Is it PMS or PMDD?

Gary Brunvoll, DO

For most women, the symptoms of PMS, or premenstrual syndrome, are all too familiar. But have you ever heard of PMDD? 

PMDD, or premenstrual dysphoric disorder, is similar to PMS in some ways, but far more severe. Because it can sometimes be difficult to know whether you’re experiencing is PMDD, PMS, or PME (pre-menstrual exacerbation of other conditions) we’d like to offer some insight about the condition.

Gary Brunvoll, DO, OB-GYN at Erlanger Center for Women, answers some common questions about PMDD:

Q: What is PMDD?

A: Premenstrual dysphoric disorder is a condition in which a woman experiences severe symptoms during the luteal phase (also known as the “premenstrual phase”) of the menstrual cycle. These symptoms may begin at ovulation and typically worsen in the five to 10 days or so before her period begins. Symptoms may include depression, irritability, extreme mood changes, hopelessness, anxiety and tension, among others. The hallmark of PMDD is that these symptoms subside within a few days of the onset of menstruation.

While researchers aren’t quite certain yet what triggers PMDD, symptoms usually begin as hormone levels start to fall following ovulation.

According to the International Association for Premenstrual Disorders, “While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. PMDD is a severe negative reaction in the brain to the natural rise and fall of estrogen and progesterone.”

Symptoms can worsen over time and/or around reproductive events such as menarche (the first menstrual cycle), pregnancy, birth, miscarriage, and perimenopause.

Q: How is PMDD different than PMS?

A: The two conditions have similar symptoms and both are related to the premenstrual phase (aka the luteal phase) of the menstrual cycle. But PMDD symptoms are much more severe than those associated with PMS.

A few of the symptoms are mentioned above, but there are many different symptoms that may be caused by PMDD, including:

  • Extreme, noticeable anger
  • Decreased interest in usually enjoyable activities
  • Fatigue
  • Change in appetite
  • Sleep problems
  • Tension or irritability
  • Mood swings
  • Sadness or despair
  • Panic attacks
  • Trouble concentrating
  • Cramps
  • Bloating
  • Breast tenderness
  • Headaches

Many of these symptoms are also common with PMS, but when a woman has PMDD, the symptoms are more serious and obvious. In most cases, the mood-related symptoms are intense enough to disrupt work and cause difficulties in relationships.

Of the two conditions, PMS is much more common, affecting one in three women, while PMDD occurs in only around 5 percent of menstruating women.

Q: How serious is PMDD?

As we mentioned above, the mood-related symptoms are intense enough to disrupt work and cause difficulties in relationships which can have a profound impact on quality of life. But, most concerning is suicidal ideation — a very real and troubling symptom of PMDD. An estimated 15% of women with this disorder will attempt an act of suicide in their lifetime. While the majority of women with PMDD do not follow through on thoughts of self-harm, it is imperative that all women with PMDD seek support, care, and intervention when needed.

Q: How is PMDD diagnosed and treated?

A: If a doctor suspects you have PMDD, he or she will thoroughly review your health history and perform a physical exam. During the exam, your doctor will talk through and rule out other potential causes for your symptoms, including underlying medical conditions like endometriosis or fibroids.

You may also be asked to keep a diary of your symptoms over two months or more to share with your doctor.

The condition is diagnosed if you have five or more of the symptoms outlined above, including at least one emotional or behavioral symptom.

If a woman is diagnosed with PMDD, treatment may come in two different types — aimed at either preventing or minimizing symptoms. Depending on a woman’s individual symptoms and health needs, treatment may include:

  • Antidepressants from a class called “selective serotonin reuptake inhibitors” or SSRIs. These act by changing serotonin levels in the brain. Since dips in serotonin levels seem to contribute to PMDD, this can help minimize the condition. These may be prescribed continuously (throughout the month) or intermittently (to be taken only during the last 10-14 days of the menstrual cycle.)
  • Birth control pills taken continuously or with a shortened pill-free interval. Because PMDD is thought to be triggered by hormonal fluctuations during the menstrual cycle, taking oral contraceptives in a way that suppresses ovulation and a normal period may help some women find relief.
  • Chemical or surgical menopause. For some women, eliminating the menstrual cycle or reproductive organs may be considered a last-resort option if symptoms have not responded well to other treatments.
  • Therapy. Various kinds of psychotherapy including talk therapy, CBT (cognitive behavioral therapy), and DBT (dialectical behavior therapy) are recommended to help those suffering from PMDD learn to better deal with stress, emotional triggers, and the impact of their symptoms on work, relationships, and their own mental and physical health.
  • Over-the-counter or prescription pain relievers. These can help women find relief from the physical symptoms of PMDD, such as headaches or cramps. Be sure to talk with a doctor about which medication might work best for your needs and with any other current medications.
  • Nutritional supplements. Some research has found that getting at least 1,200 milligrams of calcium daily can help reduce symptoms. Vitamin B-6 and magnesium have also been shown to help in some cases.
  • Lifestyle changes. Taking good care of your body can help limit or eliminate some symptoms of PMDD. Exercise regularly, limit alcohol consumption, don’t smoke, cut back on caffeine, get plenty of sleep and limit stress as much as possible.

If you suspect you may have PMDD, gaining a better understanding of the menstrual cycle and tracking your symptoms is an excellent first step. If you suspect you have PMDD, your doctor can help you determine what treatment or combination of treatment methods will work best to alleviate your symptoms.

If you’re experiencing period-related symptoms that are disrupting your quality of life, talk with your OB-GYN about your symptoms. At Erlanger Center for Women, Dr. Brunvoll and other providers offer a full spectrum of medical care with women’s unique needs in mind. Call (423) 648-6020 to schedule an appointment.