The lead up to menstruation and the start of the menstrual cycle, often called the premenstrual or perimenstrual phase, is a time of considerable change in the body. Many people notice changes in their body, mood, or behaviour in the lead-up to their period. For most, these changes are mild and manageable. Indeed, around 9 in 10 people who menstruate experience at least one symptom during this time, and more than half report some emotional changes such as increased irritability, low mood, or anxiety.

However, for others, the physical and emotional changes of the premenstrual phase can feel overwhelming, disruptive, or confusing – especially when emotional symptoms intensify each month. These symptoms can even cause significant distress or interfere with work, relationships, or daily functioning.

Understanding what’s happening – and why – is often the first step toward feeling more in control and knowing if you need extra support with these experiences.

What is Premenstrual Syndrome (PMS)?

Premenstrual Syndrome (PMS) refers to a cluster of physical, emotional, and behavioural symptoms that occur in the second half of the menstrual cycle, after ovulation and before a period begins.

While most people experience some premenstrual symptoms, PMS is diagnosed when symptoms are mildly to moderately distressing or disruptive and occur repeatedly from cycle to cycle.

Common PMS symptoms include:

  • Tiredness or low energy
  • Mood changes (feeling down, tearful, irritable, anxious, angry)
  • Food cravings
  • Nausea
  • Headaches or migraines
  • Aches and pains
  • Breast tenderness
  • Abdominal bloating or constipation
  • Difficulty concentrating
  • Acne
  • Fluid retention

A key feature of PMS is that symptoms settle once the period begins, meaning there is always a time in the cycle when the person feels like themselves again. If symptoms continue well after menstruation, it may be important to explore other explanations such as depression, thyroid conditions, or perimenopause.

PMS symptoms often become more noticeable in a person’s 30s and may continue until menopause.

When symptoms are more severe: Premenstrual Dysphoric Disorder (PMDD)

For a small but significant number of people, premenstrual symptoms are much more severe than PMS. This condition is known as Premenstrual Dysphoric Disorder (PMDD).

PMDD affects around 3-5% of people who menstruate and is recognised as a mental health condition in international diagnostic guidelines. While the timing of symptoms is similar to PMS – occurring in the days or week before a period and improving once menstruation begins – the intensity and impact are greater.

People with PMDD often experience intense emotional symptoms, such as:

  • Intense mood swings or emotional sensitivity
  • Marked irritability, anger, or conflict with others
  • Severe anxiety or tension
  • Feelings of hopelessness or being overwhelmed

These emotional symptoms are often accompanied by physical or cognitive changes, such as fatigue, poor concentration, sleep disturbance, or physical discomfort. Importantly, symptoms are cyclical, meaning there is usually a noticeable period of relief after the period starts.

Because PMDD can significantly interfere with work, relationships, and quality of life — professional assessment and support are important. Effective treatments are available and often involve a combination of psychological therapy, lifestyle strategies, and, for some people, medication.

If you suspect your symptoms may be more than PMS, seeking help can be an important first step toward relief and you can talk to your general practitioner or psychologist for more information.

When Existing Mental Health Symptoms Worsen: Premenstrual Exacerbation (PME)

PME refers to a worsening of existing mental health symptoms in the premenstrual phase. Unlike PMS or PMDD, PME occurs in people who already live with a mental health condition, such as:

For example, someone with an anxiety disorder may notice a spike in anxiety, panic, or intrusive thoughts in the days before their period.

Research suggests PME is very common:

  • Up to 60% of people with depression
  • Around 40–80% of those with panic disorder
  • Nearly half of those with social anxiety disorder

This pattern can be confusing and is often misunderstood or misattributed to treatment failure or “relapse,” – where really it may be PME and can be anticipated and responded to with compassion.

What Can Help?

1. Tracking your cycle

Keeping a menstrual and symptom diary can be incredibly helpful. Tracking patterns over time allows you to:

  • Anticipate more difficult days
  • Plan additional support
  • Reduce self-blame by recognising predictable biological patterns

2. Lifestyle strategies

Many people find that general wellbeing strategies help reduce PMS symptoms:

  • Eating regular, balanced meals
  • Reducing caffeine, alcohol, salt, and sugar
  • Getting regular aerobic exercise
  • Prioritising sleep
  • Managing stress through relaxation, yoga, meditation, or gentle movement

3. Psychological support

Psychological therapy can be particularly helpful for:

  • Managing mood and anxiety symptoms
  • Coping with PME
  • Learning cycle-aware strategies
  • Reducing the impact of symptoms on relationships and work

4. Medical options

Some people benefit from medical treatments, including:

  • Certain herbal treatments (such as chasteberry)
  • Hormonal contraception
  • Low-dose SSRIs taken continuously or only in the luteal (premenstrual) phase

Medication decisions should always be discussed with a GP or specialist.

Premenstrual Mood Changes

When to Seek Help

If your symptoms:

  • Are severe or worsening
  • Interfere with daily life
  • Affect your safety or relationships
  • Feel unmanageable

you are not “overreacting,” and you are not alone. Support is available.

At MyLife Psychologists, we recognise the powerful interaction between hormones and mental health. We offer cycle-informed psychological assessment and treatment, helping clients better understand their experiences and develop strategies that work with their body – not against it.

If you’d like support or further information, please reach out to our team.

References & Resources