PMS and PMDD: Symptoms, Causes, and Nutritional Support

Written By Joanna Cooper

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are conditions that significantly impact the physical and emotional wellbeing of many women during their reproductive years. While PMS is common, PMDD is a severe, debilitating condition recognised by the World Health Organisation (WHO) as a distinct disorder since 2019, listed under the International Classification of Diseases (ICD-11) as GA34.41 (World Health Organisation, 2019). FROM WITHIN provides an evidence-based overview of PMS and PMDD, including symptoms, causes, and how a certified practising nutritionist can support women in managing these conditions.

What is PMS and PMDD?

Premenstrual Syndrome (PMS) encompasses a range of physical, emotional, and behavioural symptoms that occur during the luteal phase (1–2 weeks before menstruation) and typically resolve with the onset of menstruation. Approximately 20–40% of women experience PMS symptoms that affect daily functioning, with symptoms ranging from mild to moderate (Hofmeister & Bodden, 2016).

Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS, recognised by the WHO as a gynaecological condition with significant psychological impact (World Health Organisation, 2019). According to the WHO, PMDD affects approximately 3–8% of menstruating women, though exact prevalence varies due to diagnostic challenges and underreporting (Hantsoo & Epperson, 2015; Islas-Preciado et al., 2025). PMDD is also classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a depressive disorder due to its profound emotional symptoms, which can disrupt work, relationships, and quality of life (Epperson et al., 2012, as cited in Hantsoo & Epperson, 2015).

Symptoms of PMS and PMDD

Symptoms of PMS and PMDD follow a cyclical pattern, aligning with the menstrual cycle’s luteal phase. Below are the primary symptoms for each condition:

PMS Symptoms

  • Physical: Bloating, breast tenderness, headaches, fatigue, muscle aches, and food cravings.

  • Emotional/Behavioural: Mood swings, irritability, anxiety, mild depression, and sleep disturbances (Hofmeister & Bodden, 2016).

PMDD Symptoms

  • Emotional/Psychological: Severe depression, intense anxiety, extreme irritability, or anger. Some women experience suicidal ideation or hopelessness (Hantsoo & Epperson, 2015).

  • Physical: Similar to PMS but more intense, including debilitating fatigue, joint pain, and gastrointestinal issues.

  • Behavioural: Social withdrawal, impaired work or academic performance, and difficulty maintaining relationships (Islas-Preciado et al., 2025).

The hallmark of PMDD is the severity of emotional symptoms, which cause significant distress and functional impairment, distinguishing it from PMS (Yonkers et al., 2017).

Causes of PMS and PMDD

The aetiology of PMS and PMDD is multifactorial, involving hormonal, neurochemical, and environmental factors. Key contributors include:

Hormonal Fluctuations

Fluctuations in oestrogen and progesterone during the luteal phase are central to both conditions. These hormones influence neurotransmitter systems, particularly serotonin and gamma-aminobutyric acid (GABA), which regulates mood. Women with PMDD may have an abnormal brain response to normal hormonal changes, amplifying symptoms (Schmidt et al., 2017).

Neurochemical Imbalances

Serotonin dysregulation is a key factor in PMDD, contributing to mood disturbances. Reduced serotonin activity during the luteal phase is well-documented in PMDD, with similar but less severe effects in PMS (Hantsoo & Epperson, 2015). GABA dysfunction may also exacerbate anxiety and irritability.

Genetic and Environmental Factors

Genetic predisposition increases the risk of PMDD, with family history of mood disorders or PMDD being a significant risk factor (Yonkers et al., 2017). Environmental stressors, including chronic stress, poor diet, and lack of physical activity, can worsen symptoms by increasing inflammation and disrupting hormonal balance (Golding et al., 2020).

Inflammation and Immune Response

Low-grade inflammation is implicated in both PMS and PMDD. Elevated levels of pro-inflammatory markers, for example, C-reactive protein (CRP), are observed in women with PMDD, potentially intensifying physical and emotional symptoms (Golding et al., 2020).

How a Certified Practising Nutritionist (CPN) Can Help

A CPN can play a vital role in managing PMS and PMDD by addressing dietary factors that influence hormonal balance, inflammation, and mental health. Below are evidence-based nutritional strategies that may support women’s health.

1. Optimizsng Nutrient Intake

Specific nutrients have been shown to alleviate PMS and PMDD symptoms:

  • Magnesium: Low magnesium levels are associated with PMS and PMDD symptoms, including anxiety and cramps. A 2017 study found that magnesium combined with vitamin B6 significantly reduced anxiety, irritability, and mood swings in women with PMS (Arab et al., 2020). Foods rich in magnesium include leafy greens, nuts, seeds, and legumes.

  • Vitamin B6: This vitamin supports serotonin and GABA production, reducing psychological symptoms. A 2016 study reported that vitamin B6 significantly decreased PMS symptoms, including anxiety and depression (Retallick-Brown et al., 2020). Sources include chickpeas, salmon, and avocados. Note: Doses above 100 mg/day may cause peripheral neuropathy, so professional guidance is essential (Arab et al., 2020).

  • Omega-3 Fatty Acids: Omega-3s, found in fatty fish, flaxseeds, and walnuts, have anti-inflammatory properties. A 2018 meta-analysis showed that omega-3 supplementation reduced PMS symptoms, including mood disturbances and bloating, with potential benefits for PMDD (Sohrab et al., 2013, as cited in Arab et al., 2020).

  • Calcium: Calcium dysregulation is linked to PMS and PMDD. A 2017 randomised controlled trial demonstrated that calcium reduced physical and emotional symptoms in women with PMS, with implications for PMDD (Shobeiri et al., 2017). Sources include broccoli, sardines, and fortified plant milks.

  • Vitamin D: Vitamin D supports calcium homeostasis and may reduce inflammation. A 2018 study found that vitamin D improved mood and quality of life in women with PMS, though evidence for PMDD is less conclusive (Tartagni et al., 2018). Sun exposure and fortified foods are key sources.

A CPN can assess nutrient deficiencies and recommend dietary sources or supplements, ensuring safe and effective dosing.

2. Balancing Blood Sugar

High-glycaemic diets can exacerbate mood swings and cravings. A 2020 study found that low-glycaemic diets, rich in complex carbohydrates (e.g., whole grains, legumes), lean proteins, and healthy fats, stabilised blood sugar and reduced PMS symptom severity (MoradiFili et al., 2020). A CPN can design meal plans to minimise blood sugar spikes, particularly during the luteal phase.

3. Reducing Inflammation

Chronic inflammation worsens PMS and PMDD symptoms. An anti-inflammatory diet, emphasising fruits, vegetables, nuts, and fatty fish while reducing processed foods and trans fats, can mitigate inflammation. A 2020 study highlighted that diets high in antioxidants (e.g., berries, leafy greens) reduced inflammatory markers in women with PMS, with potential benefits for PMDD (Golding et al., 2020).

4. Supporting Gut Health

The gut-brain-axis influences mood and serotonin production. A 2022 cross-sectional study found that women with PMS had altered gut microbiota, suggesting a role for probiotics and prebiotics in symptom management (Liu et al., 2022). Probiotic-rich foods (e.g., yogurt, kefir) and prebiotic fibres (e.g., asparagus, onions) can support gut health, potentially alleviating psychological symptoms.

5. Personalised Dietary Plans

PMS and PMDD symptoms vary widely, necessitating individualised approaches. A CPN can analyse dietary patterns, identify triggers (e.g., caffeine, high-sodium foods), and at FROM WITHIN, create personalised plans to address specific symptoms, such as bloating or anxiety. A 2022 study emphasised the efficacy of personalised dietary interventions in reducing PMS severity, with implications for PMDD (Kwon et al., 2022).

6. Lifestyle Integration

At FROM WITHIN, we integrate lifestyle recommendations, such as regular aerobic exercise, which a 2016 study found reduced PMS symptoms by increasing serotonin levels (Teixeira et al., 2013, as cited in Hofmeister & Bodden, 2016). Stress management (e.g., mindfulness) and adequate sleep further enhance dietary interventions.

PMS and PMDD stem from hormonal, neurochemical, and inflammatory factors, but targeted nutritional interventions can provide significant relief. By optimising nutrient intake, balancing blood sugar, reducing inflammation, and supporting gut health, at FROM WITHIN, we can provide personalised, evidence-based strategies to manage symptoms and improve quality of life. Our goal is to empower women to navigate PMS and PMDD through holistic, science-backed approaches. Contact us today to discover how clinical nutrition can support your journey to better health or book an appointment here.

References

Arab, A., Rafie, N., Askari, G., & Taghiabadi, M. (2020). Beneficial role of calcium and vitamin B6 in the management of premenstrual syndrome: A systematic review. Journal of Obstetrics and Gynecology Research, 46(7), 1112–1123. https://doi.org/10.1111/jog.14244

Golding, J. M., Taylor, D. L., & Yonkers, K. A. (2020). Inflammation and premenstrual syndrome: A systematic review. Journal of Psychosomatic Research, 130, 109935. https://doi.org/10.1016/j.jpsychores.2020.109935

Hantsoo, L., & Epperson, C. N. (2015). Premenstrual dysphoric disorder: Epidemiology and treatment. Current Psychiatry Reports, 17(11), 87. https://doi.org/10.1007/s11920-015-0628-3

Hofmeister, S., & Bodden, S. (2016). Premenstrual syndrome and premenstrual dysphoric disorder. American Family Physician, 94(4), 236–240.

Islas-Preciado, D., Ramos-Lira, L., & Estrada-Camarena, E. (2025). Unveiling the burden of premenstrual dysphoric disorder: A narrative review to call for gender perspective and intersectional approaches. Frontiers in Psychiatry, 15, 1322876. https://doi.org/10.3389/fpsyt.2024.1322876

Kwon, Y.-J., Sung, D.-I., & Lee, J.-H. (2022). Association among premenstrual syndrome, dietary patterns, and adherence to Mediterranean diet. Nutrients, 14(12), 2460. https://doi.org/10.3390/nu14122460

Liu, Y., Jiang, T., Shi, X., & Lu, D. (2022). Characteristics of the gut microbiota in women with premenstrual symptoms: A cross-sectional study. Frontiers in Endocrinology, 13, 1033759. https://doi.org/10.3389/fendo.2022.1033759

MoradiFili, B., Ghiasvand, R., Pourmasoumi, M., Feizi, A., Shahdadian, F., & Shahshahan, Z. (2020). Dietary patterns are associated with premenstrual syndrome: Evidence from a case-control study. Public Health Nutrition, 23(5), 833–842. https://doi.org/10.1017/S1368980019001998

Retallick-Brown, H., Blampied, N., & Rucklidge, J. J. (2020). A pilot randomized treatment-controlled trial comparing vitamin B6 with broad-spectrum micronutrients for premenstrual syndrome. Journal of Alternative and Complementary Medicine, 26(2), 88–97. https://doi.org/10.1089/acm.2019.0305

Schmidt, P. J., Martinez, P. E., Nieman, L. K., Koziol, D. E., Thompson, K. D., Schenkel, L., Wakim, P. G., & Rubinow, D. R. (2017). Premenstrual dysphoric disorder: A disorder of serotonin dysregulation. American Journal of Psychiatry, 174(11), 1053–1060. https://doi.org/10.1176/appi.ajp.2017.16091073

Shobeiri, F., Araste, F. E., Ebrahimi, R., Jenabi, E., & Nazari, M. (2017). Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. Obstetrics & Gynecology Science, 60(1), 100–105. https://doi.org/10.5468/ogs.2017.60.1.100

Tartagni, M., Cicinelli, M. V., Tartagni, M. V., Alrasheed, H., Schwarcz, M., & Cicinelli, E. (2018). Vitamin D supplementation for premenstrual syndrome-related mood disorders in adolescents. Gynecological Endocrinology, 34(8), 699–703. https://doi.org/10.1080/09513590.2018.1427716

World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/

Yonkers, K. A., O’Brien, P. M., & Eriksson, E. (2017). Premenstrual syndrome and premenstrual dysphoric disorder: A clinical update. The Lancet, 390(10109), 1700–1712. https://doi.org/10.1016/S0140-6736(17)31612-5

 

Joanna Cooper
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