PMS and PMDD

What it is

Premenstrual syndrome (PMS) is the set of physical and emotional symptoms that appear in the week before menstruation and improve once the period starts: irritability, sadness, anxiety, bloating, breast pain, headache, and changes in appetite and sleep. When the emotional symptoms are intense enough to impair work, studies and relationships, it is called premenstrual dysphoric disorder (PMDD), which affects about 3% to 8% of women. Diagnosis is clinical and based on tracking symptoms over at least two cycles, to confirm their relationship with the phase of the cycle and rule out other conditions, such as depression and thyroid disease. Treatment is individualized and may include changes in diet and lifestyle, physical activity, supplements, contraceptives that block ovulation, medication for the emotional symptoms and psychological support.

Most common symptoms

• Irritability, sadness or anxiety before menstruation
• Abdominal bloating and a feeling of fluid retention
• Breast pain and tenderness
• Headache and fatigue
• Changes in appetite and sleep
• Difficulty concentrating and mood swings
• Improvement of symptoms once the period starts

Causes and risk factors

• Individual sensitivity to the cycle's hormonal fluctuations
• Changes in neurotransmitters, such as serotonin
• Personal or family history of depression and anxiety
• Stress, sleep deprivation and a sedentary lifestyle
• High intake of caffeine, alcohol and sugar

How it is diagnosed

Diagnosis is clinical. Your gynecologist listens to the physical and emotional symptoms you report and how they relate to your cycle, and recommends a daily symptom diary for at least two cycles, which confirms the pattern of worsening before menstruation and relief once the period starts. This tracking distinguishes PMS from PMDD, which is defined by the intensity of the emotional symptoms and the impairment they cause in daily life. Blood tests, such as thyroid function, may be ordered to rule out other conditions that can be confused with this picture.

How we treat it at Femi Saúde

Treatment starts with lifestyle measures: regular physical activity, adequate sleep, a balanced diet with reduced caffeine, alcohol and sugar, and stress-management techniques. The Femi Saúde gynecology team may add supplements, when indicated, and hormonal contraceptives that block ovulation, reducing the fluctuations responsible for the symptoms. In PMDD or when emotional symptoms predominate, specific mood medications may be prescribed, either continuously or only during the premenstrual phase. Psychological support is part of the multidisciplinary care. The plan is individualized and reviewed according to the response in each cycle.

What we offer