PMDD vs. PMS: Differences Every Woman Should Know

Feeling moody, irritable, crampy, bloated, and even depressed before your period - sounds familiar, right? That’s because a large number of women experience these symptoms in the days leading up to their period, and collectively these symptoms are known as PMS or Premenstrual Syndrome. But for some women these symptoms are not quite run of the mill but are instead so exacerbated that what they experience is now categorised as a related but separate diagnosable disorder known as PMDD or Premenstrual Dysphoric Disorder. If you’ve noticed that you experience severe PMS every single month right before your period, which takes a toll on your daily life, work, and relationships, and if it has made you question why your PMS looks so different from what most women experience, then it can help knowing that what you go through is not PMS at all but PMDD. Let’s get into it and understand the differences as well as the similarities between the two. 

First Things First: What Is PMS?

Research shows that around 75% of menstruating women experience PMS, and although not all women are equally affected by their symptoms, this is still a pretty large number. It leads to a multitude of physical, emotional, as well as behavioural symptoms in women. These symptoms run the gamut from cramps, bloating, tender breasts, acne, headaches, muscle or joint pain, fatigue, insomnia, and food cravings to mood swings, anger or irritability, anxiety, crying spells, social withdrawal, and changes in sex drive. 

There is no known conclusive cause of PMS yet but researchers have suggested that it occurs due to the rising and falling levels of the hormones estrogen and progesterone during and after ovulation. These hormones reach a peak during the luteal phase after ovulation and then rapidly decline, which leads to PMS symptoms. The emotional or behavioural symptoms occur because the varying levels of these hormones also affect the levels of neurotransmitters or brain chemicals such as serotonin which influences your mood.

Most women don’t feel these symptoms to a disabling degree, and by tracking their cycle and knowing exactly what relieves their symptoms, they are able to come up with strategies to cope with them. These strategies might include a better, more balanced diet, regular exercise, regular sleeping cycle, limiting caffeine, sugar, and alcohol intake, etc. But some women experience such severe PMS that they find their daily lives to be disrupted by it to a degree that it stops them from going about their tasks, negatively impacts their relationships, and leads to psychological symptoms that they are not able to cope with without help from a professional. Such severe PMS is another disorder altogether called PMDD. Let’s learn more about it below.

PMDD: #1 Reason Why You Might Feel Depressed On Periods

PMS gets a bad rep and leads to women getting stereotyped as going through ‘that time of the month’ when they should be left to their own devices. But the truth is that a lot of women go through something even more serious than PMS every month. This is PMDD, or Premenstrual Dysphoric Disorder, which is a diagnosable disorder included in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5), and is experienced by roughly 3-9% women every month. Although PMS and PMDD share some symptoms, especially the physical ones, where they differ is in the psychological, emotional, and behavioural symptoms, which are much worse in PMDD than in PMS. Women with PMDD experience more dysphoric, or depressive, symptoms, and hence its name. In fact, if you have a past history of depression or any other mental disorder, you might be more likely to develop PMDD, and unsurprisingly PMDD often gets misdiagnosed as depression. And it’s these emotional and psychological Premenstrual Dysphoric Disorder symptoms that are critical to a PMDD diagnosis as well. 

In order to diagnose whether you have PMDD, your gynaecologist will first ask you to undergo a blood test so as to rule out any other underlying medical disorder. Once that is done, they will refer to your symptoms over the last two menstrual cycles to confirm whether your symptoms flare up excessively during the luteal phase and dissipate once you get your period. The symptoms that they would look out for include: extreme depression, suicidal ideation, constant anxiety or feeling on edge, severe mood swings that make you feel out of control, and a sense of detachment from things that otherwise make you happy.

Premenstrual Dysphoric Disorder Treatment: Help Is Out There

The first step in PMDD treatment is simply acknowledging that you are going through something for which you need help. Once you do that, and once you realise that help is out there, half the battle is won. Much like PMS, PMDD too can be managed to a certain extent through lifestyle changes, but note that treatment for PMDD often requires medication as well. Premenstrual Dysphoric Disorder medication is of two broad types - SSRIs and birth control pills.

• SSRIs: SSRIs, or Selective Serotonin Reuptake Inhibitors, are antidepressants that affect the levels of serotonin in the brain, thus improving the psychological and emotional symptoms caused by PMDD, along with helping with fatigue, food cravings, and sleep problems. Your doctor might recommend you take SSRIs either throughout the month or only during the period between ovulation and the start of menstruation, i.e. during the luteal phase.
• Birth Control Pills: Taking birth control pills can help reduce PMDD symptoms because it makes you stop ovulating, which helps avoid the subsequent hormonal fluctuations during the luteal phase. They also reduce physical symptoms such as pain and cramps. However, there is a caveat here, which is that in some women contraceptive pills actually end up worsening the symptoms, and more research is needed to arrive at any conclusion.    

How To Advocate For Yourself?

A big challenge faced by many women who suffer from PMDD is explaining to the people in their lives why they aren’t ‘just PMSing’. This can impact their familial and romantic relationships, friendships, and even their professional lives. Unfortunately, many medical professionals are also likely to dismiss their lived experience and symptoms, leading to misdiagnosis. Consequently it’s important that you read up on these conditions for yourself and not settle for a doctor who dismisses your symptoms. Additionally, if you want the people in your life to be more sensitive to your disorder, it is first important to be compassionate to yourself and validate what you are going through instead of dismissing your own symptoms as bouts of ‘feeling crazy’, as many women are wont to do. Moreover, if you are prescribed medications, remember that along with them it’s also crucial to follow some self care practices that you’ve seen work for you and to make the kind of lifestyle changes that might help alleviate some of your symptoms. Ultimately, know that you are neither alone nor beyond help.

FAQs

Q. What are 3 symptoms of Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder has the following major symptoms:

• Extreme Depression: Women with PMDD often experience feelings similar to clinical depression.

• Severe Mood Swings: They may have intense mood swings that make them feel out of control.

• Constant Anxiety: Persistent anxiety or feeling on edge is common, which impacts their daily life and well-being.

Q. What is the best treatment for PMDD?

Treatment for PMDD usually involves lifestyle changes along with the following types of medications:

• SSRIs (Selective Serotonin Reuptake Inhibitors): These antidepressants can help manage psychological and emotional symptoms by improving serotonin levels in the brain.

• Birth Control Pills: These help by stopping ovulation and reducing hormonal fluctuations associated with the luteal phase that follows ovulation.

Q. How do you deal with Premenstrual Dysphoric Disorder?

Here is how you can deal with PMDD:

• Seek Professional Help: Consult a gynaecologist or mental health professional for accurate diagnosis and treatment options.

• Lifestyle Changes: Implement a balanced diet, regular exercise, and stress management techniques.

Self-Care and Support: Practise self-care, educate yourself about PMDD, and seek support from friends, family, or support groups to manage the condition effectively.