Is it PMS or PMDD

Contributed by Danielle Bosley

If you find yourself struggling to stay focused and energized each month when Aunt Flow arrives, you’re not alone. For a lot of women, the societal stigma against periods and all things related to them makes it hard to talk about. In fact, many ladies who battle these issues suffer in silence for years. Many assume they must be clinically insane or suffering from some form of mental illness, so they don’t speak up.

PMS or PMDD - What's the differenceUnfortunately, it is that very lack of talking about PMS and PMDD that keeps people in the dark about what they’re going through, and further away from potential treatment and a better life. If you or someone you love struggles with severe premenstrual symptoms, we want you to know that it’s not your fault, and you can get better. With the proper knowledge, you should feel encouraged to talk about this, empowered to have recognized it, and prepared to handle it.

Premenstrual syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are two separate conditions that affect women in different ways. Either condition can develop at any point in a woman’s life, but PMS can spring into action without warning while PMDD typically develops following some kind of hormonal catalyst, such as a pregnancy, tubal ligation or the onset of menses.

PMS affects around 75 percent of all menstruating women, with PMDD affecting fewer women. It is estimated that 2 to 10 percent of females of reproductive age are affected, but the truth is we are still uncovering just how many women suffer with this disorder. While PMS might make for a bad day of cramps and bloating, PMDD can actually warrant the need for having three or four different clothing sizes on hand. The bloating is extreme, but most with PMDD would agree the physical symptoms aren’t the most difficult aspect of this disorder.

What is PMS?

We know that PMS symptoms occur as a result of low levels of a sex hormone called progesterone. Around a week before a woman’s period starts, progesterone plummets and remains low until the cycle starts when it begins to increase again and stabilize. This creates a temporary problem with estrogen dominance, a condition where the sex hormones estrogen and progesterone are imbalanced, leaving estrogen levels much higher and causing many side effects. During that time, women with PMS will be more sensitive to the low levels of progesterone. In many cases, these symptoms can be improved with bioidentical progesterone supplementation, which can be applied easily in topical cream form.

Symptoms of PMS include:

  • Breakouts
  • Headaches
  • Joint pain
  • Insomnia
  • A change in bowel movements
  • Water retention
  • Trouble concentrating
  • Breast swelling

What is PMDD?

When it comes to PMDD, the issue is not hormones levels that are too high or too low. In fact, a diagnosis of PMDD requires ruling out any kind of imbalance. Instead, PMDD occurs in women who are acutely sensitive to hormonal fluctuations in their body. Whether a hormone is increasing or decreasing, women with PMDD feel the effects in the form of:
  • Hot flashes
  • Irritability
  • Rage
  • Anger
  • Depression
  • Anxiety
  • Extreme fatigue
  • Lethargy

These issues affect women with PMDD very suddenly, usually during  ovulation. Symptoms tend to worsen with each passing day of the luteal phase. For some women, they resolve upon the start of menses,  but most have symptoms persist for a few more days more.

For women living with PMDD, symptoms go far beyond the sex hormones and reproductive system. Not only do these ladies suffer with the effects of cycling estrogen, testosterone and progesterone, but their bodies can’t tolerate the ebbs and flows of other hormones like adrenaline, insulin and cortisol, either. Thus, if you’re feeling like you can’t deal with stress — even in small amounts such as a sudden change of plans that sends you into a rage of irritability — it might be PMDD. Contrary to popular belief, some of these symptoms do occur outside of the luteal phase, because they are tied to the fluctuation of hormones that exist all the time, not just in the latter half of the menstrual cycle.

The side effects of PMDD may look different in different women, especially where age is a factor. Younger girls may feel like they’re just having the typical teenage experience. However, if those abrupt mood swings and meltdowns feel a little bit more like depression or anxiety, and they correlate with your cycle, it could be PMDD. Women with PMDD will often feel guilty about not being able to perform as well as society expects, in both their professional and personal lives. Weepiness, feeling overwhelmed by small events, and having trouble seeing an end in sight to the pain and upset are monthly rituals sufferers of PMDD are forced to endure. Anxiety attacks and thoughts of suicide are also sadly commonplace.

There has been some chatter about changing the name of PMDD in the future to reflect a disorder that has less similarity to PMS. This may be wise since much of the research on the disorder paints it as one that has roots in the endocrine system as an autoimmune disorder, not in the reproductive system as a menstrual one. Strong signs of inflammation in women with PMDD confirm this suspicion.


Both PMS and PMDD symptoms tend to improve with a cleaner, healthier diet that limits processed foods. Salt, alcohol and caffeine are also known to worsen the symptoms of both. Supplements like magnesium and chasteberry may help, too. That being said, certain things are also known to make PMDD worse that won’t necessarily worsen PMS.

Stress is a huge factor in PMDD. In fact, women with a history of trauma or abuse are thought to be more likely to develop the disorder. A lack of sleep will also intensify symptoms for most sufferers.  Antidepressants and birth control have been the primary means of treatment for PMDD. They do not work for everyone though, and the process of finding what does work for you is typically a long period of trial and error. This makes knowing the difference between PMS and PMDD even more important so that patients can receive treatment that aligns with the correct diagnosis.

So Which Do You Have?

If you’re struggling to figure out whether you are suffering from PMS or PMDD, the first step is a fairly easy one to accomplish: track your cycle. This means charting your mood every day of the month. After a few cycles spent doing this, you will be able to clearly see whether or not there is a pattern with your moods associated with the luteal phase of your cycle.

It’s also key to note that both physical and mental or emotional symptoms must be present, and they need to be severe enough to interrupt your quality of life to qualify for a diagnosis of PMDD. How severe is that exactly? It’ll vary some from one woman to another, but generally most women with PMDD have trouble sustaining stable relationships, holding down a job, and might also need to call off from work or skip family gatherings just to cope.

If this sounds like your life, don’t delay in getting help. Doctors of all kinds can assist you in this disorder and support groups for it are numerous now. You are not alone.

If you’d like, we welcome you to sign up for our Menstrual Education email series, where each week, we’ll deliver an email just for you, that’s designed to help you get to know your beautiful body even better. If that sounds interesting, go ahead and click the link below!

Did you like this? Share it: