Depression and premenstrual syndrome

PMS symptoms typically appear in the days before menstruation and improve after bleeding starts. Emotional changes may include sadness, irritability, anxiety, tearfulness or reduced concentration, alongside bloating, breast pain, headaches or appetite changes. Depression that is present throughout the cycle, or becomes markedly worse before each period, may need evaluation for a depressive disorder or a severe premenstrual mood condition. A symptom such as breast pain is not, by itself, an explanation for low mood.

Keep a daily record of mood, physical symptoms, bleeding and functioning for several cycles. Note medicines, sleep, stress and any missed work or social activities. Regular meals, movement, consistent sleep and reducing alcohol may support coping, but should not replace assessment when symptoms disrupt life. A clinician may discuss talking therapy, antidepressant treatment, cycle-related treatment or whether a combined pill is suitable for you.

Book an appointment if symptoms repeatedly affect relationships, work, study, self-care or safety. Seek urgent help for suicidal thoughts, self-harm urges, severe agitation, confusion or feeling unable to stay safe. Contact emergency services or an emergency department if danger feels immediate. Sudden severe pain, fainting or unusually heavy bleeding also calls for prompt medical review.

Does my symptom diary suggest PMS, a severe premenstrual mood problem or depression outside the cycle? What treatment fits my health history? Could contraception affect my mood? How should I monitor symptoms and what warning signs require urgent help?