I started getting my period two year ago, and I still haven’t found a way to deal with the PMS. Around a week before my period starts, I get horrible mood swings, cry a ton, feel constantly irritable, can’t sleep, have super painful cramps and can’t concentrate on anything. I end up getting into huge fights with my friends and family, which isn’t normally a problem! My mom tells me this is all totally normal and it’ll get better, but so far it hasn’t! Will I have to live with this for the rest of my life? What can I do?

We’re so sorry you’re going through so much distress. Premenstrual symptoms are never fun, but it sounds like they’ve been particularly hard for you. We want to reassure you that you do NOT have to live with this for the rest of your life.

First, some basics: Most people who get periods have some premenstrual symptoms like bloating, muscle aches and some mild mood changes. These are caused by the changes in your hormones throughout the month. However, some people’s bodies have a stronger reaction to these hormonal changes. If the symptoms become severe enough to disrupt your daily life—for example, if you need to stay home from school because the cramps are so bad—then you may have Premenstrual Syndrome (PMS). While not everyone who gets periods has PMS, it’s relatively common.

Some people have an even more extreme reaction to the hormonal changes, however. This is called Premenstrual Dysphoric Disorder (PMDD). Symptoms include mood swings, irritability, fatigue, sleep problems, difficulty concentrating, headaches, appetite changes, anxiety, depression, cramps, muscle pain, bloating and more. The biggest difference between PMS and PMDD is that people with PMDD have much more extreme mood changes and can become depressed, tense, irritable and often angry. Like with PMS, symptoms of PMDD begin 7-10 days before your period starts. The symptoms will usually start to go away when you get your period, though sometimes they’ll last until it ends.

Since you talk about your “horrible mood swings” and getting into big fights with the people around you, it seems possible that you could have PMDD. You should make an appointment to talk to your health care provider about what you’re going through. Whether you have PMDD or PMS, your provider can diagnose and treat it so the symptoms are less intense or even go away.

If you DO have PMDD, your health care provider will likely prescribe you antidepressants to help with your mood swings, or birth control pills to stabilize your hormones. Sometimes, taking nutritional supplements can ease symptoms, but talk to your health care provider before taking any. Eating healthily, exercising regularly, getting enough sleep and learning some breathing or other mindfulness techniques can also make a big difference. It’s possible that your health care provider will recommend seeing a therapist, who can help you learn how to cope with your mood swings and deal with stress.

As for the physical pain, you can take over the counter pain killers like ibuprofen. Some people find warm baths, electric blankets or warm water bottles also soothe the pain. We talk a bit more about soothing cramps here, strategies for managing anger here, and how to get a good night’s sleep here.

It may take a few tries to find the right treatment for you, but you definitely don’t have to accept the level of physical and emotional pain that you’ve been living with.

If you are 10-22 years old and live in NYC, you can make an appointment at the Mount Sinai Adolescent Health Center for completely free, confidential, comprehensive health care, including sexual health and wellness services. Call (212) 423-3000 to make an appointment.