PMS, PMDD and the GP

PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder) can cause over 150 different physical, psychological and behavioural symptoms. Around 75% of people who menstruate notice symptoms of PMS, and 3-8% experience PMDD.

If the symptoms of PMS or PMDD are impacting your quality of life, you can visit your GP for advice, support, or medical treatment. Knowing when to make a GP appointment for PMS, what you can do before the consultation, and what you hope to get out of it can help you feel better prepared and in greater control of your health.

PMS is a term we often use to describe symptoms experienced a week or two before our period. A clinical diagnosis of PMS (one made by your GP) relies on the timing and severity of those symptoms. Namely, the symptoms must be physical, psychological, and behavioural, cause significant impairment to the person, and occur only during the luteal phase of the cycle – the time between ovulation and our period. These symptoms may affect our work, social life, exercise, or ability to complete day-to-day tasks. 

If your PMS symptoms are affecting your daily life or causing significant impairment, talking to a doctor or booking a GP appointment can be extremely helpful as you may have PMDD.

PMS symptoms can be split into three categories:  

• Physical symptoms, such as painful breasts, abdominal bloating, or acne
• Psychological symptoms, including low mood, anxiety, mood swings, or irritability
• Behavioural symptoms, including difficulty concentrating, brain fog, or aggression.

Symptoms will typically follow a pattern of worsening in the week or two before your period is due, followed by gradual relief in the days after your period arrives.

PMDD is an intense form of PMS that causes extreme distress. It can disrupt day-to-day activities, impact your ability to work, and put your personal relationships under huge pressure.

Many PMDD symptoms are psychiatric, and for this reason, some people with PMS have sadly been misdiagnosed with bipolar disorder, depression or personality disorders.

A particular combination of symptoms (at least five, including one mood-related symptom) occurring in the luteal phase (second half of your cycle) is required to diagnose PMDD.

As with PMS, PMDD symptoms start in the week or two before your period and then gradually improve or disappear within a few days of your period starting.

If you’re experiencing persistent PMS/PMDD symptoms, book an appointment with your GP, as the underlying cause may be something other than PMS or PMDD. Some conditions, such as thyroid disease or low mood, can mimic PMS. Therefore, it’s still important to seek medical advice and treatment even if your symptoms don’t seem to follow a cyclical pattern.

It’s useful to do a little preparation before seeing a doctor about PMS. This will help to provide a clear picture of your symptoms and lifestyle, so that your GP can make an accurate diagnosis before recommending an appropriate management plan.

Make the appointment right for you

First off, if you’re more comfortable seeing a female GP, don’t be afraid to request this when you book your appointment.

Secondly, ask the reception staff if anyone at the practice has specific experience with female health or hormonal health. This will hopefully mean they’ve diagnosed and dealt with other female-specific health conditions before.

It can be helpful to go online to your GP practice’s website before you call to book your appointment. Look for doctors with the letters ‘RCOG’ after their name. This means they’ve trained and qualified under the Royal College of Obstetrics and Gynecology, which means they’ll have a lot of experience in this area. Whilst this isn’t the only way someone can gain experience, it’s a good starting point for patients.

Keep a diary

Your GP is likely to ask you a lot of questions about your cycle. So that you can give the doctor a comprehensive picture of the nature and severity of your PMS, keep a diary of the symptoms you notice for two menstrual cycles in a row. This is crucial to allow the doctor to make a diagnosis of PMS.

To do this, write down the first day of your period (day one of your period), and document how you feel each day for the rest of the month. Record the nature of your symptoms (cramps, low mood, bloating, anxiety, etc.) and how they impact your work, personal plans or family life. Also note down the severity. For example, your low mood may feel like a 6 out of 10 one day, and a 2 out of 10 the next. Keep a record for as long as you can so your doctor can understand the impact PMS or PMDD is having on you.

Take this diary with you to your appointment so that your doctor can review it. It may feel slightly intimidating sharing such personal information, but try not to worry; your doctor is there to help. Even if your record does not lead to a diagnosis of PMS, your doctor can still offer PMS treatment to see if your symptoms improve. If starting treatment provides relief from, or eases, your symptoms, this can help confirm the diagnosis, too.

Speak about it

If possible, it’s helpful to ask your relatives if they’ve ever experienced symptoms of PMS or PMDD. This is relevant as there is some evidence that genetics may be a contributing factor. Having this information may support your diagnosis.

Write down your medical history

If you have any other medical conditions, or take prescribed or over-the-counter medications, vitamins, or herbal remedies, note these down so that you can give your GP a full and accurate picture of your medical history. It might also be helpful to make a note of the PMS/PMDD treatments you’ve tried (if any) and whether these had an effect.

Ask for support

Some people prefer to see a doctor with a friend or relative. If having someone with you will make you feel more comfortable, ask for an appointment on a date/time that suits your friend/family member.

Sometimes it can feel overwhelming to discuss PMS with a GP, and you may forget to say certain things or ask the questions that have been on your mind. To make sure you leave with the information you need, it’s helpful to have a list of questions to ask during the appointment.

Your questions will depend on your personal circumstances, but the list could include:

• Is there any medication you would recommend to ease my PMS symptoms?
• How long might I need treatment for?
• Does the treatment have any risks associated with it?
• Will treatment stop me from becoming pregnant or affect my ability to get pregnant in future?
• Are there any alternative treatments available?
• Can I manage PMS without taking medication?
• Do I need to carry on with my symptom diary?
• Could something else be causing my symptoms, and do I need any tests to check?
• Could I benefit from being referred to a gynaecologist with a special interest in PMS?
• Should I book another appointment to see you, and when?

PMS and PMDD are sometimes misunderstood, even by healthcare professionals. If you feel disappointed or dissatisfied with the information or advice received from your GP, it’s important to seek a second opinion.

Every GP will have their own professional interests and areas of strength, and there may be another GP at your practice who can better support you with your symptoms. Alternatively, if you’re not happy with the practice in general, you can always register with a different surgery near where you live. 

Alternatively, you may wish to ask your GP for a referral to a specialist gynaecology department. In some cases, they may be able to make a referral via the NHS, but in others, a private referral may be necessary. If this is the case, it’s worth checking with your employer to see if medical insurance is offered as an employee perk, and whether it can be used to cover these costs. 

If you’d like to find and reach out to a specialist PMS doctor in the UK yourself (to get an independent, expert opinion), you may find it helpful to search online for a PMS clinic near you. These clinics are typically run by specialist gynaecologists in private hospitals nationwide.

While the correct medical management of PMS or PMDD can lead to a dramatic improvement in your symptoms, you may benefit from additional support, too. If you’ve been living with PMS or PMDD for a long time, it may have affected your career, mental health, self-esteem, confidence, and personal relationships.

In these cases, it can be empowering to access psychological or specialist support. Your GP may refer you to a counsellor, psychiatrist, or clinical psychologist, or you may need to seek this privately. Charities including Mind and the International Association for Premenstrual Disorders (IAPMD) also offer a wealth of information relating to PMS, PMDD and your overall emotional wellbeing.

Having the support of your family, guardians, friends, teachers and/or colleagues can also be helpful. If you feel able to, having an open and honest conversation with those close to you about your symptoms, needs or any helpful adjustments can make a big difference to how you feel.