PMS and PMDD treatments at The Bespoke Clinic, Newcastle
Premenstrual Syndrome (PMS) describes the physical, emotional and hormonal symptoms that many women experience in the days or weeks leading up to their period. For some, symptoms are mild and manageable. For others, they can significantly affect mood, energy, relationships, work, confidence and overall quality of life.
At The Bespoke Clinic, we take a more in-depth and personalised approach to hormone-related symptoms. While hormonal fluctuations are often involved, symptoms are rarely caused by just one thing alone. Stress, gut health, inflammation, sleep, blood sugar regulation, nutrient status and thyroid function can all influence how someone experiences their cycle.
Many women are told their symptoms are “normal” or simply something they need to put up with. However, significant PMS symptoms are often a sign that the body may be under strain somewhere and deserve proper attention
Common PMS symptoms
Symptoms can vary widely between individuals and may change throughout life, particularly during times of stress, after pregnancy, or approaching perimenopause.
Common symptoms include:
- Mood changes, irritability or anxiety
- Low mood or emotional sensitivity
- Fatigue and poor sleep
- Breast tenderness
- Bloating and fluid retention
- Headaches or cyclical migraines
- Food cravings or appetite changes
- Acne or skin flare-ups
- Pelvic discomfort or cramping
- Brain fog or reduced concentration
- Low motivation or feeling overwhelmed
Some women also notice worsening of existing conditions around their cycle, including migraines, IBS symptoms, eczema, rosacea, histamine symptoms or autoimmune-related flare-ups.
PMS is often more complex than simply “hormone imbalance”
Hormones do play an important role, particularly the balance and fluctuation between oestrogen and progesterone during the second half of the menstrual cycle. However, PMS is often more complex than simply having “low progesterone”.
Many functional medicine practitioners now recognise that hormones interact closely with the nervous system, metabolism, gut health and inflammation, rather than operating in isolation.
Factors that may contribute to PMS symptoms include:
- Chronic stress and cortisol dysregulation
- Poor sleep and nervous system overload
- Blood sugar instability
- Gut health and microbiome imbalances
- Inflammation
- Histamine sensitivity
- Thyroid dysfunction
- Nutrient deficiencies
- Perimenopausal hormonal shifts
- Over-exercising or under-fuelling
- Significant weight changes
For some women, symptoms may worsen during periods of chronic stress, burnout or after years of “putting up with it”, even when standard hormone blood tests appear technically within range.
When PMS symptoms may be more than “normal PMS”
While some mild cyclical symptoms are common, severe symptoms should not simply be dismissed.
Extreme pain, heavy bleeding, clotting, severe fatigue, worsening mental health symptoms, or significant disruption to daily life may indicate another underlying issue requiring assessment.
Conditions that can sometimes overlap with or mimic PMS include:
Endometriosis
PMOS (previously PCOS
Thyroid dysfunction
Perimenopause
Iron deficiency
Chronic stress and burnout
Gut and inflammatory conditions
Severe period pain is not something women should simply “put up with”. Increasing awareness is highlighting how often women’s symptoms have historically been minimised or overlooked.
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a more severe and debilitating form of PMS that can have a profound impact on mental health and daily functioning.
Symptoms often occur during the luteal phase of the cycle, typically improving once the period begins, and may include:
- Severe anxiety or panic
- Depression or hopelessness
- Extreme irritability or rage
- Mood swings
- Feeling overwhelmed or unable to cope
- Sleep disturbance
- Suicidal thoughts
PMDD remains under-recognised and under-researched, and many women spend years feeling unheard or dismissed before receiving support.
Important: If symptoms are severe, particularly if there are thoughts of self-harm, suicidal thoughts, extreme hopelessness, or significant mental health concerns, it is important to seek medical help promptly.
Hormone and functional medicine testing
At The Bespoke Clinic, we may recommend more detailed investigation where appropriate, depending on symptoms and clinical history.
This may include:
- Comprehensive female hormone blood testin
- Thyroid and metabolic assessment
- Iron and nutrient testing
- Functional gut health testing
- Microbiome assessment
- Advanced hormone testing such as DUTCH testing
The DUTCH test (Dried Urine Test for Comprehensive Hormones) is an advanced at-home hormone test used within functional medicine. Unlike standard blood tests, it can provide additional information around hormone metabolism, cortisol patterns, stress response and how hormones are being processed within the body.
For some women, gut testing may also help identify issues relating to inflammation, the microbiome, digestion or the “estrobolome”, the collection of gut bacteria involved in processing and clearing oestrogen. Gut health and hormone health are closely interconnected.
Not everyone will require advanced testing, but in more complex or longstanding cases it can sometimes help us better personalise treatment and understand the wider picture.
Our approach at The Bespoke Clinic
Our consultations aim to look at the whole picture, rather than focusing on hormones alone. Depending on your symptoms and history, your treatment plan may include lifestyle and nutrition strategies, sleep and stress support, blood sugar balancing approaches, targeted supplementation, gut health support, nervous system regulation, exercise and recovery guidance, bioidentical hormones where clinically appropriate, or onward referral for further investigation if needed.
The goal is not simply to suppress symptoms, but to better understand what may be driving them and create a personalised plan that feels realistic and supportive. Many women notice improvements not only in their PMS symptoms, but also in sleep, mood, skin, migraines, digestion, energy and overall quality of life once the wider picture is addressed.
You can also read our related blog on PMS and PMDD symptoms, when symptoms may need further investigation, and why severe cyclical symptoms should never simply be dismissed.
A patient example
One woman in her early 40s initially came to clinic wondering whether she may be entering perimenopause, as her PMS symptoms had become increasingly severe with age. On more detailed discussion, however, it became clear that many of the emotional and physical symptoms had actually been present for much of her adult life, but had gradually intensified over time.
She described cyclical anxiety, overwhelm, irritability, poor sleep and feeling emotionally unlike herself in the lead-up to her period. At times, the intensity of her symptoms felt so extreme that she worried about the impact they were having on her relationships and family life. These were symptoms she had spent years trying to “push through”, assuming they were simply something she had to tolerate.
Rather than focusing on hormones alone, we looked at the wider picture including stress, lifestyle, nutrition, sleep and nervous system support. Alongside targeted supplementation and lifestyle changes, a low dose of bioidentical progesterone was introduced.
Over time, she reported significant improvements not only in her cyclical symptoms, but also in her sleep, resilience, relationships and overall quality of life. For her, simply understanding that these symptoms were real, valid and potentially treatable was an important part of the process.
Ready to stop feeling like you just have to put up with it?
If PMS or PMDD symptoms are affecting your mood, sleep, energy, relationships, work or quality of life, a personalised consultation can help you better understand what may be driving your symptoms.
At The Bespoke Clinic in Jesmond, Newcastle, we take time to look at the wider picture, including hormones, stress, sleep, gut health, nutrition, inflammation and overall wellbeing, so we can guide you towards a realistic and supportive plan.
Questions answered
Frequently asked questions.
How do I know if my symptoms are PMS or PMDD?
PMS symptoms can range from mild to more disruptive. PMDD, however, tends to involve much more severe emotional and psychological symptoms. Women with PMDD may
experience intense anxiety, panic, rage, hopelessness, depression or feeling unable to cope in the days before their period. Symptoms are typically cyclical and often improve once the period begins.
If symptoms are significantly affecting your relationships, work, mental health or quality of life, it is important to seek support rather than simply trying to “push through”.
Can I still have hormone-related symptoms if my blood tests are “normal”?
Yes. Many women experiencing significant PMS or PMDD symptoms are told their hormone levels are “normal”. Standard blood tests can still be useful, but they only provide a snapshot in time and do not always reflect how hormones are fluctuating, being metabolised, or interacting with stress, sleep, inflammation and the nervous system.
At The Bespoke Clinic, we look at symptoms, cycle patterns and the wider clinical picture alongside any test results.
Can gut health and stress affect PMS symptoms?
Yes, absolutely. Chronic stress, poor sleep, inflammation, blood sugar instability and gut health imbalances can all influence hormone symptoms and how the body responds throughout the menstrual cycle.
Within functional medicine, there is increasing discussion around the connection between the gut microbiome, inflammation, cortisol and hormone metabolism. In some cases, further investigation such as gut testing or DUTCH hormone testing may help us better understand the wider picture and personalise support more effectively.
