Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms that affect women about a week or two before they begin their period. Symptoms usually resolve soon after the start of their menstrual cycle. Premenstrual dysphoric disorder (PMDD) is a type of PMS that causes more severe symptoms and can have a negative impact on a woman’s daily life and relationships.
PMS is estimated to affect 20–32% of premenopausal women and PMDD is estimated to affect 2–5% of premenopausal women. PMDD is included by the American Psychiatric Association as a depressive disorder in the DSM-5, the gold standard for diagnosing psychiatric and mental health conditions. Understanding the difference between PMS and PMDD can be very helpful in recognizing PMDD symptoms vs. PMS symptoms and finding treatment.
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Types of Premenstrual Mood Changes
Hormones are responsible for premenstrual mood changes that many women experience before their period. Varying levels of estrogen and progesterone cause chemical changes in the body and affect every woman differently. Biological, genetic, psychological, social and environmental factors all play a role in how specific hormonal changes contribute to the symptoms a woman experiences.
Because every woman is affected differently, there are many possible symptoms that a woman may experience — both physically and emotionally. The emotional changes and the impact they have on a woman’s daily routine are helpful in distinguishing between PMS and PMDD.
What Is PMS?
PMS is described by the American College of Obstetricians and Gynecologists (ACOG) as physical and emotional changes that happen prior to a woman’s period on a consistent, monthly basis. These symptoms appear at least five days before her period, resolve within four days after the start of her period and may interfere with her normal activities.
Examples of PMS symptoms include:
Physical changes, such as:
- Food cravings
- Breast tenderness
- Bloating or swelling
- Skin changes
- Stomach upset or abdominal pain
Emotional changes, such as:
- Sadness or depression
- Social withdrawal
- Poor concentration
What Is PMDD?
PMDD is a severe type of PMS that is widely accepted as a mental health condition. This is because the intolerable symptoms have a negative impact on a woman’s daily routine, including her personal, social and work relationships.
In order to confirm a diagnosis of PMDD, certain criteria must be met. The criteria include details about symptom timing, type, quantity, severity and whether or not the symptoms are caused by another health condition, medication or substance.
The list of PMDD symptoms that are possible for a diagnosis are:
- Exaggerated changes in mood or emotion that can occur suddenly
- Irritability, anger or increased relationship conflicts
- Depressed mood, feelings of hopelessness or being overly critical of yourself
- Anxiety, tension or increased feelings of nervous excitement
- Decreased interest in usual activities
- Noticeable difficulty while trying to concentrate
- Severe fatigue or lack of energy
- Drastic changes in appetite, including overeating or specific food cravings
- Changes in sleep patterns, including excessive sleeping or the inability to sleep
- Feeling overwhelmed or out of control
- Presence of physical symptoms that are also found with PMS (breast tenderness, bloating, swelling, etc.)
Because PMDD is a more severe form of PMS, there is an overlap of the common symptoms for the two conditions. Common PMS and PMDD symptoms may include:
- Breast tenderness and swelling
- Acne or other skin changes
- Bloating and weight gain
- Headache or joint pain
- Food cravings
- Irritability, mood swings, crying spells and depression
Differences in Severity
It is not unusual that women may experience emotional or physical changes prior to starting their period. The symptoms that a woman experiences will depend greatly on her individual biology and environment. The greatest factor when understanding PMS and PMDD differences is whether the changes are so severe that they cause a negative effect on the woman’s daily life.
PMDD is defined as severe PMS, with the changes being so intolerable that they cause a significant negative impact on the woman’s life. PMDD depression is a treatable mental health condition that can be properly managed by a health care professional.
Which One Do I Have?
When trying to determine if you may have PMDD, it can be helpful to ask yourself the following questions:
- Do you have sudden mood changes a few days before your period that seem to go away after it starts?
- Do you experience increased irritability or anger before your period that goes away after the start of it?
- Do you have overwhelming feelings of depression or hopelessness before you get your period?
- Do you tend to feel more anxious or “on edge” prior to getting your period?
- Do you still feel interested in normal activities prior to getting your period?
- Do you have trouble concentrating before getting your period?
- Do you feel very tired before getting your period?
- Do you have big changes in your eating habits before getting your period?
- Do you have trouble sleeping (either feeling too sleepy or not being able to sleep) before getting your period?
- Do you feel very overwhelmed before getting your period?
- If “yes” to any of the above questions, do the symptoms cause problems in your daily life?
If you answered yes to five or more of the above questions, including question 11, then you may have PMDD. The next step is to talk to your doctor about your symptoms.
In order to diagnose PMDD, your doctor must confirm a pattern of symptoms. In order to do so, your doctor may ask you to keep a journal of any physical or emotional symptoms you experience before and during your period. Details about your symptoms will be helpful to the doctor when deciding if you meet the specific PMDD criteria listed in the PMDD DSM.
If the symptoms meet the criteria listed earlier, then your doctor may include a specific PMDD ICD 10 diagnosis code in your patient chart. From here, they will recommend specific treatment options based on your symptoms and risk factors for side effects.
There are many treatment strategies available for PMS and PMDD. However, your doctor’s recommendations for PMS and PMDD treatments will primarily depend on the severity of your symptoms. If PMS symptoms are mild to moderate, dietary or lifestyle changes may be effective. If PMS symptoms are severe and diagnosed as PMDD, then medication may be necessary.
Lifestyle or diet changes are effective examples of how to deal with PMS symptoms. Lifestyle changes include a well-balanced diet, relaxation methods such as massage or breathing techniques and aerobic exercise for at least 30 minutes most days of the week. Vitamin supplements such as calcium, magnesium, vitamin B6, vitamin E and tryptophan have shown some effectiveness for PMS treatment when taken in recommended doses.
Some studied natural remedies for PMS include evening primrose and chaste tree berry. However, keep in mind that these supplements are not regulated by the FDA for effectiveness or safety. Over-the-counter medications such as ibuprofen can help reduce pain and swelling caused by PMS. Before beginning any treatment regimen, it is recommended to speak with your health care provider to gather more information.
Because PMDD is classified as a depressive disorder, some women may be prescribed certain antidepressant medications or anti-anxiety medications to help in their PMDD treatment. The first-line option for PMDD medication is an SSRI, which is a type of antidepressant. An SSRI for PMDD can help reduce the severe emotional symptoms experienced with the disorder. Depending on the specific medication chosen and the patient being treated, the medication may not have to be taken on a daily basis. Instead, it’s used during specific times of a woman’s reproductive cycle. Examples of SSRIs used in the treatment of PMDD are Prozac (fluoxetine), Paxil (paroxetine) and Zoloft (sertraline).
There have been studies to evaluate the effectiveness of certain hormonal therapies for the treatment of PMDD. However, the success of these treatment options varies with each patient. The use of birth control for PMDD might, in theory, help balance any hormonal imbalance that is causing the PMDD symptoms. However, these oral contraceptive pills have not shown consistent benefit for the treatment of PMDD.
It is very important to talk to your doctor about any questions or thoughts that you may have regarding treatment for PMDD. Although there is a variety of treatment options available, the best option depends on your symptoms, your risk factors for possible side effects and other health conditions you may have.
Key Differences Between PMS and PMDD
Because PMDD is classified as a more severe type of PMS, many of the symptoms are the same. This makes it difficult to recognize the difference between PMS and PMDD. The key difference between PMS and PMDD is the severity of symptoms and how your symptoms impact your daily life. If the symptoms you experience before your period are consistently severe and have a negative impact on your daily life, you may be suffering from PMDD.
If you or a loved one needs help or assistance, The Recovery Village has several facilities that can help individuals receive treatment for PMS or PMDD co-occurring with substance use disorder. To learn more about our treatment programs, call The Recovery Village to speak with a representative.
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American College of Obstetricians and Gynecologists. “Premenstrual Syndrome (PMS).” May 2015. Accessed June 9, 2019.
Bhatia, Ssubhash; Bhatia, Sshashi. “Diagnosis and Treatment of Premenstrual Dysphoric Disorder.” American Family Physician, October 2002. Accessed June 9, 2019.
Biggs, Wendy; Demuth, Robin. “Premenstrual Syndrome and Premenstrual Dysphoric Disorder.” American Family Physician, October 2011. Accessed June 9, 2019.
Epperson, C. Neill; et al. “Premenstrual Dysphoric Disorder: Evidence for a New Category for DSM-5.” American Journal of Psychiatry, October 2012. Accessed June 9, 2019.
International Association for Premenstrual Disorders. “What is PMDD.” January 2019. Accessed June 9, 2019.
MedlinePlus. “Premenstrual Syndrome.” February 2019. Accessed June 9, 2019.
MGH Center for Women’s Mental Health. “PMS & PMDD.” June 2018. Accessed June 9, 2019.
Reid, Robert. “Premenstrual Dysphoric Disorder.” Endotext, January 2017. Accessed June 9, 2019.