If the days before your period change your mood, your body and the way you relate to the people around you, you are not exaggerating and it is not “just nerves”. Severe premenstrual syndrome and premenstrual dysphoric disorder have causes that can be investigated and treated.
On this page I explain how I understand PMS, the approach I use in my practice and the research we are promoting to understand it better.
Premenstrual syndrome (PMS) is a set of physical and emotional symptoms that appear cyclically in the days before your period and ease once it starts: irritability, sadness, anxiety, sudden mood swings, bloating, breast tenderness, headache or pelvic pain, fatigue, insomnia or food cravings. Some mild discomfort is normal; when it lasts for days and overwhelms you, it is not.
Premenstrual dysphoric disorder (PMDD) is its most severe form, in which mood symptoms dominate. It is recognised as a diagnosis in the DSM-5, the reference manual of psychiatry, and in the World Health Organization's international classification of diseases. It affects a minority of women of reproductive age, but it can shape their work, their relationships and their family life, and it is often mistaken for depression or bipolar disorder.
It is not “just nerves” and it is not something you simply have to put up with. It is a response of the body with a biological basis, and it deserves a thorough assessment.
Dr. Jorge Lolas Talhami, a Chilean gynaecologist, has devoted much of his career to severe premenstrual syndrome and proposed a different way of understanding it. For decades it has been attributed only to the hormonal changes of the cycle, yet treatments that simply suppress hormones are often not enough.
His hypothesis is inflammatory: chronic inflammation of the cervix and genital tract, often caused by low-grade infections that go unnoticed, produces an excess of inflammatory mediators such as prostaglandins. These substances enter the bloodstream and, in women who are more sensitive to them, disturb hormonal balance, the pain threshold and mood in every cycle.
The practical consequence is clear: look for that source and treat it, instead of only silencing the symptoms with painkillers, anti-inflammatories or antidepressants.
This is the approach I use in my practice, always within a comprehensive plan tailored to each woman: the treatment, its intensity and its length depend on what we find in your case.
Clinical experience raises questions that only research can answer. That is why I have promoted the rigorous study of PMS and PMDD, bringing several research groups together through the DISFEM project, in which the Miguel Hernández University of Elche takes part, with funding and support from the PMDD Foundation, where I serve as medical science liaison.
DISFEM compares women with severe premenstrual symptoms with a control group to study the vaginal microbiota, the inflammatory cells of the cervix (mast cells) and the immune and inflammatory mechanisms that could explain the disorder. My doctoral thesis at the UMH, “Premenstrual dysphoric disorder: from the clinic to the omics”, is part of this work.
A clinical study of premenstrual dysphoric disorder and severe premenstrual disorders, backed by the Dr. Balmis General University Hospital in Alicante, the Alicante Institute for Health and Biomedical Research (ISABIAL), the Miguel Hernández University and the PMDD Foundation, in collaboration with the CREATIO group at the University of Barcelona.
disfem.orgA foundation working to make PMDD known, recognised and researched: it builds partnerships with hospitals, universities and scientific bodies, trains healthcare professionals and provides information for women affected and their families.
pmddfoundation.orgThe public university of Elche, where my doctoral thesis is being carried out and which, through its Bioengineering Institute, has hosted the scientific meetings on PMDD.
umh.esOn 18 September 2026, the La Valona building on the UMH's Elche campus hosted the 1st Conference on Premenstrual Dysphoric Disorder, “The role of the uterus–brain axis in women's health”, organised by DISFEM and sponsored by the PMDD Foundation.
Researchers from different fields and institutions (the Spanish National Research Council, the University of Barcelona, ISABIAL and CIBERehd, the Catholic University of Murcia and the UMH itself, among others) spoke about the vaginal microbiome, neuroinflammation, endometrial inflammation and artificial intelligence applied to diagnosis. Dr. Lolas took part with a video contribution.
The conference was streamed live on YouTube and the full recording is available to the public. It is in Spanish.
Every woman arrives with a different story, so the path is built with you, step by step.
We start with your story: when the symptoms appear, how they change with your cycle, what you have tried and how they affect your life. A symptom diary over two or three cycles helps a great deal.
The PMS self-assessment test helps you put a name and a measure to what you are going through, and gives us a starting point to compare against later.
Take the PMS testA careful gynaecological examination, paying special attention to the cervix, and the cultures and tests your case needs: microbiome, hormonal and nutritional blood tests, or an inflammation work-up.
See the testsWe treat the source when we find it and look after everything else: diet, microbiota, rest and stress. We review together how your symptoms evolve over the following cycles and adjust the plan.
This page is for information only and does not replace a medical assessment. If you are having thoughts of harming yourself, please seek help straight away: in Spain you can call 024, the suicide prevention helpline, or 112; elsewhere, call your local emergency number.
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