Premenstrual syndrome (PMS) and PMDD: symptoms, causes and what helps

Premenstrual syndrome (PMS) is a set of physical and emotional symptoms that start between a few days and two weeks before a period and ease or go within a few days of the period starting (Korea Disease Control and Prevention Agency, 2026; Pinkerton, 2026). Because they come in the luteal phase, after ovulation, they only happen in women who ovulate (Asan Medical Center, n.d.). Symptoms often get much worse about 6 days before a period and peak about 2 days before (Yonkers et al., 2008), and there has to be a clear symptom-free stretch between the end of a period and around ovulation (O’Brien et al., 2011).

Some change in body or mood before a period is common. Most women of reproductive age have one or more premenstrual symptoms, but they are usually mild (Yonkers et al., 2008). When such symptoms come back month after month and get in the way of normal life, they are called PMS (ACOG, 2021), and when the mood symptoms are far more severe and cause great distress or clearly disrupt life, the condition is premenstrual dysphoric disorder (PMDD) (WHO, 2024). Guidance from the Japan Society of Obstetrics and Gynecology describes the two as one continuous concept rather than clearly separate conditions (Japan Society of Obstetrics and Gynecology, 2025a).

The International Classification of Diseases (ICD-11) places PMS and PMDD in a grouping of premenstrual disturbances in its chapter on diseases of the genitourinary system (WHO, 2026). Because mood symptoms are so prominent in PMDD, it is also listed in the mood disorders grouping (WHO, 2024). In the American Psychiatric Association’s diagnostic manual, PMDD was only in an appendix of the previous edition, DSM-IV (Epperson et al., 2012), and became a full diagnosis among the depressive disorders in DSM-5 in 2013 (Zhitnik et al., 2026; Prasad et al., 2021).

The names vary. PMS is also known as premenstrual tension, and PMDD is short for premenstrual dysphoric disorder. Period pain is a different condition that starts with the period rather than before it and does not usually come with mood symptoms (WHO, 2024), so this guide does not cover it. mind.io does not offer a PMS or PMDD test, and this guide is not a diagnosis. It sets out, from research and official sources, the symptoms and their timing, how common they are, causes, how to tell them from similar conditions, what helps and where to get care.

Common emotional symptoms are irritability, anger, low mood, anxiety, feeling on edge, mood swings, poor concentration, changes in sleep (insomnia or sleeping too much) and changes in appetite, especially food cravings; physical symptoms include breast pain, swelling, weight gain, headaches, tiredness, and joint and muscle pain (Korea Disease Control and Prevention Agency, 2026; NHS, 2024). Mood and behaviour symptoms, including tearfulness, are the most distressing, but physical symptoms such as breast tenderness and bloating can also be hard (Yonkers et al., 2008).

In a Korean survey of 2,970 girls aged 14 to 17, the most common symptoms were irritability (43.8%), bloating (32.8%) and breast tenderness (27.5%) (Lee et al., 2025). In a survey of 238,114 users of a period-tracking app in 140 countries, food cravings were reported most often, by 85.28%, though these were app users answering for themselves (Hantsoo et al., 2022). The same set of symptoms usually comes back each cycle (Yonkers et al., 2008), but it can change from year to year: in a French survey, three in four women who met the PMS definition in one year did not meet it in both years (Potter et al., 2009).

PMDD centres on mood. The World Health Organization’s diagnostic guidance describes it as, in most cycles over the past year, at least one mood symptom such as mood swings, irritability, low mood or anxiety, plus physical or cognitive symptoms such as lethargy, joint pain, overeating, sleeping too much, breast tenderness, swollen hands or feet, poor concentration or forgetfulness. Symptoms begin a few days before a period, start to improve within a few days of it starting and are minimal or gone about a week after, and they must cause great distress or clear disruption to life. The mild mood changes many women have are not counted as PMDD (WHO, 2024). The US diagnostic manual (DSM-5) also looks at whether several symptoms, including a core mood symptom, were present in most cycles over the past year (Hantsoo & Epperson, 2015). This guide does not turn the criteria into a checklist: a diagnosis is confirmed only with daily records over at least two cycles, and is otherwise provisional (Reilly et al., 2024).

In PMDD, interest in usual activities can drop sharply, and suicidal thoughts can occur (Pinkerton, 2026; National Center for Mental Health, 2021). In a meta-analysis that reviewed 13 studies, people with PMDD had about seven times the odds of a suicide attempt (comparing 373 people with 3,355) and about four times the odds of suicidal thoughts (comparing 227 with 4,463), though most studies looked at a single point in time (Prasad et al., 2021). If before your periods you feel so bad that you think of harming yourself, do not wait: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere.

How common PMS is varies widely from survey to survey, because the numbers change with the definition and tool used and with whether people answered from memory or kept daily records. An international expert consensus gave the example that estimates swing from 80% to 95% for mild premenstrual symptoms, to 30% to 40% for PMS and 3% to 8% for PMDD, depending on the definition (O’Brien et al., 2011). An analysis of 17 studies from several countries (18,803 people) put PMS at 47.8% on average, but it ranged from 12% in France to 98% in Iran (Direkvand-Moghadam et al., 2014).

In a meta-analysis of 44 studies (50,659 participants), PMDD confirmed with daily records over at least two cycles was found in 3.2%, provisional diagnoses made without records gave 7.7%, and confirmed diagnoses in community samples alone gave 1.6%; the authors noted that studies relying on provisional diagnoses tend to inflate prevalence (Reilly et al., 2024). In a random sample of 1,246 US women who kept daily records for two cycles, 1.3% met the DSM-IV criteria (Gehlert et al., 2009). In a Korean interview survey of 2,499 women aged 18 to 64, the 12-month prevalence was 2.4%, a figure based on interviews rather than daily records (Hong et al., 2012).

Reported premenstrual symptoms and PMS are far more common than that, but the figures depend on what was asked. In a 2022 national survey of 3,088 Korean women aged 13 to 55, 41.1% rated their premenstrual symptoms over the past three years as severe, at 7 or more out of 10; this is self-rated severity, not a diagnosis rate (Han et al., 2025). In a Korean survey of 2,970 girls aged 14 to 17, 70.5% met the study’s definition of PMS, also from their own answers (Lee et al., 2025). In a French survey of women aged 18 to 44, interviewed in 2003 (1,587 women) and 2004 (1,440), 12.2% across the two years reported PMS that affected daily life, including 4.1% with severe PMS (Potter et al., 2009). Among 1,187 women aged 20 to 49 seen at a uterine cancer screening clinic in Japan, 95% had premenstrual symptoms, but on a questionnaire, moderate to severe PMS was found in 5.3% and PMDD in 1.2% (Takeda et al., 2006). The Japan Society of Obstetrics and Gynecology says 70% to 80% of Japanese women notice some premenstrual discomfort and 5% have severe PMS that makes daily life difficult (Japan Society of Obstetrics and Gynecology, 2025b).

Few people get care, even with symptoms. In the Japanese study above, 5.3% of women with moderate to severe symptoms had been treated (Takeda et al., 2006). In the health insurance records of 121,024 working women in Korea followed for eight years, 7.0% had a medical visit for PMS (Lee et al., 2022). Korea’s national mental health portal notes that many women cannot tell PMS from PMDD, assume it will get better with time and do nothing about it (National Center for Mental Health, 2021).

The exact cause of PMS is not yet fully known; hormone changes, changes in brain chemicals and genes are the main candidates (Korea Disease Control and Prevention Agency, 2026). But consistent differences in hormone levels between women with and without PMS have not been shown (O’Brien et al., 2011). In one experiment, switching off the ovaries with medicine improved symptoms in women with PMS; when oestrogen or progesterone was added back, symptoms returned in these 10 women, while the 15 women without PMS had no mood changes on the same treatment. The researchers read this as an abnormal response to normal hormone changes (Schmidt et al., 1998).

A later experiment in women with PMDD found that symptoms appeared when hormone levels changed from low to high, not while they stayed steady (Schmidt et al., 2017). Both experiments were small, with a few dozen participants at most, but the NHS also says some women may be more affected by the same hormone changes than others (NHS, 2024).

In the brain, the serotonin and GABA systems are the best studied. Lowering serotonin can produce PMS-like symptoms (Rapkin & Akopians, 2012), and treatments that boost serotonin have been found to reduce premenstrual symptoms (Yonkers et al., 2008). Researchers are also studying the idea that some people react strongly to allopregnanolone, a substance the body makes from progesterone (Bixo et al., 2025). Still, a fault in a single brain chemical is unlikely to explain it (Rapkin & Akopians, 2012), and the old idea that PMS comes from a lack of progesterone is not supported (Yonkers et al., 2008).

Genes also seem to play a part. Twin studies put the genetic share of premenstrual symptoms at 56% (Kendler et al., 1998) and 44% (Treloar et al., 2002), both based on symptoms reported from memory. The link with depression differs between studies: in the first twin study the risk factors for the two overlapped little (Kendler et al., 1998), but in the first large genome-wide study, of 72,297 women, the genetic correlation with depression was fairly high, and the researchers said this needs confirming in larger groups (Hysaj et al., 2026).

Symptoms can get worse during stress or in the years before menopause (Pinkerton, 2026). In a Korean survey, PMDD often came together with depression, post-traumatic stress disorder, phobias, alcohol problems and insomnia (Hong et al., 2012), but that means they occur together, not that the cause is known. PMS tends to ease with age: in a US study that followed 436 women in the years around menopause for 5 years, it decreased as they got older (Freeman et al., 2004).

To check whether symptoms really are premenstrual, daily records are more accurate than memory. When 200 US women recruited because they reported premenstrual emotional symptoms rated their symptoms every day for two to four months, 19% met the PMDD criteria, 23% had a milder menstrually related mood problem and 58% had neither (Eisenlohr-Moul et al., 2017). A small study of 49 women also found that they reported bigger premenstrual changes when answering later from memory than when they recorded them as they went (Marván & Cortés-Iniestra, 2001).

That is why a symptom diary kept every day for at least two cycles is recommended for diagnosis (WHO, 2024; NHS, 2024). Write down and rate each symptom every day, and note the dates of your periods too (ACOG, 2021). Research and clinics sometimes use a standard chart such as the DRSP (Endicott et al., 2006), but no particular form is required, so a period-tracking app or simple notes are fine (Japan Society of Obstetrics and Gynecology, 2025a). No single blood test confirms PMS, but blood tests can rule out other causes of similar symptoms, such as an underactive thyroid (Asan Medical Center, n.d.).

The most common mix-ups are depression and anxiety disorders. About half of women seeking treatment for PMS have one of them, and in depression symptoms are present all month and may get worse before or during periods (ACOG, 2021). When an existing condition gets worse before periods like this, it is called premenstrual exacerbation, and about 60% of women with mood disorders report it. Treatments that work for PMDD work less or not at all for premenstrual exacerbation, so the difference matters (Kuehner & Nayman, 2021). WHO guidance also tells PMDD apart by the absence of symptoms a week after the period starts (WHO, 2024). So if your mood stays low after your period is over, look at depression symptoms or anxiety symptoms before PMS.

Bipolar disorder can also change with the menstrual cycle. A review found that, in studies based on memory, 25% to 77% of women with bipolar disorder met the criteria for PMS and 15% to 27% for PMDD (Teatero et al., 2014). It overlaps with ADHD too: in an online survey of 715 people aged 18 to 34 by UK researchers, 31.4% of those who said they had an ADHD diagnosis screened positive for PMDD, against 9.8% of those without ADHD (Broughton et al., 2025). There is more in adult ADHD symptoms.

In your 40s, symptoms can overlap with those of the menopause transition; premenstrual symptoms repeat with the cycle, while menopausal symptoms come regardless of periods (Japan Society of Obstetrics and Gynecology, 2025a). Thyroid disease, chronic fatigue syndrome and irritable bowel syndrome can also mimic or overlap with PMS (ACOG, 2021). Mood symptoms that start after beginning a hormone treatment such as the pill may be side effects, and symptoms that go once the medicine is stopped are not diagnosed as PMDD (WHO, 2024). Talk to a doctor before changing or stopping the pill.

No single treatment works for everyone (Pinkerton, 2026), so care usually starts with lifestyle changes, adding psychological therapy and medicine if symptoms are severe. Whatever you choose, keep the symptom diary going for at least another 2 to 3 months to see whether it is working (RCOG, 2018). The 2023 guideline of the American College of Obstetricians and Gynecologists also says many people may benefit from combining several approaches (ACOG, 2023).

Several guidelines suggest exercise as a first step. A review of 15 randomised trials (717 women) of exercise lasting at least 8 weeks, 7 of them pooled, found fewer premenstrual symptoms in the exercise groups, but most trials were at high risk of bias, so it is too early to be sure (Pearce et al., 2020). Exercise regularly, not just on days with symptoms, and going to bed and getting up at the same times every day, weekends included, may ease moodiness and tiredness (ACOG, 2021). PMS often comes with poor sleep and daytime sleepiness, but most of those studies looked at a single point in time, so it is not known which comes first (Jeon & Baek, 2023).

Not drinking too much alcohol and not smoking are recommended (NHS, 2024). In an analysis of 19 observational studies, PMS was more common among people who drank, and more so with heavy drinking (Fernández et al., 2018), and in a US cohort of nurses, women who smoked were about 2.1 times as likely as never smokers to develop PMS over the next 2 to 4 years (Bertone-Johnson et al., 2008); both looked at associations. Cutting down on caffeine is also common advice (ACOG, 2021), but in the same cohort caffeine intake was not linked with developing PMS; that study did not test whether cutting caffeine eases existing symptoms (Purdue-Smithe et al., 2016). Diet advice such as eating less salt is so far only something a review of the research says may help; larger randomised trials are needed before firm recommendations (Oboza et al., 2024).

In the UK, cognitive behavioural therapy (CBT) is offered as a treatment option (RCOG, 2018). In a pooled analysis of randomised trials, CBT reduced premenstrual anxiety and depression, but the evidence was of low quality (Busse et al., 2009). An analysis of 22 studies found small to medium effects for both CBT and antidepressants (Kleinstäuber et al., 2012), and a recent analysis of 20 randomised trials (1,369 women) also found that psychological therapy reduced premenstrual symptoms, but the trials were small, so it is too early to be sure (Liu et al., 2026). In a trial of 174 women with PMDD, 8 weeks of therapist-guided internet CBT had effects that lasted 6 months, though the comparison group was a waiting list (Weise et al., 2019). Education alone did not help (Busse et al., 2009).

The evidence for supplements is weak. A 2025 review of 31 randomised trials found consistently positive results for vitamin B6, calcium and zinc on mood symptoms, but only 1 trial was at low risk of bias, and there was not enough evidence for vitamin D, magnesium, multivitamins or special PMS diets (Robinson et al., 2025). Of 62 herbs, vitamins and minerals claimed to help PMS, only 10 had randomised trials, and evening primrose oil showed no benefit (Whelan et al., 2009). Chasteberry (Vitex agnus-castus) extracts look good in trials, but bias and publication bias may have inflated the effect (Verkaik et al., 2017), and it may not be safe in pregnancy, while breastfeeding or with hormone-sensitive conditions (NCCIH, 2025). High doses of vitamin B6 can damage nerves and cause numbness in the arms and legs, so the NHS advises not taking more than 10mg a day in supplements unless a doctor advises it (NHS, 2020). The NHS also says there is not much evidence that supplements work, and that if you take any medicines you should check with a GP or pharmacist before starting one (NHS, 2024).

If symptoms are severe, you can discuss medicines with a doctor. In a Cochrane review of 34 randomised trials, SSRI-type antidepressants probably reduce premenstrual symptoms (moderate-certainty evidence) and probably work better taken every day than only in the two weeks before a period. Nausea rose from 7% on placebo to 20% and lack of energy from 5% to 14%, and 68% of the included studies were funded by drug companies (Jespersen et al., 2024). Some combined pills that stop ovulation may reduce symptoms in women with PMDD by a small to moderate amount, but the evidence is low quality and the placebo effect was large (Ma & Song, 2023), and the pill sometimes makes symptoms worse (Pinkerton, 2026). For severe cases where other treatments have not worked, GnRH analogues, which temporarily switch off the ovaries, may be used together with replacement hormones, and surgery is considered only when all other treatments have failed (RCOG, 2018; Wyatt et al., 2004). Progesterone has not been shown to work (Ford et al., 2012). Do not start or stop medicines on your own, and stop antidepressants only gradually, with your doctor (RCOG, 2018).

See a doctor if lifestyle changes have not helped or symptoms affect daily life (NHS, 2024), or if symptoms cause problems at work or in relationships, or the monthly symptoms are hard to bear (Ministry of Health, Labour and Welfare, n.d.). It helps to bring a symptom diary covering at least two cycles (NHS, 2024).

In Korea, seeing a gynaecologist is important when symptoms are severe (Korea Disease Control and Prevention Agency, 2026); if lifestyle changes are not enough, hormone treatment such as the pill may be tried, and psychiatric care may be needed when mood symptoms are severe (Asan Medical Center, n.d.). Mental health welfare centres, run in most cities and districts, also offer consultations with psychiatrists (National Center for Mental Health, 2021). If you have never seen a psychiatrist, see seeing a psychiatrist for the first time.

In Japan, diagnosis is made by obstetrics and gynaecology or women’s clinics (Ministry of Health, Labour and Welfare, n.d.), and referral to psychiatry or psychosomatic medicine is considered when psychiatric symptoms are severe or an existing mental illness seems to worsen before periods (Japan Society of Obstetrics and Gynecology, 2025a). In the UK, see a GP first; if symptoms continue after treatment, you may be referred to a specialist such as a gynaecologist, psychiatrist or counsellor (NHS, 2024). In France, women with severe PMS are advised to see a gynaecologist for a full check-up (VIDAL, 2020).

mind.io does not offer a PMS or PMDD test. The PHQ-9 check-in looks at your mood over the past 2 weeks, not at your cycle, so it can help you see whether low mood carries on after your period. Its result is not a diagnosis.

If you think about suicide or harming yourself before your periods, do not carry it alone. Guidance from the Japan Society of Obstetrics and Gynecology says referral to psychiatry should be considered when suicidal thoughts grow, and warns that some reports describe the premenstrual phase as a time of higher suicide risk (Japan Society of Obstetrics and Gynecology, 2025a). Please reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

Q. Isn’t PMS all in the mind? A. No. PMS appears to be a different response to normal hormone changes (Schmidt et al., 1998), and Japan’s Ministry of Health, Labour and Welfare says these problems are not down to personal qualities or poor self-management (Ministry of Health, Labour and Welfare, n.d.). Korea’s national mental health portal says that seeing PMDD only as a normal reaction to the cycle is what helps treatment least (National Center for Mental Health, 2021), and Korea’s disease control agency says menstrual symptoms should be seen not as simple discomfort but as a health problem that can affect mental health (Korea Disease Control and Prevention Agency, 2025).

Q. Do all women get moody before their periods? A. No. Of 47 studies that tracked daily mood in women from the general population, only 7 (14.9%) found more negative mood in the premenstrual phase alone, and 18 (38.3%) found no link between mood and the cycle (Romans et al., 2012). Only a minority, far fewer than 10%, have premenstrual distress severe enough to meet the PMDD criteria, so it is wrong to generalise it to women as a group (Epperson et al., 2012).

Q. Is PMS just about mood? A. No. Physical symptoms are common too. In an Australian study of 720 pairs of female twins, breast tenderness and bloating or weight gain were reported more often than mood symptoms (Treloar et al., 2002).

Q. Is there a PMDD self-test score? A. This guide does not include one. Answers from memory are a poor guide to who will be diagnosed with daily records (Eisenlohr-Moul et al., 2017), so diagnosis relies on daily records over at least two cycles (WHO, 2024). mind.io has no such test either, and the PHQ-9 check-in looks at low mood over the past 2 weeks; it is not a PMDD test.

Q. I get hungrier and crave sweet food before my period. A. That is a common symptom. Changes in appetite and food cravings are typical premenstrual symptoms (NHS, 2024), and cravings were the symptom app users reported most (Hantsoo et al., 2022). The NHS suggests that eating smaller meals more often, every 2 to 3 hours, may be better (NHS, 2024).

Q. I can’t sleep, or I’m very sleepy, before my period. A. Both insomnia and sleeping too much are premenstrual symptoms (Korea Disease Control and Prevention Agency, 2026). Going to bed and getting up at the same times every day may help (ACOG, 2021), and if sleep problems carry on regardless of your cycle, see insomnia: what helps.

Q. Can it affect work or school? A. It can. In a study of 822 women from several countries who kept daily records for two months, those with moderate to severe PMS or PMDD recorded on average 5.6 days with at least moderately lower productivity, against 1.1 days for the others (Heinemann et al., 2010). In a UK survey of 125 working women, very few told their workplace about premenstrual symptoms or took time off for them (Hardy & Hunter, 2021). Japan’s Ministry of Health, Labour and Welfare notes that PMDD can get bad enough to need time off work (Ministry of Health, Labour and Welfare, n.d.), and guidance from the Japan Society of Obstetrics and Gynecology says premenstrual symptoms can affect school life too, through absences and lower grades (Japan Society of Obstetrics and Gynecology, 2025a).

Q. Does it go away with age? A. It usually lessens. In a US study that followed 436 women for 5 years, PMS decreased with age (Freeman et al., 2004), but symptoms can get worse in the years before menopause (Pinkerton, 2026). Mood changes around menopause are covered in Menopause and mood, and other common reasons moods swing in mood swings.

Q. I’ve heard the pill helps PMS. A. It varies. Some combined pills may reduce PMDD symptoms (Ma & Song, 2023), but the pill can also make symptoms worse, particularly in the first 6 weeks after starting (Pinkerton, 2026). Decide about the pill with a doctor, and do not change or stop it on your own, so that you are not left without contraception.

Q. Before every period I feel like I want to die. A. Please do not carry this alone. PMDD is a condition that needs treatment, and help is available (National Center for Mental Health, 2021). Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

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