Normal NOT Normal

Mild, Moderate, or Severe? How to Measure the Severity of PMS

Even though Premenstrual Syndrome (PMS) is more common than we think, its severity can vary greatly from person to person. Some women may only feel mild discomfort, while others experience intense physical and emotional symptoms that interfere with (and often disrupt) their daily lives. Given this diversity, how do we accurately measure PMS severity?

Here’s a quick rule of thumb about what's 'normal' and what's not:

Normal Mild to moderate symptoms that are annoying, but don’t stop you from living your life. These include occasional mood swings, light cramps, or manageable bloating.

Not Normal Symptoms that are severe, long-lasting, or seriously impact your daily life. These include intense depression or anxiety episodes, chronic fatigue, or extremely painful cramps that disrupt your routine.

Understanding PMS severity

Since PMS manifests in different ways, researchers have developed various scales and scores to measure its severity. However, there is no single, universally accepted scale. The key to assessing severe PMS lies in tracking symptoms consistently and distinguishing between typical premenstrual syndrome (PMS) and more severe conditions like premenstrual dysphoric disorder (PMDD).

While PMS symptoms are generally mild to moderate, PMDD is a more extreme form that can significantly impact daily functioning.

What’s normal in PMS – and what’s not?

Mild premenstrual syndrome (PMS) symptoms like bloating, fatigue, and mood swings are common and generally considered normal. However, symptoms that disrupt daily life or cause significant emotional distress fall outside the normal range.

Could your PMS really be PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS that significantly impacts daily life. Just like PMS, PMDD is linked to hormonal and neurotransmitter imbalances, and impacts between 3.7%⁵ to 65.7%⁶ women in India.

PMDD symptoms may include:

1. Severe depression

2. Suicidal thoughts

3. Panic attacks and anxiety

4. Sudden mood swings

5. Insomnia

6. Concentration trouble

7. Binge eating

8. Painful cramping and bloating

If you suspect that you or someone you know may have PMDD, know that you're not alone, and support is available. Reaching out to a professional can provide the guidance and relief you deserve.

PMS vs. PMDD: when does it become more serious?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria¹, PMDD is diagnosed when at least five out of 11 possible symptoms occur intensely in most cycles over the past year².

Emotional Symptoms	Physical & Physiological Symptoms
Depressed mood, feelings of hopelessness, or self-deprecating thoughts.	Change in appetite, overeating, or specific food cravings.
Anxiety, tension, feelings of being ‘on edge’.	Hypersomnia or insomnia.
Affective lability, which refers to rapid, unpredictable changes in affective states, and reactivity of mood.	Breast tenderness or swelling.
Persistent anger, irritability or increased interpersonal conflicts.	Headaches.
Decreased interest in usual activities, like work, school, friends, and hobbies.	Joint or muscle aches and pains.
Difficulty concentrating.	An uncomfortable sensation of bloating or weight gain.
Feeling overwhelmed or out of control.	Lethargy, a marked lack of energy, or easy fatigability.

At least one of these severe PMS symptoms must be a severe psychological symptom, such as mood swings, irritability, or depression. PMS symptoms always appear in the final week before menstruation and subside a few days after it begins, interfering with daily activities, work, or relationships.

An accurate diagnosis of PMDD requires tracking your symptoms daily for at least two consecutive symptomatic cycles. Remember, the premenstrual syndrome symptoms cannot be an intensified version of another mental health condition.

Does a PMS/PMDD severity scale exist?

Premenstrual Symptoms Screening Tool (PSST) and Daily Record of Severity of Problems (DRSP) are two widely used tools to assess the severity of PMS and PMDD. You can find them by asking your gynaecologist, or by using a medical website or period app.

Read more about them here:

1

Premenstrual Symptoms Screening Tool (PSST)

PSST is a self-report questionnaire designed to identify severe PMS/PMDD. It evaluates both physical and emotional symptoms and their impact on your daily life. Although the tool helps screen for PMDD, it is not a diagnostic tool by itself.

2

Daily Record of Severity of Problems (DRSP)

DRSP is a daily tracking tool recommended for diagnosing PMDD. It involves recording symptoms every day for at least two menstrual cycles to confirm if they follow a PMS/PMDD pattern.

The Premenstrual Symptoms Screening Tool (PSST) should be considered as a screening tool, while the Daily Record of Severity of Problems (DRSP) should be considered as a diagnostic tool. Positive cases of PMS/PMDD diagnosed by PSST are further evaluated by using the DRSP⁴.

So how can you take control today?

If you suspect your premenstrual syndrome (PMS) symptoms are severe, consider the following steps:

• Maintain a Symptom Diary

Track your symptoms daily for at least two cycles to identify patterns.

• Use a PMS Severity Scale

Screening tools, like PSST and DRSP, can help quantify PMS symptoms.

• Seek Medical Advice

If your PMS symptoms are significantly impacting your life, don't worry – you're not alone! Consult your gynaecologist for further evaluation and specialized guidance.

References

1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders: DSM-V, 5th edition. Washington, D.C. 171-5.
2. Mishra, S., Elliott, H., Marwaha, R., (2025). Premenstrual Dysphoric Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
3. Skrzypulec-Plinta, V., Drosdzol, A., Nowosielski, K., Plinta, R., (2010). The complexity of premenstrual dysphoric disorder--risk factors in the population of Polish women. Reprod Biol Endocrinol. 8:141.
4. Henz, A., Ferreira, CF., Oderich, CL., Gallon, CW., Castro, JRS., Conzatti, M., Fleck, MPA., Wender, MCO., (2018). Premenstrual Syndrome Diagnosis: A Comparative Study between the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST). Rev Bras Ginecol Obstet. 40(1):20-2.
5. Raval, CM., Panchal, BN., Tiwari, DS., Vala, AU., Bhatt, RB., (2016). Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar, Gujarat. Indian J Psychiatry. 58(2):164–7
6. Bhuvaneswari K, Rabindran P, Bharadwaj B (2019). Prevalence of premenstrual syndrome and its impact on quality of life among selected college students in Puducherry. Natl Med J India. 32(1):17-19.