Extreme premenstrual syndrome: symptoms and treatment options

Symptoms can include marked irritability, low mood, anxiety, tearfulness, anger, poor concentration, fatigue, bloating, headaches, cramps and breast pain. A severe pattern tends to recur in the premenstrual phase and ease after bleeding starts, although symptoms can overlap with depression, anxiety, thyroid problems or other conditions. Keeping a daily symptom diary across several cycles helps show timing and impact.

Record mood, physical symptoms, bleeding and their effect on work, relationships and sleep. Regular meals, movement, sleep routines and reducing alcohol may help some people. A clinician may discuss psychological therapy, symptom-directed medicines or hormonal options such as the combined pill after reviewing migraines, blood pressure, smoking, clot history and other risks. Do not start or stop treatment without advice.

Arrange medical care when symptoms repeatedly interfere with ordinary activities, relationships or safety. Seek urgent help for thoughts of suicide, self-harm, feeling unable to stay safe or severe agitation. Sudden chest pain, breathlessness, weakness or a severe allergic reaction also needs emergency assessment and should not be attributed to PMS.

Does my symptom pattern fit PMS or another condition? How should I keep a diary? Which treatment matches my medical history? Could the combined pill affect my mood or migraine risk? What should I do if symptoms become unsafe before my next appointment?