Pre-menstrual syndrome (PMS)
What is pre-menstrual syndrome? Pre-menstrual syndrome is the name given to the symptoms women experience in the lead up to their period. What are the symptoms of pre-menstrual syndrome? Every women will experience PMS differently but the most common symptoms are: headaches mood swings tiredness acnes bloating and abdominal pain feeling sad or anxious changes in appetite ch
What it is
PMS and PMDD are not "just hormones" — they are diagnosable, structured conditions distinguished from underlying depression by their strict cyclical pattern. A symptom diary across two cycles is the diagnostic standard. Severe PMDD is associated with substantial functional impairment and a meaningful suicide-risk signal.
Symptoms and signs
- Cyclical low mood, irritability, anxiety in the 1–2 weeks before periods, settling within days of bleeding.
- Physical features — bloating, breast tenderness, headache, fatigue, sleep disturbance.
- Significant functional impact on work, relationships or daily life.
- Severe presentations — PMDD with suicidal thoughts, self-harm, relationship breakdown.
- Symptom-free luteal-equivalent windows in cycles where bleeding does not occur (confirms cyclical pattern).
How we investigate
Two-cycle symptom diary, structured PMS / PMDD score, thyroid function, vitamin D, B12 and ferritin where fatigue dominates, mental-health screening tools.
Treatment options at The Vesey
- Lifestyle, sleep and nutrition optimisation — with structured psychology input where helpful.
- SSRI therapy — first-line for PMDD, given either continuously or luteal-phase only.
- Combined hormonal contraception — particularly drospirenone-containing pills with shortened pill-free interval.
- GnRH analogue with add-back HRT — for severe refractory PMDD as a diagnostic test before considering surgery.
- Definitive surgery — bilateral oophorectomy ± hysterectomy is rarely needed but is appropriate in selected refractory cases.
- Coordinated psychiatry input for high-risk presentations.
What is the difference between PMS and PMDD? +
PMS covers a range of physical and psychological symptoms in the luteal phase that cause some disruption. PMDD (premenstrual dysphoric disorder) is the severe end of the spectrum — marked by disabling mood symptoms, suicidal thoughts or self-harm — that significantly impacts daily functioning. PMDD meets DSM-5 diagnostic criteria and warrants specific pharmacological treatment.
How is PMS or PMDD diagnosed? +
Diagnosis relies on a prospective symptom diary across two full menstrual cycles. Symptoms must be present in the luteal phase, absent in the follicular phase, and cause functional impairment. Blood tests exclude thyroid disorder, vitamin deficiency and perimenopause rather than diagnose PMS directly.
Can the contraceptive pill make PMS worse? +
Some women find certain progestogens in combined pills worsen PMS-type symptoms, particularly mood-related ones. However, drospirenone-containing pills with a shortened pill-free interval are specifically beneficial for PMDD. Switching pill type or using a progesterone-free method can be the right answer depending on your symptom pattern.
Are there non-hormonal treatments for severe PMS? +
Yes. SSRIs are first-line for PMDD, given either every day or only in the luteal phase. CBT-based psychological support is also evidence-based. GnRH analogues with add-back HRT can suppress cycles entirely as a diagnostic test or short-term bridge before definitive surgery is considered.
Pricing at a glance
Initial gynaecology consultation £260 (60-minute slot). Follow-up reviews £180. Hormone profile from £180. Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
Book an appointment
When to see a specialist
Book if your cyclical symptoms are interfering with work, relationships or daily life, if first-line lifestyle and SSRI options have not worked, or if you want a structured second opinion before considering more aggressive treatment.
Cost and pathway
Initial gynaecology consultation £260 (60-minute slot). Follow-up reviews £180. Hormone profile from £180.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with our gynaecology team
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
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Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
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