PMDD, a specialist may suggest injections that switch off the ovaries for a time.
Talking therapy. CBT can help with PMDD, on its own or alongside medicine.
Other options. Some women try vitamin B6, magnesium or chasteberry. The evidence for these is weaker than for SSRIs.
Self-care and living with PMS or PMDD
- Track your periods and cycle so you know which weeks may be harder. Plan demanding tasks for the weeks after your period if you can.
- Talk to the people close to you. Explaining PMDD can reduce conflict and help them support you.
- Keep moving. Even a 20-minute walk on a hard day can help.
- Look after your sleep. Read more about sleep difficulties.
- Be kind to yourself. PMDD is a medical condition, not a lack of willpower.
Outlook
PMS is not dangerous, but it can affect your quality of life. PMDD can be more serious. Some women have severe low mood and thoughts of suicide before their periods. This needs treatment.
Treatment works for many women. If one approach does not help, there are others to try. PMS and PMDD stop after menopause, although symptoms can get worse for a while during perimenopause.
If your low mood lasts all month, read about depression and low mood. For sudden waves of fear, read about panic attacks.
How Doccy doctors can help
A Doccy consultation can help if you have PMS or PMDD and none of the warning signs on this page. A Doccy consultation can:
- provide a medical certificate if you need time off work or study, or a carer's certificate
- provide a special consideration letter if PMS or PMDD has affected a university assessment or deadline
- prescribe contraception, including options that may help PMS or PMDD, if it is appropriate
- continue a prescription for medicine you already take, such as an antidepressant, if it is appropriate
If you would like a Mental Health Treatment Plan for psychology sessions, see your usual GP. A Doccy consultation is not suitable if you are in crisis or have any of the signs in the emergency box.
Resources and support
Lifeline: 24-hour crisis support on 13 11 14.
Suicide Call Back Service: 24-hour support on 1300 659 467.
Beyond Blue: support for depression and anxiety on 1300 22 4636.
Jean Hailes for Women's Health: information on PMS and PMDD.
International Association for Premenstrual Disorders (IAPMD): information and peer support for people with PMDD.
healthdirect: health information and a 24-hour nurse advice line on 1800 022 222.
These services and websites can provide extra information, but they do not replace advice from your own doctor.
Abbreviations used in this article
- CBT: cognitive behavioural therapy, a type of talking therapy
- DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th edition
- GABA: gamma-aminobutyric acid, a brain chemical that helps calm the nervous system
- GP: general practitioner (family doctor)
- IAPMD: International Association for Premenstrual Disorders
- PMDD: premenstrual dysphoric disorder
- PMS: premenstrual syndrome
- SSRI: selective serotonin reuptake inhibitor, a type of antidepressant medicine
- Jean Hailes for Women's Health. Premenstrual dysphoric disorder (PMDD). https://www.jeanhailes.org.au/health-topics/periods/premenstrual-dysphoric-disorder-pmdd/
- Jean Hailes for Women's Health. Premenstrual syndrome (PMS). https://www.jeanhailes.org.au/health-topics/periods/premenstrual-syndrome-pms/
- healthdirect. Premenstrual syndrome (PMS). https://www.healthdirect.gov.au/premenstrual-syndrome-pms
- Reilly TJ, Patel S, Unachukwu IC, et al. The prevalence of premenstrual dysphoric disorder: systematic review and meta-analysis. J Affect Disord. 2024;349:534-540. https://pubmed.ncbi.nlm.nih.gov/38199397/
- Jespersen C, Lauritsen MP, Frokjaer VG, Schroll JB. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev. 2024;8:CD001396. https://pubmed.ncbi.nlm.nih.gov/39140320/
- Reilly TJ, Wallman P, Clark I, et al. Intermittent selective serotonin reuptake inhibitors for premenstrual syndromes: a systematic review and meta-analysis of randomised trials. J Psychopharmacol. 2023;37(3):261-267. https://pubmed.ncbi.nlm.nih.gov/35686687/
- Yonkers KA, O'Brien PMS, Eriksson E. Premenstrual syndrome. Lancet. 2008;371(9619):1200-1210. https://pubmed.ncbi.nlm.nih.gov/18395582/