How is PMDD different from PMS? Is there any relief? Here’s what to know about premenstrual dysphoric disorder.

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For the vast majority of women worldwide, premenstrual symptoms are a certainty, like clockwork.

Premenstrual syndrome (PMS) affects up to 90% of women during their reproductive years.

For 3–8% of menstruating women, the mental and physical symptoms brought on by their menstrual cycle are so severe that PMS doesn’t accurately describe them.

Premenstrual dysphoric disorder (PMDD) is an extreme form of PMS that’s now officially classified as a depressive disorder.

In PMDD, you experience severe psychological and physical symptoms in the week or two before your period. PMDD can affect any person in their childbearing years and significantly interferes with your daily functioning.

If you have PMDD, there are many possible symptoms you might have.

Psychological symptoms might include:

Physical symptoms might look like:

We still don’t totally understand what causes PMDD, but experts are beginning to get a better idea.

Some research indicates that women with PMDD are unusually sensitive to hormonal changes in the body.

That would help explain why the luteal phase of the menstrual cycle — 1 to 2 weeks before your period — would trigger symptoms, as estrogen and progesterone levels dramatically rise and fall.

These hormone changes also spur a drop in serotonin, which may be responsible for PMDD symptoms like low mood, anxiety, and sleeping problems.

Recent research has shown a connection between PMDD and the naturally-produced steroid, allopregnanolone (ALLO), which is metabolized by progesterone. ALLO has anti-anxiety and antidepressant properties, but according to the research, brains of people with PMDD appear to be less sensitive to its helpful functions.

Contributing factors

Though these alone won’t cause PMDD, certain factors may increase your chances of developing it. They include:

  • family history of PMS or PMDD
  • personal or family history of mood or anxiety conditions
  • cigarette smoking
  • high stress

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has specific criteria laid out to help doctors diagnose someone with PMDD.

PMDD differs from other depressive disorders due to its connection with menstruation. During most periods over the course of a year:

  • at least 5 symptoms must be present in the week before your period
  • symptoms must start improving during your period
  • symptoms must resolve in the week following menstruation

At least one more of these symptoms must occur:

  • Affective lability: shifts in mood, sudden sadness or crying, increased sensitivity to rejection
  • Irritability: anger, irritability, and increased interpersonal conflicts
  • Depression: depressed mood, feelings of hopelessness, self-defeating thoughts
  • Anxiety: anxiousness, tension, or feeling edgy

Additionally, at least 5 of the below symptoms must also be present:

  • decreased interest in your usual activities
  • difficulty concentrating
  • fatigue or lack of energy
  • changes in appetite or eating habits
  • sleeping difficulty (like insomnia or hypersomnia)
  • feeling overwhelmed
  • physical symptoms, including:
    • bloating
    • breast tenderness
    • joint or muscle pain
    • weight gain

All of these symptoms must affect your ability to function in daily life, including social and work settings.

Your symptoms also cannot be due to another medical condition like major depressive disorder or hyperthyroidism, or due to substance use.

Diagnosing PMDD can be quite challenging since many other mental and physical health conditions are exacerbated during certain points in the menstrual cycle. Other possible causes of your symptoms must first be ruled out by a medical professional.

Many who seek treatment for PMDD actually have a different mood disorder with episodes that worsen in the week before their period.

There’s no blood test or instrument that can definitively diagnose PMDD. Instead, a healthcare professional will likely do a physical and psychiatric evaluation and ask you to track your symptoms over the course of a few cycles.

For many folks, premenstrual symptoms can become more severe as they approach menopause.

Like with many other mental health conditions, hormonal changes that are typical of mid-life can exacerbate PMDD.

That being said, not all people will have worsened symptoms as they age. And unlike other mental health conditions, PMDD should resolve completely after menopause.

For some, self-care and at-home techniques can significantly help relieve symptoms of both PMS and PMDD.

Some steps you can do at home include:

  • aerobic exercise
  • yoga
  • aromatherapy
  • reducing intake of alcohol, caffeine, and sugar
  • increasing intake of protein
  • stress management and relaxation techniques

For women with symptoms that can’t be managed by these changes alone, medication and therapy may be necessary.

Selective serotonin reuptake inhibitors (SSRIs) are generally regarded as the first line of pharmaceutical treatment for PMDD.

Unlike SSRI use for major depressive disorder (MDD), research indicates that even low doses can significantly reduce symptoms and go into effect almost immediately.

Birth control pills are also commonly used as a treatment for PMDD, but evidence of their efficacy is lacking.

Although research findings have been largely inconclusive, some women find that supplements and vitamins help relieve symptoms.

Examples include:

  • vitamin B6 (Pxridoxine)
  • calcium
  • chasteberry (Vitex agnus castus)
  • magnesium
  • ginger
  • valerian

Cognitive behavioral therapy (CBT) is also a sound form of treatment that can help you learn how to manage your mental and physical symptoms.

Many women experience unpleasant symptoms during their time of the month. But if you’re having anxiety, depression, and intense physical pain in the week or two before your period, it may be more than PMS. It may be PMDD.

PMDD is highly treatable, so with the right approach, you can find relief from your symptoms and improve your overall quality of life.

Whether it’s PMDD or another mental health condition, reaching out to a healthcare professional can help you get the right diagnosis and treatment plan.