PMS clinic at Haywards Heath Hospital

What is a PMS clinic?

A PMS clinic is a specialist service for people with premenstrual syndrome (PMS) or its more severe form, premenstrual dysphoric disorder (PMDD), where physical and emotional symptoms linked to the menstrual cycle are affecting daily life. It offers assessment, diagnosis and a range of treatment options, tailored to the individual.

What conditions does it treat?

PMS is a common group of physical and psychological symptoms caused by the normal hormonal changes of the menstrual cycle, typically appearing in the second half of the cycle and easing with the onset of a period. Around 80% of women experience some degree of PMS, usually without it being particularly troublesome, though around a third notice a real impact on work, relationships or self-image, and around 5% experience severe symptoms that seriously affect their wellbeing.

PMDD is a form of PMS with more severe emotional symptoms, which can include:

• extreme mood swings, including sadness, anxiety, irritability and anger, and, in serious cases, thoughts of suicide, which should always be discussed with a doctor promptly
• fatigue and difficulty concentrating
• sleeping much more or much less than usual
• a sense of being overwhelmed or out of control.

The exact cause isn't known, though it's clearly linked to the cycle, since it doesn't occur before puberty, during pregnancy, or after the ovaries are removed. A genetic link is possible, symptoms tend to worsen with age, and a history of depression or anxiety increases the risk of severe PMS. PMS is also linked to a higher chance of postnatal depression and of depression or anxiety at menopause.

What are the benefits?

Getting a clear diagnosis, confirming that symptoms genuinely follow a cyclical, hormone-related pattern rather than another cause, is the first step towards effective treatment. A specialist clinic offers a tailored plan rather than a one-size-fits-all approach, since people need differing hormone doses, combinations and delivery methods.

This means access to a full range of options in one place, from lifestyle advice through to hormonal treatment, non-hormonal medication and psychological support, along with ongoing monitoring and adjustment as your needs change.

Are there different treatment approaches?

Treatment is usually stepped. Lifestyle changes, such as regular exercise, a balanced diet, stress management and limiting caffeine and alcohol, are often tried first, sometimes alongside talking therapies such as cognitive behavioural therapy.

For more troublesome symptoms, hormonal treatment that suppresses the natural cycle is generally the most effective option. This usually means oestrogen, delivered as a gel, patch or implant, alongside progesterone to protect the womb lining; since progesterone can itself trigger PMS-type symptoms in some people, a hormone-releasing coil is sometimes used instead of tablets, since it delivers progesterone locally with fewer whole-body side effects.

Combined contraceptive pills suppress ovulation too, though older formulations can sometimes worsen symptoms in those sensitive to progesterone; some newer pills are associated with fewer side effects and may help milder cases. Non-hormonal options include antidepressants, used alone or alongside hormonal treatment, and some clinics also offer psychotherapy, nutritional advice, pelvic health physiotherapy, or, in specific circumstances such as low sexual desire, testosterone therapy.

What happens before your appointment?

Some services need a referral from your GP, while others, including most private clinics, can be accessed directly; it's worth checking this beforehand. Keeping a record of your symptoms over a couple of months is genuinely useful, since a definite cyclical pattern is central to diagnosis.

What happens during your appointment?

1. A comprehensive consultation covering your symptoms, medical history and how they affect your daily life.
2. A physical examination, along with hormone profile blood tests if these are considered helpful.
3. A discussion of the treatment options suitable for you, and agreement on a personalised plan.
4. A prescription issued at the first visit, if appropriate.
5. Additional tests arranged as needed, such as a pelvic ultrasound scan, cervical screening or a bone density scan.
6. A follow-up appointment arranged, typically after 2 to 3 months, to review progress and make any adjustments.

What happens after your first appointment?

A follow-up appointment, usually around 2 to 3 months after starting or changing treatment, checks how well it's working and allows for any adjustments to dose or approach. Some services offer this remotely, by phone or video, for anyone who can't attend in person.

Once your treatment is established and stable, periodic reviews, often annually, help ensure it remains safe and effective over the longer term. Depending on the treatment used, this may include blood pressure checks, blood tests or bone density scans.

Are there any risks or side effects to be aware of?

As a non-surgical service, there are no procedural risks, though the treatments offered carry their own considerations worth being aware of:

• progesterone, needed alongside oestrogen to protect the womb lining, can itself trigger PMS-type symptoms in some people; this can often be reduced by using natural rather than synthetic progesterone, adjusting the dose with careful monitoring, or using a hormone-releasing coil instead
• older-style combined contraceptive pills can sometimes worsen symptoms in those sensitive to progesterone
• hormonal treatment carries its own general side effects and considerations, which your clinician will discuss with you individually
• antidepressants carry a separate set of possible side effects, which your prescriber will explain if this option is suitable for you.