Around 90% of all menstruating women are familiar with it: something changes in their emotional and physical well-being shortly before their period [1]. In 20-25% of cases, these premenstrual symptoms (PMS) are severe. At the extreme end of the spectrum, 1.6% to 8% of all menstruating women suffer from PMDS [1-3] - a serious, chronic condition that can really throw you off track every month.
Research assumes that PMDS is caused by hypersensitivity to natural hormone fluctuations (especially oestrogen and progesterone) and their effect on messenger substances such as serotonin in the brain, making PMDS a neurobiologically caused disease. Although the hormone levels themselves are completely normal, the brain reacts differently to them in PMDS [4].
PMDS is now officially recognized as a diagnosis - both in the DSM-5 (2013), the Diagnostic and Statistical Manual of Mental Disorders, mainly used in the USA [5] and in the ICD-11 (2022), the International Classification of Diseases of the WHO - worldwide standard [6].
You must have at least five symptoms, including at least one that affects your mood, for example:
and one or more of the other symptoms to make a total of 5 symptoms:
The symptoms usually occur in the last week before the period - sometimes they even start two weeks before. They typically subside a few days after the onset of bleeding and are barely present, if at all, in the week after the period [5].
The PMDS symptoms must have a noticeable impact on your life - be it at work, in relationships, in your free time or in everyday tasks [5]. It is also important that other possible causes are ruled out: The symptoms must not be better explained by other conditions such as depression or anxiety disorder [5].
PMDS doesn't just affect how you feel subjectively - it can turn your whole life upside down. At work, PMDS often leads to lower productivity and more sick days [8]. In relationships, it can lead to arguments, misunderstandings and emotional distance, which can quickly turn PMDS into a stress test for partnerships [9]. Self-perception also changes: many sufferers experience themselves as a completely different person in the second half of the cycle - a phenomenon often described as the "Dr. Jekyll & Ms. Hyde" effect [10]. PMDS is also closely associated with an increased risk of depression, anxiety disorders and even suicidal tendencies [11].
For an official diagnosis, you should keep a symptom diary - for at least two complete cycles [7,10]. If you are wondering whether your PMS might be PMDS: Here you will find the link to a downloadable cycle diary from the groundbreaking work PMDS as a challenge by Dr. phil. Dipl.-Psych.Almut Dorn, Dr. med. Anneliese Schwenkhagen and Univ.-Prof. Dr. med.Anke Rohde. With this diary you can systematically document your symptoms. Keep the symptom diary for at least two months and present it to your treating gynecologist at your next appointment - she has the necessary expertise to determine whether it is PMDS or not. In future, you can also conveniently document your symptoms in the CAONA app - digitally, securely and available at any time.
Document your symptoms: Track your symptoms for at least two menstrual cycles, preferably using a symptom diary or a specialized app. This will give you solid information for your consultation with your doctor.
Seek professional support: Make sure you speak to a gynecologist who is familiar with PMDS. Bring your diary with you and address PMDS directly.
Eat a balanced and nutritious diet: focus on healthy foods and plant-based foods. Avoid highly processed foods, too much sugar, alcohol and smoking.
Exercise regularly: sports such as yoga, aerobics, Pilates or swimming have been proven to help combat PMDS symptoms. Just 20 minutes, three times a week, can bring noticeable improvements.
Pay attention to your stress levels: relaxation techniques, meditation, yoga and mindfulness have been proven to reduce stress and improve emotional balance.
Inform yourself and learn to recognize the positive aspects of your cycle. Knowledge helps you to deal better with PMDS. A holistic view of your symptoms - i.e. not only noticing the negative but also the positive changes that happen in your body - strengthens your self-confidence in dealing with your cycle.
Get emotional support: Whether in a self-help group, with a therapist or in conversation with friends - talking is an important step towards healing. At this point, we recommend the self-help group of the PMDS Hilfe Verein. Here you can talk to other PMDS sufferers every other Tuesday free of charge and without obligation.
Be loving and patient with yourself: PMDS is not a weakness, your body simply needs support. 🌱✨
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