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Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

NICE CKS Premenstrual syndrome. Last revised: Sep 2024.

Article Last Updated: 11 July 2025

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Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Premenstrual syndrome (PMS) causes cyclical physical, psychological, and behavioural symptoms during the luteal phase of the menstrual cycle. Symptoms improve with menstruation and cause functional impairment. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS with prominent mood symptoms and significant functional impairment.

This updated UKMLA guide to PMS and PMDD is based on NICE CKS, which covers definition, symptoms, diagnosis, and management.

Definition

Risk Factors

Clinical Features

Investigation and Diagnosis

Management

Category	Management
Lifestyle advice	Regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates Regular exercise and sleep Stress reduction Smoking and alcohol cessation (if applicable)
Pain management (headache / cramps / generalised aches and pains)	NSAIDs as required (e.g. ibuprofen, naproxen, mefenamic acid)
Breast pain management	Wearing a well-fitted bra during the day, more supportive bra during exercise, and a soft support bra at night Pharmacological Paracetamol and/or ibuprofen, or Topical NSAID

Management / medication	Description / indications
COCPCombined oral contraceptive pill (e.g. drospirenone and ethinylestradiol)	Especially if the woman requires contraception
Refer for CBTCognitive behavioural therapy	If the woman would benefit from psychological intervention (e.g. psychological symptoms predominate)
SSRISelective serotonin reuptake inhibitor	Consider if: There are mood (affective) symptoms, or Diagnosed with PMDDPre-menstrual dysphoric disorder

References

NICE CKS Premenstrual syndrome

Contraception (Non-Emergency)

Depression

Antidepressants

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Psychological symptoms	Depression Anxiety Irritability Loss of confidence Mood swings Poor concentration Change in libido Food cravings
Physical symptoms	Bloating Breast pain and tenderness Headache Backache Weight gain Acne GI disturbances
Behavioural symptoms	Reduced cognitive ability Aggression

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Definition

Risk Factors

Clinical Features

Investigation and Diagnosis

Primary Care

Secondary Care

Management

ALL Patients (Less Severe PMS)

More Severe PMS

References

Related Articles

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