Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are common but often misunderstood conditions that affect many people who menstruate.

Despite their impact on physical and mental health, they are frequently underdiagnosed and undertreated.

PMS is a chronic condition experienced by many women who menstruate, with approximately 25% experiencing moderate to severe symptoms.

It is characterised by physical, psychological and behavioural symptoms in the luteal phase (before period, from ovulation) of the menstrual cycle. These symptoms will then disappear when menstruation occurs (period begins) or by the day of the heaviest flow.

PMDD is one type of severe PMS and a complex hormone-based mood disorder characterised by extreme mood changes, anxiety, sleep disturbance and physical changes that start in the luteal phase.

If premenstrual symptoms impact on everyday functioning and wellbeing, this should be recognised as clinically significant, and the woman should be offered appropriate treatment and care.

Anyone assigned as female at birth may experience symptoms and so people who identify as trans, non-binary or gender fluid may also suffer from PMS/PMDD.

• An estimated 25% of menstruating women have moderate or severe PMS.
• Around 5–8% of all menstruating women diagnosed with PMDD.
• There is emerging evidence that thoughts of self-harm/suicide present with severe PMS.
• Misdiagnosis and delays in diagnosis are common and prevent women who are living with these conditions from accessing the treatment they need.
• Symptoms first present and may increase in severity at times of hormonal change in the reproductive lifespan, such as menarche (onset of periods), pregnancy loss, postnatally, cessation of breastfeeding, sterilisation and during the perimenopause.

There are more than 150 identified cyclical symptoms, and no-one experiences them all. Not all cycles are the same or as severe as each other. For example, one symptom may be more dominant, or symptoms may vary in severity from one cycle to the next. New symptoms can also present during a woman’s ongoing experience of PMS. Below are some of the most common symptoms:

Physical symptoms

• breast tenderness
• bloating or weight gain
• headaches
• clumsiness
• acne
• food cravings.

Behavioural symptoms

• extreme tiredness
• poor concentration
• food cravings
• sleep disorders, for example insomnia or hypersomnia.

Psychological symptoms

• depression
• mood swings
• anxiety
• irritability
• anger or feeling out of control
• hopelessness.

• menstrual cycle tracking/diary for a minimum of two cycles
• symptom reporting
• blood tests may be used to eliminate other conditions
• An example of a diary can be found on the NAPS website.

Management and treatment vary depending on the needs of the individual, the severity of symptoms and response to treatment options, which may need to change over time.

Treatment may include a combination of:

• lifestyle changes
• talking therapies
• complementary therapies
• Selective serotonin reuptake inhibitors (SSRIs)
• hormone treatment to suppress ovulation
• surgery.

• Listen attentively to the person’s experience and record findings fully.
• Encourage them to complete a menstrual diary or symptom tracker app.
• Signpost them to resources and support available.
• Recognise the serious nature of symptoms and refer on for diagnosis and treatment.

• RCN clinical topics web page.
• NAPS: Guidelines on PMS (PDF).
• RCOG: Premenstrual Syndrome management.

• National Association for Premenstrual Syndromes.
• International Association for Pre-Menstrual Disorders.

PMS and PMDD can have a serious effect on a person’s quality of life, yet awareness and understanding remain limited. Accurate diagnosis, compassionate care and access to appropriate treatment are essential.

By listening, signposting and referring to the appropriate service, nurses and other health care professionals can help ensure that those living with PMS or PMDD receive the support they need.

The full PDF explores this topic in more detail. The publication may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.