Currently, up to 75% of women of reproductive age experience some degree of premenstrual syndrome (PMS), making it one of the most common hormonal conditions affecting women worldwide. As many as 20–30% experience symptoms severe enough to significantly disrupt their daily life. Despite this, PMS is frequently dismissed, misdiagnosed, or left untreated — because many women don't realise their symptoms have a hormonal cause, or because healthcare providers fail to recognise the severity of the condition.
Premenstrual Syndrome affects up to 75% of women of reproductive age. Symptoms range from mild discomfort to severe disruption of daily life.
Answer 15 yes/no questions about symptoms you experience in the days before your period to understand the severity of your PMS and what you can do about it.
Do you experience this symptom in the days before your period?
PMS Self-Assessment — HRT.org
Premenstrual syndrome (PMS) is a collection of physical, emotional, and behavioural symptoms that occur in the luteal phase of the menstrual cycle — typically in the 1–2 weeks before menstruation — and resolve within a few days of the period beginning. PMS is caused by the hormonal fluctuations that occur in the second half of the cycle, particularly the rise and fall of progesterone and oestrogen following ovulation. The exact mechanism is not fully understood, but sensitivity to progesterone metabolites, oestrogen dominance, serotonin dysregulation, and nutritional deficiencies all play a role.
Premenstrual dysphoric disorder (PMDD) is a severe form of PMS characterised by significant mood disturbance — including severe depression, anxiety, irritability, and emotional dysregulation — in the luteal phase. PMDD affects approximately 3–8% of women of reproductive age and is classified as a depressive disorder in the DSM-5. It is distinguished from PMS by the severity of mood symptoms and the degree to which they impair daily functioning. PMDD responds to specific treatments that are different from those used for general PMS.
- Mood swings, irritability, and anger — often disproportionate to circumstances
- Anxiety, tension, or feeling on edge
- Depression, hopelessness, or persistent low mood
- Fatigue and low energy
- Difficulty concentrating or brain fog
- Bloating, water retention, and weight gain
- Breast tenderness or swelling
- Headaches or migraines
- Food cravings — particularly for sugar, salt, or carbohydrates
- Sleep disturbance — insomnia or sleeping too much
- Acne or skin breakouts
- Joint or muscle pain
- Decreased interest in usual activities
- Feeling out of control or overwhelmed
- Conflict in relationships or social withdrawal
Yes, you can begin assessing your hormonal status at home using a reliable at-home female hormone test kit. Testing progesterone (day 21 of the cycle), oestradiol, testosterone, and thyroid function helps identify the hormonal imbalances driving PMS symptoms. Tracking symptoms across two or more cycles using our quiz above — alongside hormonal testing — provides the most complete picture of your premenstrual pattern.
- PMS Type A (Anxiety) — Characterised predominantly by anxiety, irritability, and nervous tension in the luteal phase. Associated with elevated oestrogen relative to progesterone.
- PMS Type C (Cravings) — Characterised by intense food cravings, increased appetite, fatigue, and headaches. Associated with blood sugar instability and magnesium deficiency.
- PMS Type D (Depression) — Characterised by depression, confusion, memory difficulties, and poor coordination. Associated with low oestrogen and elevated progesterone, or low serotonin.
- PMS Type H (Hyperhydration) — Characterised by bloating, breast tenderness, weight gain, and swelling due to water retention. Associated with elevated aldosterone and oestrogen dominance.
- PMDD — Severe PMS with predominant and disabling mood symptoms meeting diagnostic criteria. Requires specific clinical assessment and treatment.
The following tests are available to assess the hormonal drivers of PMS and PMDD:
- Progesterone (day 21) — to confirm ovulation and assess luteal phase adequacy; low progesterone is a primary driver of PMS
- Oestradiol (E2) — elevated oestrogen relative to progesterone (oestrogen dominance) drives many PMS symptoms
- Oestrogen-to-progesterone ratio — the balance between the two is more clinically meaningful than either level alone
- Testosterone (total and free) — contributes to mood, energy, and libido changes premenstrually
- SHBG (Sex Hormone-Binding Globulin) — affects the availability of active hormones
- TSH, Free T3, Free T4 — thyroid disorders commonly exacerbate premenstrual symptoms
- Cortisol — chronic stress elevates cortisol and depletes progesterone, worsening PMS
- Magnesium (red blood cell) — deficiency is strongly associated with PMS, particularly mood and cravings symptoms
- Vitamin B6 — essential cofactor for serotonin synthesis; deficiency linked to PMS mood symptoms
Progesterone Test—Taken on day 21 of the cycle (7 days after ovulation), this test confirms whether ovulation occurred and whether progesterone is adequate in the luteal phase. Low progesterone is the most common hormonal finding in PMS and is directly responsible for many emotional and physical symptoms.
Oestradiol Test—This test measures oestrogen levels. Elevated oestradiol relative to progesterone — oestrogen dominance — is a key driver of PMS symptoms including breast tenderness, bloating, mood swings, and irritability.
Thyroid Panel—Thyroid disorders, particularly subclinical hypothyroidism, are common in women of reproductive age and significantly worsen premenstrual symptoms. TSH, Free T3, and Free T4 should always be assessed alongside sex hormones.
Cortisol Test—Elevated cortisol from chronic stress depletes progesterone through the pregnenolone steal pathway, worsening the oestrogen-to-progesterone imbalance that drives PMS. Adrenal assessment is an important part of the PMS workup.
Progesterone Test—A day-21 progesterone below 16 nmol/L indicates inadequate luteal phase progesterone, confirming a key driver of PMS. Micronised progesterone supplementation in the luteal phase is the most targeted treatment.
Oestradiol Test—Elevated oestradiol alongside low progesterone confirms oestrogen dominance. Dietary and supplement interventions to support oestrogen metabolism alongside progesterone therapy can significantly reduce PMS severity.
Thyroid Panel—Hypothyroidism worsens virtually every PMS symptom. Optimising thyroid function should be a priority before other hormonal interventions. You can also assess this using our Comprehensive Female Hormone Home Test Kit.
Cortisol and Magnesium—Elevated cortisol and low red blood cell magnesium are the two most common and correctable findings in PMS. Both respond well to targeted nutritional and lifestyle intervention.
- Inadequate luteal phase progesterone (anovulatory or short luteal phase)
- Oestrogen dominance — excess oestrogen relative to progesterone
- Serotonin deficiency or sensitivity — amplifies mood symptoms
- Chronic stress and elevated cortisol depleting progesterone
- Magnesium deficiency — strongly associated with mood and cravings symptoms
- Vitamin B6 deficiency — impairs serotonin synthesis
- Poor diet — excess refined sugar and carbohydrates driving blood sugar instability
- Thyroid dysfunction amplifying hormonal sensitivity
- Inflammatory diet and gut dysbiosis affecting oestrogen metabolism
- Genetic sensitivity to progesterone metabolites (allopregnanolone)
Treatment for PMS and PMDD may include:
- Micronised progesterone — used in the luteal phase to address progesterone deficiency; the most targeted hormonal treatment for PMS
- SSRIs and SNRIs — particularly effective for PMDD; can be used continuously or only in the luteal phase
- Combined oral contraceptive pill — suppresses the hormonal cycle and can reduce PMS in some women, though it worsens symptoms in others
- GnRH agonists — suppresses ovarian hormone production entirely; used only in severe, refractory PMDD due to significant side effects
- Spironolactone — reduces bloating, breast tenderness, and water retention by blocking aldosterone
Natural support may also include magnesium glycinate (300–400mg daily, increasing to 600mg in the luteal phase), vitamin B6 (50–100mg/day), evening primrose oil for breast tenderness, chasteberry (vitex agnus-castus) for luteal phase support, and omega-3 fatty acids for inflammation and mood. Reducing caffeine, alcohol, and refined sugars — particularly in the luteal phase — significantly reduces symptom severity in most women. Regular aerobic exercise and mindfulness-based stress reduction both have strong evidence for PMS symptom reduction.
Based on your PMS assessment and symptoms, you may be experiencing premenstrual syndrome or PMDD.
See a healthcare practitioner to discuss your symptoms and possible testing, or order tests on your own and share results with your doctor.
References
1Yonkers KA, et al. "Premenstrual syndrome." Lancet. 2008;371(9619):1200–1210.
2"Premenstrual syndrome (PMS)." American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 15. 2000.
3Rapkin AJ, Lewis EI. "Treatment of premenstrual dysphoric disorder." Womens Health. 2013;9(6):537–556.
A deficiency or imbalance of progesterone and oestrogen in the luteal phase of the cycle can affect virtually all body functions. The severity of symptoms ranges from mild and manageable to severely debilitating — significantly disrupting work, relationships, and quality of life in the days before menstruation. It is estimated that up to 75% of women of reproductive age experience some degree of PMS, yet many go undiagnosed and untreated.
Self-assessment Questionnaire
Because many symptoms of PMS and PMDD are similar to those of depression, anxiety disorders, thyroid dysfunction, and adrenal fatigue, they can easily be confused or misinterpreted. The key distinguishing feature of PMS is the cyclical pattern of symptoms — appearing in the second half of the cycle and resolving within a few days of menstruation beginning. A symptom diary tracked across two or more cycles is the most reliable diagnostic tool.
We strongly suggest that you contact your healthcare provider if you have any concerns that you may be experiencing PMS or PMDD. The self-assessment above should not be substituted for hormone testing and clinical evaluation by your provider.
A PMS assessment is typically done by tracking symptoms across two or more menstrual cycles — noting when symptoms begin and end relative to the period — alongside blood tests measuring progesterone (day 21), oestradiol, and thyroid function. The cyclical pattern of symptoms is the most important diagnostic criterion. Doctors may also assess magnesium, vitamin B6, cortisol, and inflammatory markers as part of a comprehensive PMS workup.
Yes, most home hormone tests are accurate when used correctly and processed by certified laboratories. Day-21 progesterone testing from an at-home blood spot kit is clinically comparable to a venous blood draw and is the most important single test for identifying the hormonal driver of PMS.
Online PMS assessments using validated symptom questionnaires and at-home hormone test kits are effective and practical tools for identifying premenstrual hormonal patterns. They provide a useful first step in quantifying symptom severity, identifying the hormonal drivers, and determining whether clinical treatment is warranted.
Yes, physical signs of PMS include bloating and visible abdominal distension, breast swelling and tenderness, skin breakouts or acne flares in the days before the period, weight gain of 1–3kg due to water retention, and joint or muscle pain. In PMDD, physical symptoms are typically less prominent than the severe mood disturbance that characterises the condition.
