PMS and PMDD: What’s the difference?

Experiencing changes in mood and body before your period is common. These issues are categorized as Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) – the latter being a more severe form. Understanding the difference can help you know when it’s time to seek support.

What is PMS (Premenstrual syndrome)?

PMS (Premenstrual xyndrome) is a very common experience, affecting up to 30% of menstruating individuals. It involves various physical and psychological symptoms that typically begin one to two weeks before menstruation and disappear when the period starts.

Symptoms can affect both mood and physical well-being, and they are often experienced as a noticeable change from how one feels the rest of the month.

Common symptoms of PMS include:

• Mood swings, irritability, anxiety, and low mood.
• Physical discomfort such as bloating (in the abdomen or breasts), headaches, tender breasts, and fatigue.
• Increased cravings for sweets and altered appetite.
• Sleep problems.

The severity of symptoms can vary from month to month and usually doesn’t require medical treatment, often being manageable with lifestyle changes.

What is PMDD (Premenstrual dysphoric disorder)?

PMDD (Premenstrual dysphoric disorder) is a more severe and intense form of PMS, affecting approximately 3-5% of menstruating individuals.

With PMDD, the symptoms are so severe that they significantly impact daily life. They can lead to difficulties in relationships, work life, school, and overall functioning. The symptoms of PMDD are often more psychological and can resemble those of depression or anxiety, but unlike these conditions, PMDD symptoms disappear when menstruation begins.

To be diagnosed with PMDD, one must experience at least five specific symptoms, of which at least one must be an emotional symptom such as:

• Marked low mood, feelings of hopelessness, or self-deprecating thoughts.
• Significant anxiety or tension, a feeling of being keyed up or on edge.
• Pronounced mood swings. Persistent irritability, anger, or increased interpersonal conflicts.

In addition to these, other PMS symptoms (such as physical discomfort, decreased interest in activities, difficulty concentrating, fatigue, appetite changes, and sleep problems) may also occur. PMDD is a treatable condition, and it’s important to seek professional help if you suspect you are affected by it.

The difference between PMS and PMDD.

The main difference between PMS and PMDD lies in the severity of symptoms and their impact on daily life. While PMS can be troublesome, PMDD involves symptoms so intense that they disrupt daily life, relationships, and functional ability. Both conditions are linked to the menstrual cycle and occur in the days leading up to menstruation, but PMDD often requires professional support and treatment to be managed effectively.

Why do we get PMS and PMDD?

PMS and PMDD occur because of how the body reacts to the natural hormonal changes during the menstrual cycle. It’s not about having too much or too little hormones, but rather how sensitive your body and brain are to them.

Here’s how it works:

• Hormonal Changes: During the menstrual cycle, especially after ovulation and leading up to menstruation, levels of female sex hormones like estrogen and and progesterone change.
• Progesterone’s Role: When progesterone breaks down, substances (called byproducts) can form that affect the brain. One of these substances, allopregnanolone, impacts neurotransmitters like GABA, which is important for calm and relaxation in the brain.
• Brain Sensitivity: For individuals with PMS and especially PMDD, the brain is believed to be extra sensitive to these hormonal changes and the substances that are formed. It’s as if the brain reacts more strongly than in others.
• Emotional Centers Affected: These reactions occur in conjunction with different parts of the brain. The amygdala, which is the brain’s “fear center,” can become more active. This can amplify feelings like worry, anxiety, irritability, and low mood, which are typical of PMS and PMDD.

It’s important to remember that PMS and PMDD are biological conditions. They are not something you “just make up” or can control through sheer willpower. Understanding this biological basis can help both you and those around you manage the symptoms better.

Common symptoms of PMS and PMDD.

PMS and PMDD can affect both the body and the mind. Here are some of the most common symptoms:

• Mood swings: Rapid shifts between joy, anger, and sadness.
• Worry and anxiety: A restless, nervous feeling that can be hard to pinpoint.
• Low mood and lack of energy: Feelings of hopelessness, fatigue, and a general lack of energy.
• Sleep problems: Difficulty falling asleep or waking up frequently during the night.
• Bloating and tender breasts: The body often feels swollen and uncomfortable.
• Headaches and increased appetite: Some may experience headaches and a strong craving for sweets or specific foods.

In PMDD, these symptoms are often even more intense and affect one’s ability to function normally. Many experience that relationships, work, or studies suffer during these periods, and it can feel overwhelming to manage daily life.

Treatment for PMS and PMDD.

Treatment for PMS and PMDD can be tailored based on the intensity of symptoms. Lifestyle changes are often the first step. Regular exercise, good sleep, and nutritious food can reduce sensitivity to hormonal changes and alleviate symptoms. For some, mindfulness and relaxation techniques can contribute to a sense of control and well-being.

For PMDD, medication may be necessary. Antidepressants have been shown to help many achieve better mood balance. Certain hormone treatments, such as birth control pills or other hormones that stabilize the cycle, can also reduce symptoms.

Psychotherapy, especially Cognitive Behavioral Therapy (CBT), is important support for managing severe PMS and PMDD. Therapy can provide strategies for coping with anxiety and emotional reactions and help you plan for those periods in the cycle when symptoms are most challenging.

What you can do yourself to manage PMS and PMDD.

Understanding your own menstrual cycle can be a first step to help. By using a cycle tracking app, you can more easily predict when symptoms will occur, and thus be better prepared. Here are more tips:

• Create routines: Regular sleep, exercise, and a balanced diet provide a stable foundation for the body and can reduce symptoms.
• Plan according to your cycle: Try to schedule more stressful activities during the weeks when you feel your best, and reduce demands during periods when you know symptoms are strong.
• Prioritize self-care: During times when you experience PMS or PMDD symptoms, try to make time for relaxing and calming activities. Small breaks and self-care can reduce stress.

When should you seek help?

If your PMS or PMDD symptoms affect your daily life, your relationships, or your ability to work, it’s wise to seek help. PMDD is a medical condition that can be treated effectively, and with the right support, you can find relief from symptoms and better control over your well-being.

Talking to a therapist can provide both practical tools and emotional support that allow you to better navigate the periods when symptoms are strongest.

Therapy test – See if therapy can help you.

Do you recognize the symptoms of PMS or PMDD and wonder if therapy could be a support? You’re not alone – and it’s perfectly okay to feel unsure if therapy is the right path.

By taking our therapy test and answering a few questions, you’ll get a clearer picture of whether therapy can help you manage emotions, mood swings, and daily challenges.

The test takes only a couple of minutes – and can be an important first step towards feeling better.

Go to the therapy test.