Dr. Sarah Daccarett on When PMS Stops Being “Just PMS”
Most women are taught that premenstrual symptoms are part of the deal. A physician on what is common, what is not, and why the pattern can change in your late thirties.
You know the week. The cravings, the bloating, the sudden urge to cry at an ad, the flash of rage at someone walking slowly in front of you.
Most women learn early that this is simply part of having a cycle, and for plenty of them it is. For some, it is something more specific, and it has a name.
PMS Is Common, and PMDD Is a Different Condition
As many as three in four women say they get PMS symptoms at some point, according to the Office on Women’s Health. Fewer meet the clinical definition. Guidance from the American College of Obstetricians and Gynecologists puts that at up to 30 percent.
Premenstrual dysphoric disorder, or PMDD, is a more severe condition affecting roughly 5 percent of women of reproductive age. The mood symptoms are strong enough to disrupt work, relationships and daily life, and they ease once a period starts. Johns Hopkins Medicine describes it as possibly “an abnormal reaction to normal hormone changes.”
That phrase is the key to all of it.
The Problem Is Sensitivity, Not Abnormal Hormone Levels
Women with PMS and PMDD do not usually have unusual hormone levels. Clinical reviews describe an increased sensitivity to the normal rise and fall of reproductive hormones across the month. Part of that involves allopregnanolone, a byproduct of progesterone that acts on the brain’s calming GABA system.
It is also why a blood test cannot diagnose PMS. MedlinePlus, the National Library of Medicine’s health site, is direct about it: there are no lab tests that detect the condition, and diagnosis relies on a symptom calendar kept over several months. Dr. Sarah Daccarett has spoken about what a hormone panel can and cannot tell you, and why a normal result so often ends the conversation too early.
Photo Courtesy: Inner Balance
Symptoms Can Shift in Your Late Thirties
The Office on Women’s Health notes that PMS symptoms may get worse as women reach their late thirties or forties and move into perimenopause, the transition before menopause. Cleveland Clinic adds a useful distinction. There is little evidence that PMS itself worsens with age, so what feels like worse PMS is often perimenopause adding changes of its own.
Those changes are real. Johns Hopkins notes that cycles can become shorter and more irregular as ovulation becomes erratic. Mayo Clinic says women with a history of PMS, PMDD or postpartum depression are more likely to have mood changes during perimenopause. A 2024 analysis of seven studies, led by researchers at University College London, found women in perimenopause had a 40 percent higher risk of depression than women before it.
Daccarett, who founded the women’s telehealth practice Inner Balance, argues this process starts earlier than most women are told. On her reading of the research, progesterone falls first and estradiol becomes erratic. She went through it herself in her mid-thirties, when her own cycle was, in her words, “normal enough,” her lab results were normal, and she was given a list of explanations that did not fit.
“You are not broken. You are not crazy. You are not just getting older,” she says. “Your hormones shifted, and no one taught you what that would feel like.”
Track It Before Anyone Tests It
The most useful thing to bring to an appointment is a record. Diagnostic criteria for PMDD call for daily symptom ratings across at least two consecutive cycles, and any period app or notes file will do. Note what the symptom is, when it starts relative to your period, how bad it gets, and when it lifts.
The Office on Women’s Health suggests seeing a clinician if symptoms bother you or affect your daily life. Medical guidelines list several evidence-based options, from exercise and cognitive behavioral therapy to prescription medication, and the right one depends on the pattern.
At Inner Balance, care begins with a detailed health assessment reviewed by a licensed clinician, who looks at the full history rather than a single lab value.
A bad week before your period is common. A week that takes over your life, or a pattern that suddenly changes, is worth writing down and taking seriously.
___
Dr. Sarah Daccarett is a physician specializing in hormone health and the founder of Inner Balance, a clinician-led telehealth practice for women in perimenopause and menopause.
This article is for informational purposes only and does not substitute for professional medical advice.
