PMS, and when it is PMDD?

I know what PMS is, what is PMDD?

This is a question I hear all the time. Many of us have some of the typical signs of PMS before our periods, but when is it a concern? In both Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Syndrome (PMS), symptoms usually start 7 to 10 days before your period starts and can continue for the first few days of your period. PMDD is a severe, sometimes disabling form of PMS. It affects only between 3% and 8% of women.

A PMS Refresher

Most women experience at least one sign of PMS each month. These are different for everyone and change as you age. At least 90% of women with regular menstrual cycles report some uncomfortable physical or psychological symptoms monthly. For the majority of women, these symptoms are mild and well-tolerated. But, for a subset of women, these symptoms can be very distressing and disrupt their lives. 

Physical signs of PMS:

• Bloated tummy
• Cramps
• Tender breasts
• Hunger
• Headache
• Muscle aches
• Joint pain
• Swollen hands and feet
• Pimples
• Weight gain
• Constipation or diarrhea
• Feeling tired

Emotional and behavioral signs of PMS:

• Feeling tense/anxious/irritable
• Feeling depressed
• Crying
• Mood swings
• Insomnia 
• Feeling anti-social 
• Feeling overwhelmed 
• Having angry outbursts
• Forgetfulness/brain fog

We don’t know the exact causes of PMS, but women are definitely reacting to the monthly fluctuation of estrogens and progesterone. Researchers now agree that women who are vulnerable to both PMS and PMDD are not reacting to abnormal levels of hormone or to a hormone imbalance. They are just particularly sensitive to normal cyclical hormonal changes.

Also, many healthcare professionals believe there is a decrease in serotonin in some women during the premenstrual phase, and that brain chemical improves mood!  

How is premenstrual dysphoric disorder (PMDD) different from PMS? 

Although many of the symptoms of the two overlap, it is the severity of the problems with mood regulation that defines PMDD. In PMDD at least one of these emotional and behavioral symptoms stands out:

• Sadness or hopelessness
• Anxiety or tension
• Extreme moodiness
• Marked irritability or anger

This mood disturbance is severe enough to impact work, social life, and relationships. The major risk factors for PMDD include personal history of a mood or anxiety disorder, and a family history of premenstrual mood dysregulation. It often appears in the late 20s to mid-30s.

It is important to distinguish PMDD from other mood disorders such as depression and bipolar disorder. This can be done by keeping a chart of symptoms for a few months. PMDD caused mood disturbance will only happen in the last two weeks of your menstrual cycle (luteal phase), and should resolve when you get your period. Some women who do have a mood disorder find that their symptoms are worse during this part of their cycle.  

There are lots of ways to manage and improve PMS symptoms. As you would guess, these are lifestyle goals I recommend for overall health: 

• Exercise about 30 minutes a day. Get 15 minutes of sunshine.
• Eat healthy foods like whole grains, fruits, and vegetables.
• Try to get enough calcium from foods (think dairy, green leafy vegetables, and salmon).
• Avoid too much salt, caffeine, and alcohol.
• Don’t smoke.
• Take steps to improve your sleep.
• Work to lower stress by starting a meditation practice
• Try over-the-counter pain relievers like ibuprofen, acetaminophen, or naproxen, following dosing instructions.

Those with debilitating PMDD should consult their healthcare provider to discuss possible treatment. 

• Antidepressants that slow the re-uptake of serotonin provide can provide effective treatment and women don’t necessarily have to take the drugs every day.
• Hormone therapies provide additional options but are generally considered second-line treatments.