PMS vs. PMDD: What's the difference, and how to manage both
If your period wasn't already annoying enough, the days (or weeks) leading up to it can be even worse.
PMS and PMDD symptoms affect many women in the days and weeks leading up to their period.
Premenstrual syndrome and premenstrual dysphoric disorder are two conditions that make many women's lives more difficult each month leading up to their period. And while experiencing some type of PMS is common for many women, sometimes the symptoms can be so severe that they interfere with your quality of life. If you can relate to the latter, understanding what qualifies as PMDD can be helpful for understanding your symptoms and finding relief.
Keep reading to find out more about the difference between PMS and PMDD, and what you can do to help ease the symptoms.
What is PMS?
"Premenstrual syndrome, commonly referred to as PMS, describes the pattern of physical, emotional and behavioral symptoms occurring one to two weeks before and remitting with the onset of menses," Dr. Jessica Shepherd, OB-GYN, told me. "PMS is common, and affects 30-80% of women of reproductive age," Shepherd said.
PMS can include a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It's estimated that as many as three out of four menstruating women have experienced some form of PMS.
The cause of PMS is typically attributed to hormonal imbalances or changes in hormones that occur in the body leading up to a period. Changes also occur chemically in the brain, which can be the culprit behind many of the mood-related symptoms.
PMS can also involve many physical symptoms including muscle pain, bloating, acne and digestive issues like constipation and diarrhea.
What is PMDD?
"Premenstrual dysphoric disorder is a more severe form of premenstrual syndrome and is characterized by significant premenstrual mood disturbance, often with more prominent mood reactivity and irritability," Shepherd said. "The mood disturbances result in marked social impairment."
So if your symptoms leading up to your period tend to sideline you for days, making you miss work, school or keep you from doing things you normally want to do, your symptoms may require more advanced treatment.
Further, according to Mayo Clinic, in order to classify as PMDD, at least one of several distinct symptoms must be present. "In PMDD, however, at least one of these emotional and behavioral symptoms stands out: sadness or hopelessness, anxiety or tension, extreme moodiness, marked irritability or anger."
The connection between PMDD and mood disorders like anxiety and depression
Since mood- and behavior-related symptoms are part of why PMDD is so distressing, it makes sense that there's a connection to mood disorders like anxiety and depression. According to Mayo Clinic, it's common for someone who already has depression or anxiety to also experience PMDD. In fact, the hormonal changes that happen in the body naturally before a period can potentially make mood disorders symptoms worse, which is important to consider if you have a diagnosed condition like anxiety or depression.
It's important to note that for a PMDD diagnosis, the mood and behavioral symptoms must only happen about two weeks leading up to your period. Dr. Andrea Chisholm emphasizes in an article for Harvard Medical School the importance of noting the timing of the onset of your symptoms and when they resolve for your doctor to make a diagnosis. If your symptoms occur for a longer period of time, or throughout the month, you could still have PMS or PMDD, but you may also need to be checked for a mood disorder like anxiety or depression.
Period tracking apps like Clue allow you to track your cycle and note any PMS or PMDD symptoms.
What can you do to help manage PMS or PMDD?
One action you can take to help manage your symptoms is to start by tracking your cycle with an app or smart watch. "Tracking cycles can help by knowing when moods may change and helping to find ways to alter these mood changes," Shepherd said. Various period-tracking apps like My Flo and Clue allow you to track not only the days of your cycle, but also important symptoms and mood changes.
Besides keeping track of your symptoms, you can also use diet, lifestyle and exercise to help manage symptoms. Some dietary changes that can help include eating smaller, more frequent meals, limiting salty foods and incorporating more complex carbohydrates (like fruits and veggies over processed carbs like bread or pasta). You can also eat more calcium-rich foods since calcium is shown to help improve PMS symptoms. Limiting alcohol and caffeine can also help.
Regular exercise can also be helpful for overall health, and in preventing and managing symptoms like fatigue and feelings of depression. Other than exercise and diet, you can also work on managing stress and getting more sleep to help manage your symptoms.
If lifestyle interventions don't help, doctors can use a variety of treatments or medications to help. Some drugs commonly used to treat PMS and PMDD include antidepressants, NSAIDs, diuretics and hormonal contraceptives. "There is a strong theory that the fluctuations in circulating estrogen and progesterone cause marked effects on central neurotransmission, specifically serotonergic, noradrenergic and dopaminergic pathways," Shepherd said. "This is important as there are certain medications that can help regulate these pathways and possibly minimize the mood changes."
When should you see a doctor?
"If a person thinks they have PMS or PMDD, it is important to talk to a clinician so that other diagnoses can be ruled out," Shepherd advised. Again, if you suspect you might have PMDD, experience PMS or have mood symptoms that present around your period (or at any point in the month), it's best to see a doctor so you can get the proper diagnosis and treatment.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.