PMS and PMDD: when the days become a burden
PMS & PMDD: symptoms and treatment – gynaecologist Basel
FMH Gynecology
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Spalenvorstadt 3
4051 Basel
Many women feel different in the days before menstruation – more irritable, more emotional or physically unwell. Mild symptoms are common and normal. But if they become so severe every month that work, family or relationships suffer, premenstrual syndrome (PMS) or – in particularly pronounced cases – premenstrual dysphoric disorder (PMDD) may be the cause.
You don't simply have to accept these symptoms. There are effective treatments – from lifestyle measures to hormonal therapies to SSRIs for PMDD.
Women of any age with a cycle can be affected. The timing pattern is decisive: symptoms only in the second half of the cycle, improving quickly once the period starts.
Key facts
At a glance.
- Mild symptoms before the period are common and normal.
- If they noticeably burden daily life, work or relationships every month, PMS or – more severely – PMDD may be present.
- Typical: symptoms only in the second half of the cycle, disappearing quickly once the period starts.
- Hormone levels are usually normal – hormone testing is generally not needed.
- Effective treatments: lifestyle, hormonal therapies and, for PMDD, also SSRIs.
- The combined pill with drospirenone in a 24/4 regimen has the strongest evidence.
Causes
Background and risk factors.
The exact cause is not fully understood. Women with PMS or PMDD usually have no hormone deficiency and no hormonal disorder – hormone levels are usually completely normal. It is thought that some women are particularly sensitive to the normal hormonal fluctuations after ovulation. The problem is not the amount of hormones, but the individual sensitivity of the body and brain to these changes. This is why hormone testing usually does not help in most cases.
Risk factors
- Family history
- Known depression or anxiety disorder (can worsen premenstrually)
- High stress levels, lack of sleep
Frequency
Mild premenstrual symptoms are very common. Significantly burdensome PMS and the more severe PMDD are less common, but well treatable.
Symptoms & findings
How does it present?
Typical symptoms
- Physical: breast tenderness, bloating, fluid retention, lower abdominal pain, headaches, fatigue, cravings, sleep disturbances
- Psychological: irritability, mood swings, heightened emotionality, anxiety, inner restlessness, difficulty concentrating, depressive mood, reduced resilience
- Onset a few days to about two weeks before menstruation
- Marked improvement with the onset of the period
- Symptom-free interval after the period
Common incidental findings
- PMDD: pronounced irritability, severe mood swings, depressed mood, anxiety, hopelessness
- Conflicts in relationships or family
- Significant impairment in work and private life
When you should react
PMDD is not an emergency – but it can become one. If you feel so bad before your period that you have thoughts of harming yourself or not wanting to live anymore: don't wait – get help immediately. In an acute emergency call 144 (ambulance) or go directly to the nearest emergency department.
Available around the clock
Dargebotene Hand, tel. 143. At our practice you will get an appointment promptly. Suicidal thoughts are a known, treatable symptom of PMDD – not a sign of weakness.
Diagnostics
How the diagnosis is made.
For treatment, one question is crucial
do you feel completely like yourself again between periods? If symptoms – such as low mood or anxiety – persist throughout the whole cycle and only worsen before the period, another, equally treatable cause is often behind it (for example depression or an anxiety disorder), which is treated differently. This distinction is best made with a symptom diary over two to three cycles.
Examinations
- Detailed conversation (onset, end, severity, effect on daily life, monthly recurrence)
- Symptom diary over 2–3 cycles
- Gynaecological examination, with ultrasound if needed
What do the findings mean?
PMS and PMDD are diagnosed based on typical symptoms and their timing in relation to the cycle. Hormone testing is not part of the standard work-up.
Treatment
Possible approach.
Watchful waiting
Treatment is based on the severity of symptoms and your personal needs.
Lifestyle
regular exercise, adequate sleep, less stress, a balanced diet and a regular daily rhythm can already provide noticeable relief. Magnesium (e.g. 200–300 mg daily, preferably in the second half of the cycle) can relieve physical symptoms such as fluid retention, headaches and irritability in many women and is well tolerated. Cognitive behavioural therapy can be effective – alone or in addition to medication.
Medication
Pain relief
for lower abdominal or headache pain, NSAIDs such as ibuprofen or naproxen help.
Hormonal (for relevant impairment)
the goal is to suppress ovulation and reduce hormonal fluctuations. The combined pill with ethinylestradiol and drospirenone in a 24/4 regimen has the best evidence; it can relieve both physical and psychological symptoms of PMS and especially PMDD. For drospirenone alone (e.g. Slinda®), there are promising early studies and good clinical experience, though with a smaller evidence base so far. In pronounced symptoms, it can also be used as an extended cycle or continuously without a monthly break.
PMDD
SSRI antidepressants are one of the most effective options – taken daily or only in the second half of the cycle, often effective within just a few days.
Surgery
Surgery is not the rule for PMS and PMDD. In rare, very severe and treatment-resistant cases, there are further specialised treatment options, which we discuss together.
Prevention
What you can do yourself.
- Keep a symptom diary over 2–3 cycles
- Regular exercise, adequate sleep, stable daily rhythm
- Balanced diet, reduce stress
- Magnesium (200–300 mg/day, especially in the 2nd half of the cycle) can relieve physical symptoms and irritability; vitamin B6 can additionally be tried
- Seek help early if symptoms burden daily life or relationships
One appointment. One main concern. So we can give you our full, unhurried attention, we address one main topic per appointment. We're happy to schedule additional or complex questions in a separate appointment. This is what allows consultations to run on time and without long waiting times – thank you for your understanding.
Frequently asked questions
FAQ.
Related topics
Keep reading.
- Cycle Balance – infusion programme for PMS
- Annual check-up and Pap smear
Cycle and hormone work-up as part of the annual check-up.
- Painful periods
- Irregular periods
- Heavy periods
- Contraception & IUDs
- Bioidentical hormone therapy
Medically responsible.
Dr. med. Anna Margareta Wagner is a board-certified FMH specialist in gynecology and obstetrics with her own practice at Spalenvorstadt 3 in Basel. Special focus on surgical gynecology; further focus areas: gynecological check-ups, colposcopy and dysplasia consultations, intimate surgery, pregnancy care, and consultations for girls and adolescents.
- FMH specialist certification in gynecology and obstetrics
- Special focus: surgical gynecology
- SGGG member
- Certified colposcopy diploma
- Languages: German, English
- Service area: Basel-Stadt, Basel-Landschaft, northwestern Switzerland
The content on this page is reviewed regularly against current specialist medical recommendations.
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