When sadness is more than PMS

Feeling teary or flat for a day or two before your period is common. But if sadness is heavy, lasts for weeks, or never fully lifts, it is worth looking at more closely. Getting help early is a strength, not a failure.

Three patterns to know

• PMS: mood and body symptoms in the weeks before your period that ease once it starts. The NHS says most people get PMS at some point.
• PMDD: a much more intense form of PMS that can have a big effect on daily life. Reviews estimate that it affects roughly 3 to 8 in every 100 people who have periods. The NHS says it can include feeling very anxious, angry, depressed or suicidal.
• Depression or anxiety that gets worse before periods: symptoms most of the time, sometimes sharper in the days before a period (sometimes called premenstrual exacerbation).

Signs of depression

The NHS says a low mood that lasts 2 weeks or more could be a sign of depression. Signs include:

• Persistent low mood or hopelessness
• Not getting any enjoyment out of things you used to enjoy
• Changes in sleep or appetite
• Low energy and trouble concentrating
• Feeling worthless or guilty
• Thoughts of self-harm or suicide

What can help

For PMS and PMDD, the NHS says a GP may suggest hormonal medicine such as the combined pill, CBT, or antidepressants, and may refer you to a specialist if these do not help. These have better evidence than supplements or special diets.

Where to get support

• Your GP, who can advise on treatments and refer you on
• NHS Talking Therapies (you can self-refer if you are 18 or over, registered with a GP, in England)
• Samaritans: 116 123, free, 24/7
• Shout: text SHOUT to 85258, free, 24/7
• Someone you trust: a friend, family member or teacher