Over 90% of women report symptoms like cramps, fatigue and mood changes in the weeks between ovulation and menstruation. You may know this combination of symptoms as premenstrual syndrome (PMS), and you may have even heard of its more severe cousin, premenstrual dysphoric disorder (PMDD).
For many, PMS symptoms are uncomfortable and annoying. But if your monthly symptoms include serious emotional and interpersonal difficulties, it may be a sign of PMDD.
So what’s the difference between these conditions, and how do you know if you have PMS, PMDD or another health condition? Here, we answer these questions and others. Read on to learn about the symptoms of PMS vs. PMDD, risk factors and how a doctor can help you find relief.
PMDD is a more severe form of PMS
PMS and PMDD both cause symptoms that appear around 1-2 weeks before menstruation and go away 2-3 days after menstruation. PMS symptoms can be physical, emotional or behavioral and range from mild to severe, which is why it can be hard to tell apart from PMDD.
Although PMDD often includes many of the same symptoms as PMS, it’s characterized by one or more specific, serious mood changes. Researchers estimate that PMDD affects about 5.5% of reproductive-age women and people who were assigned female at birth.
PMS symptoms can be physical or mental
PMS can cause a variety of symptoms. Symptoms and their severity may change from month to month.
Physical PMS symptoms
Physical symptoms of PMS can include:
- Acne flare-ups
- Appetite changes, such as cravings
- Bloating
- Breast tenderness or swelling
- Constipation or diarrhea
- Cramps
- Fatigue
- Headaches
- Increased fluid retention (resulting in weight gain or hand and foot swelling)
- Joint or muscle pain
Emotional or behavioral PMS symptoms
Mental symptoms of PMS can include:
- Anxiety
- Concentration issues
- Depression
- Irritability
- Libido changes
- Sleep issues
PMDD symptoms include severe emotional changes
In addition to PMS symptoms, PMDD includes one or more of the following:
- Feeling overwhelmed, out of control or on edge
- Increased sensitivity to conflict and rejection
- Lasting irritability
- Severe depression (feelings of hopelessness, worthlessness, guilt or despair)
- Severe mood swings
The causes of PMS and PMDD aren’t fully understood
PMS and PMDD have been linked to hormone changes that occur during the menstrual cycle, but they do not appear to be the result of a hormone imbalance. These normal, cyclical hormone changes cause chemical changes in the brain, and many experts believe that PMS and PMDD result from sensitivities to these changes. For example, studies have found that people who experience PMS or PMDD symptoms often have a notable drop in serotonin levels during the premenstrual period.
Additionally, studies have shown an association between PMS and PMDD symptoms, and certain risk factors, such as:
- Consuming a lot of sugar or caffeine
- Consuming processed, fatty or fried foods
- Drinking alcohol
- Existing mental health conditions
- Family history of premenstrual mood issues
- Lack of exercise
- Poor sleep quality
- Stress
Both PMS and PMDD are diagnosed based on symptom patterns
A PMS or PMDD diagnosis is mainly based on when your symptoms appear. In both PMS and PMDD, symptoms specifically appear during the luteal phase (the second half of the menstrual cycle when your body prepares for a period or pregnancy). Because of this, a doctor may ask you to track your premenstrual symptoms for at least two menstrual cycles. For a PMDD diagnosis, you must have at least five PMS symptoms, with at least one of the “core” emotional symptoms listed above.
If your symptoms happen outside of the luteal phase as well, they may be the result of another health condition. Thyroid conditions, endometriosis and chronic fatigue syndrome are all examples of conditions that can cause symptoms that are similar to PMS. Existing mental health conditions can also be worsened during the luteal phase, resulting in symptoms that mimic PMDD. This is known as premenstrual exacerbation (PME).
Treatment for PMS and PMDD can include medication, lifestyle changes and supplements
There are a number of treatments that can help relieve PMS or PMDD symptoms. Generally, a combination of treatments is most effective.
Adjusting your lifestyle to improve PMS or PMDD
Getting regular exercise and maintaining good sleep hygiene can both help reduce premenstrual symptoms. Additionally, it can help to spend time on activities that help you relax, such as yoga, meditation or massages.
Which foods and supplements to eat for PMS or PMDD
Since premenstrual symptoms have been linked to fatty or highly processed food, sugar, alcohol and caffeine, it can help to limit or avoid these things. Focus on eating plenty of complex carbohydrates (such as whole grains, brown rice, beans and lentils), as this can boost your levels of tryptophan, which helps create serotonin.
Calcium and magnesium may also help reduce premenstrual symptoms. You can get these nutrients from foods like yogurt, green leafy vegetables, and beans or lentils. If you aren’t able to get enough of these nutrients from the foods you eat, you could consider taking a dietary supplement.
The only herbal supplement that’s been shown to help with premenstrual symptoms is chasteberry extract. Supplements are not regulated by the U.S. Food and Drug Administration, so talk with your doctor before you start taking one.
Relieving PMS or PMDD symptoms with medication
Hormonal birth control can help relieve physical symptoms of PMS or PMDD, like cramps and back pain, but it doesn’t always improve mental or emotional symptoms. Antidepressants or antianxiety medications can help with these symptoms. Depending on your needs, your doctor may recommend taking these medications throughout your cycle, or just before your luteal phase.
Additional medications may be useful for relieving specific symptoms. Examples include nonsteroidal anti-inflammatory medicines (NSAIDs) for pain, or diuretics to reduce fluid retention.
Getting mental health support
Even when you know what’s causing your symptoms, PMDD can be overwhelming. Cognitive behavioral therapy has been shown to help with PMDD by providing strategies for recognizing and managing disruptive thoughts and feelings. Your primary care doctor or clinician can get you started with mental health support and refer you to a mental and behavioral health specialist if necessary.
Looking for help with premenstrual symptoms? Talk with an expert.
Uncomfortable premenstrual symptoms are common, but if physical or mental symptoms are disrupting your life, talk with a doctor. A primary care doctor or women’s health expert can help rule out other possible causes, recommend treatments and refer you to specialists if necessary.
