The Numbers and the Picture: How Common Are PMS and PMDD, and What Do They Actually Look Like

How common are PMS and PMDD, really — and why does the research seem so contradictory? In this episode, Dr Georgina Standen unpacks the numbers behind these conditions, and the full picture of symptoms that goes far beyond bloating and a bit of tearfulness.

In this episode:

• Why estimates of PMS prevalence range so wildly across studies — from 12% to 98%
• What the actual research says about how many women meet criteria for PMS and PMDD
• The 200+ documented symptoms of PMS, and which specific cluster defines PMDD
• Why symptoms can look completely different from one woman to the next
• Why perimenopause so often brings a resurgence of PMS/PMDD-type symptoms — and what that pattern actually means

Mentioned in this episode:

• Belle app: https://bellehealth.co/
• Flo app: https://app.flo.health/
• Sirona Health PMS/PMDD page: sironahealth.co.uk/pms

A full transcript of this episode is available above.

Sirona Health specialises in menopause, PMS/PMDD and teen health. Find out more at sironahealth.co.uk.

Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health (sironahealth.co.uk), a specialist women's health practice covering menopause, PMS/PMDD and teen health. Book a consultation at sironahealth.co.uk.

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Transcript

Copy Transcript Copied

0:04

Hormones don't just run your cycle. They run your mood, your mind, your whole sense of self. I'm Dr. Georgina Standen, GP and founder of Sirona Health, and this is the Sirona Health Podcast, where we talk about the relationship between female hormones and mental health properly, without the mystique and without the dismissal. So last time, I talked about what actually separates PMS from PMDD the definitions, the pattern, the fact that there's no blood test for either of them. Today, I want to do two things that go hand in hand really: give you the numbers and give you the picture. Because I think when I say PMS, everyone sorts of nods like you know exactly what that means. But if you asked 10 women to list their symptoms, you'd probably get 10 quite different lists. And when people ask me how common this actually is, you'd think that'd be a simple question with a simple answer, and it really isn't. So I want to get into both of those today, the numbers and then the symptoms nobody really tells you about I think one of the questions I get asked most is, is this normal? And the honest answer is almost everyone experiences something. Studies suggest something like nine in ten women notice some kind of premenstrual change, a bit of bloating, a shorter fuse, that sort of thing. But only around a fifth say those symptoms are actually disruptive enough to interfere with their daily life. So there's quite a big gap between I notice something, and this is actually a problem, and that gap is really where PMS and PMDD live. If you look at the big global reviews, roughly half of women of reproductive age, somewhere around forty-eight percent, meet the criteria for PMS specifically. That's quite a lot of people. And yet the range you see quoted across different studies is honestly quite wild. Anywhere from twelve percent up to ninety-eight percent, depending on the country, the population, the method they've used. I think there's a few reasons for that mess, and they're genuinely interesting. First, there's no single agreed definition. Some researchers use strict diagnostic criteria. Others use a symptom questionnaire. Others just ask, "Do you get PMS? Yes or no?" Which, as you can imagine, gets you very different answers. Second, culture matters quite a lot. In places where talking about periods is still a bit taboo, you get real underreporting. In places with more open conversation or active awareness campaigns, the numbers climb, not because more women are actually affected, but because more women feel able to say so. Third, who's actually being studied matters. Nurses, students, general community samples, they all show different rates because stress, age, and lifestyle all play into it. And fourth, I think the honest truth is that the gold standard method, tracking symptoms daily across multiple cycles, is expensive and time-consuming, so most large studies just don't do it. They rely on people's memory of how it usually is, which, if you've ever tried to accurately recall how you felt three weeks ago, you'll know isn't always that reliable Now, PMDD, this is the smaller, much more severe cousin. Strict studies, the ones using proper cycle-tracked diagnostic criteria, put confirmed PMDD at somewhere between 1.6 to 3% of women. If you widen that out to include provisional cases, so women whose symptoms strongly suggest PMDD, but haven't been formally tracked yet, that climbs to around 7 or 8%. Now, 3% might not sound like a huge number, but scale that up to the global population, and you're talking about millions of women living with a condition that can be genuinely disabling, depression, anger, anxiety, all tightly bound to their cycle, and a huge proportion of them have never even heard the term PMDD, let alone been diagnosed. I think that's the bit that really gets me. This isn't rare in any meaningful sense. It's under-recognized. Those are quite different things. So if PMS is genuinely this common, what does it actually look like? Because I think most of us have a fairly narrow mental list, bloating, maybe a headache, feeling a bit tearful, and yes, those are real, but that list barely scratches the surface. There are, by some counts, over 200 documented symptoms associated with PMS, 200, and I think that explains quite a lot about why this gets missed or dismissed so often, because nobody's really looking for 200 things. So on the physical side, you've got bloating, breast tenderness, headaches or migraines, joint and muscle pain, fatigue. Those are the ones people tend to expect, but it goes a lot further than that. Changes in appetite, digestive changes, skin breakouts, sleep disruption in either direction, so either insomnia or wanting to sleep constantly. And then there's the whole emotional and behavioral side, which I think is more relevant to what this whole podcast is about really, irritability, mood swings, anxiety, low mood, crying spells that feel like they've come out from nowhere, poor concentration, wanting to withdraw from people socially. Now, there's an important distinction here, and I think it's worth holding onto because it matters for the rest of this series. Not all 200 of those symptoms are part of the actual diagnostic criteria for PMDD. PMDD's diagnostic criteria focuses specifically on a cluster of emotional and cognitive symptoms, not the full sprawling list of physical PMS complaints. So to meet criteria for PMDD, a woman needs at least five symptoms in total, and crucially, at least one of them has to be a core mood symptom, so marked mood swings, sudden sadness or tearfulness, a heightened sensitivity to rejection, that kind of thing. Physical symptoms like breast tenderness or joint pain can count towards the total, but only if they're accompanied by those emotional or behavioral changes. Physical symptoms on their own, however extensive, don't really get you to a PMDD diagnosis, so bloating and sore breasts and headaches on their own, however miserable, that's PMS territory. It's the mood cluster that tips things into PMDD Not every woman experiences this the same way, and I don't think that's random. I think it's biological. Sensitivity to hormonal fluctuation rather than the actual hormonal levels themselves seems to be what drives symptoms, and that sensitivity is shaped by genetics, stress, lifestyle, and other conditions you might already have. Thyroid issues and endometriosis both seem to play a role. So one woman might mostly get physical discomfort, bloating, tenderness, headaches, and barely notice a mood shift. Another might have relatively mild physical symptoms, but a mood change severe enough to meet PMDD criteria. Same underlying mechanism, quite a different presentation, and it changes across your life too. In your teens, cycles are often irregular, which makes PMS harder to pin down and predict. Through your 20s and 30s, things tend to be a bit more stable, though pregnancy and contraception can shift the picture. And then you get to your 40s, and this is the bit I want to spend a bit more time on because it's honestly one of the most common things I see in clinic week in, week out. What tends to happen is something like this, a woman comes to see me, often mid to late 40s, and she'll say something like, "I've always had a bit of PMS, nothing major. I could always cope with it, but over the last year or two it's become unrecognizable. I'm anxious in a way I've never been. I can't sleep. My concentration's gone. Some weeks I don't feel like myself at all." And very often she's already been told this is just stress or just getting older or worse, sent away with a straightforward diagnosis of anxiety or depression with no mention of hormones at all. What's actually going on more often than not is perimenopause layering itself on top of an already hormone sensitive nervous system. And when I take a proper history with these women, a pattern tends to show up again and again. Many of them had real premenstrual mood symptoms back in their 20s or 30s. Some had postnatal depression or anxiety after having children. Some remember feeling flat, low or irritable on the contraceptive pill in a way that resolved as soon as they came off it. I don't think any of that is a coincidence. I think it's the same underlying trait showing up at different points across a woman's reproductive life, not general psychological fragility, a brain that has always responded more strongly to hormonal change than average. Perimenopause is a bit different from that first regular estrogen dip before a period though. It's not one predictable dip. It's years of estrogen and progesterone swinging around fairly unpredictably, sometimes quite dramatically before they finally settle at a lower baseline. So if you're someone whose brain has always been sensitive to hormonal shifts, perimenopause isn't just menopause a bit early, it's really an extended unpredictable version of exactly the kind of hormonal turbulence that's always affected you, just stretched out over years instead of two weeks a month. I think that's part of why the research shows what it shows, that the perimenopausal transition is associated with a real measurable rise in new onset depression and anxiety over and above what you'd expect from aging alone. I do want to be clear this doesn't happen to everyone. Plenty of women move through perimenopause without much emotional disruption at all. But if you recognize yourself in this, a history of PMS or PMDD, maybe postnatal low mood, maybe a rocky relationship with hormonal contraception, and now a really unfamiliar shift in your mood or anxiety in your 40s, I don't think that's you falling apart, and I don't think it's just getting older. I think that's a pattern, and it deserves proper assessment, not a blanket anxiety or depression label and a standard prescription. I'll come back to menopause and mental health properly in a future series, but I wanted to flag it here because I don't think many women realize their 40s experience is connected to everything they went through decades earlier So to bring today together, PMS is genuinely common. PMDD is real, but much rarer, and both are almost certainly undercounted because of how messy the research is and how much stigma is still baked into how women report or don't report their symptoms. And symptom-wise, I think the picture is so much bigger than a bit bloated, a bit tearful. Two hundred plus physical and emotional symptoms, but a much tighter specific cluster of mood symptoms that actually define PMDD. If any of today made you think, "Oh, that's what it is," that's really the point of this series. Next time I want to move from recognizing your symptoms to actually getting a diagnosis, the tools doctors use, and a proper look at cycle mapping so you can start building your own evidence That's it for today. I'm Georgina. Thanks for listening. A quick note before you go. This podcast is for general information, not individual medical advice. It doesn't replace seeing your own GP or a specialist. So if anything you've heard today feels relevant to you, please do talk to someone. And if you're struggling, please reach out to your GP, to someone you trust, or to a crisis line if you need one right now. You can find Sirona Health and book your appointment at sironahealth.co.uk. See you next time