PMS vs PMDD: symptoms and getting help

PMS and PMDD both involve 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 occur before a period and usually improve once it starts.	Symptoms appear before a period and usually improve within a few days after bleeding begins.
Typical symptoms	Breast tenderness, bloating, headaches, tiredness and emotional changes.	Severe irritability, depression or anxiety, sometimes alongside physical symptoms, sleep problems or difficulty concentrating.
Effect on daily life	Can range from manageable symptoms to substantial disruption.	Can cause marked distress or interfere with work, school, relationships or usual activities.
How it is diagnosed	A clinician reviews your symptoms and their pattern, supported by a diary.	A clinician assesses specific criteria and other possible explanations, using daily symptom records to confirm the pattern.
Treatment options	Self-care, pain relief and, where needed, talking therapy or prescribed medicines.	Treatment may include antidepressants, certain hormonal contraceptive pills and psychological support, alongside self-care.

The table compares the symptoms and treatments described in RCOG’s PMS guidance and MedlinePlus’s PMDD guidance. PMS can be difficult 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 describes assessment through your health history, an examination and a symptom diary. PMDD criteria include at least five symptoms, with at least one related to mood. A clinician also needs to assess their timing and effect on your life.

Daily recording helps a clinician assess whether symptoms follow the required pattern. Confirming it involves daily ratings during at least two symptomatic cycles. A provisional diagnosis may be made before that confirmation. Recording over those cycles is part of the assessment. You can ask for care while you are still keeping the diary.

There isn’t a blood test that diagnoses PMDD. Tests or other assessments may be used to check for alternative explanations. Tell the clinician about symptoms throughout the month, including those that don’t improve after your period.

An existing mental health condition can worsen before a period. The PMDD review distinguishes this worsening from PMDD, although the conditions can coexist. Counting symptoms or finding a pattern in a calendar cannot diagnose PMDD or explain what caused a change in mood. Read more about what your notes can show in recorded patterns and predictions.

Recording symptoms through the month

Ask your clinician whether they want you to use a particular symptom-rating form. A peer-reviewed PMDD review describes structured daily recording; MedlinePlus recommends noting which symptoms occur, their severity and how long they last.

Alongside your period dates, describe what happened in ordinary words. A fictional entry could be: “Felt anxious through the afternoon. Found it difficult to concentrate and left a meeting early.” On a day when symptoms settle, record that too. Leave an unrecorded day marked as a gap; filling it with a guess would hide what’s missing.

Bring both the record and the question you want answered to your appointment. You might ask, “These entries seem to cluster before my period; could they be related?” Keep the entries about how you felt on the day, without assigning an expected mood to a cycle phase.

Help with PMS and PMDD

Arrange a GP appointment if symptoms affect daily life or self-care hasn’t helped. Describe what is being interrupted, even if you haven’t kept a diary.

Everyday options for PMS

The NHS recommends regular exercise, a balanced diet and enough sleep. Relaxation approaches such as yoga or meditation may help too. Trying these changes doesn’t guarantee that symptoms will disappear.

Choose something you can reasonably fit into your day, such as a walk or a relaxation exercise. Keep a short note of what you tried. You can ask for help while trying these approaches; a self-care checklist isn’t something you must complete before asking for care.

For pain, options include paracetamol or ibuprofen. Follow the pack leaflet and ask a pharmacist about suitability if you’re unsure. Ibuprofen isn’t suitable for everyone and can interact with other medicines. Check suitability even for medicines you can buy without a prescription.

Be cautious about promises made for supplements. The NHS says evidence for complementary therapies and supplements for PMS is limited, and advises checking with a GP or pharmacist before taking regular supplements alongside medicines. If cramps are your main concern, there’s more on managing them in period pain and when to get help.

Treatments to discuss with a GP

For PMDD, the Office on Women’s Health lists antidepressants called selective serotonin reuptake inhibitors (SSRIs) and certain contraceptive pills among treatments. A clinician can discuss what suits you; the comparison table isn’t a prescription.

Write down what you want to ask about treatment and take it with you. You could ask what improvement to look for, what side effects to discuss and when to review progress. Preparing notes for a healthcare appointment can help you organise those questions.

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 complete. The NHS specifically advises calling 999 or going to A&E if you have PMDD symptoms and feel suicidal.

• In the UK, call 999 or go to A&E now if you cannot keep yourself safe, have seriously harmed 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, for urgent mental health help that is not an emergency, call NHS 111 and select the mental health option, or request an urgent GP appointment. Elsewhere use your local urgent mental health service.

These routes are explained in the NHS urgent mental health guidance.

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 speak to a listening service.