Premenstrual Syndrome (PMS) is something a lot of people joke about and, once it’s over, most women can look back and marvel at their hormone-induced episodes of irritability and overwrought emotions. 

PMS is something that at least 75 percent of women know about from personal experience. But how do you know if what you are experiencing is normal PMS or the more severe PMDD (premenstrual dysphoric disorder)? Sometimes I see patients who tell me that their period doesn’t just make them feel weepy and bloated, but also makes them feel an overwhelming sense of hopelessness, completely drains them of energy, and causes their anxiety level to soar, and that makes a diagnosis of PMDD a possibility.

The symptoms of PMS

Our monthly menstrual cycles can come with some very uncomfortable symptoms. A large number of my patients share their complaints of menstrual cramps, bloating, muscle aches, insomnia, tender breasts, mood swings, anxiety, and even depression. Altogether, these symptoms comprise what is widely known as PMS.

For some women, these symptoms become more than an irritant or an inconvenience. Instead, they begin to interfere with their ability to function during the day. When PMS symptoms become this bad, they are referred to as premenstrual dysphoric disorder or PMDD. Severe period symptoms can also signify the presence of fibroids or adenomyosis.

What’s The Difference Between PMS and PMDD?

First, it may be helpful to know what the similarities are. Both disorders are caused by the changes in hormone levels during the period. In particular, the increase in progesterone and the decrease in estrogen around the time of ovulation trigger the symptoms of PMS or PMDD. However, it is not clear why some women develop premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and others do not. Levels of estrogen and progesterone are similar in women with and without these conditions. The most likely explanation, based on several studies, is that women who develop PMDD are highly sensitive to normal changes in hormone levels.

According to Viva Eve’s NYC Ob/GYNs and Nurse Practitioners, the difference between the two lies in the severity of the symptoms. PMDD generally begins a week to a week and a half before the period is supposed to start and stops about a day before the period begins. The symptoms can include extreme depression, diarrhea, and cramping that does not respond to pain relievers. It is also primarily dominated by emotional symptoms, such as feelings of hopelessness, extreme anxiety, and rapid mood changes. PMDD is usually a chronic condition that causes mood shifts that are so extreme, that they can play havoc with your daily life, affect your work, and damage your relationships. Some women report having panic attacks, feeling out of control, and even having thoughts of suicide in the week leading up to their periods.

How do I know that I have PMDD and not a different problem?

It must be said that there are disorders that mimic the symptoms of PMS and PMDD. These conditions include depression, anxiety disorders, bipolar disorder, and perimenopause.  It is important to distinguish between underlying depression (which often worsens before menses) and true PMS or PMDD because the treatments are quite different.

Women with underlying depression often feel better during or after menses, but their symptoms do not resolve completely. On the other hand, women with PMS or PMDD have a complete resolution of symptoms when their menstruation begins. 

How widespread is PMDD? 

PMDD tends to be relatively rare, affecting only 3 to 8 percent of women. and disproportionately affecting women who have a history of depression. While it doesn’t usually start until you are in your 20s, it can worsen as you age. This condition can affect women of any socioeconomic, cultural, or ethnic background.

How is PMDD diagnosed?

There is no single test that can diagnose premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). The symptoms must occur only during the second half (luteal phase) of the menstrual cycle, most often during the five to seven days before the menstrual period, and they must be physical as well as behavioral. In women with PMS or PMDD, these symptoms should not be present between days 4 through 12 of a 28-day menstrual cycle.

A blood test cannot really diagnose PMS or PMDD. There is a thyroid function test that can rule out thyroid disorders because some of the symptoms might resemble PMDD or PMS, and I often recommend it to my patients.

I also ask my patients to carefully record their symptoms on a daily basis for two full menstrual cycles. This may help me to come up with a definitive diagnosis. 

Is there a treatment for PMDD?

Fortunately, a variety of treatments and self-care measures can effectively control the symptoms in most women.

If you want to tackle PMS or PMDD, there are a few things you can try:

Diet and lifestyle changes. Regular exercise often reduces PMS and PMDD. Reducing your caffeine intake and avoiding alcohol and nicotine may also ease symptoms. A good night’s sleep and relaxation techniques, such as mindfulness, meditation, and yoga may also help. Try to avoid stressful and emotional situations, such as arguments over financial issues or relationship problems, whenever possible. Make a conscious effort to deal with difficult situations when you are better equipped to act rationally.

Birth control pills. Taking birth control pills with no pill-free interval or with a shortened pill-free interval may reduce PMS and PMDD symptoms for some women.

Nutritional supplements. Consuming 1,200 milligrams of dietary and supplemental calcium daily may possibly reduce symptoms of PMS and PMDD in some women. Vitamin B-6, magnesium and L-tryptophan also may help, but please ask your NYC Ob/Gyn or Nurse Practitioner for advice before taking any supplements.

Herbal remedies. Some research suggests that chasteberry (Vitex agnus-castus) may possibly reduce irritability, mood swings, breast tenderness, swelling, cramps and food cravings associated with PMDD, but more research is needed. The Food and Drug Administration doesn’t regulate herbal supplements, so talk with a medical professional before taking any of the supplements.

Antidepressants. For truly severe and debilitating PMDD symptoms some doctors recommend selective serotonin reuptake inhibitors (SSRIs). They may diminish emotional symptoms, fatigue, food cravings, and sleep problems. You can reduce symptoms of PMDD by taking SSRIs all month or only in the interval between ovulation and the start of your period. SSRIs should be taken for at least two menstrual cycles to measure their benefit. Approximately 15 percent of women do not experience relief with these drugs after two cycles, in which case an alternative treatment is recommended.

These measures can help to alleviate your symptoms and make the week leading up to your period a little more bearable.

As women’s health experts, the NYC Ob/Gyns and Nurse Practitioners at Viva Eve are concerned with all facets of women’s health. Your health care provider at Viva Eve is the best source of information for any questions and concerns. During your longer than usual appointment we take the time to answer all of your questions so that together we can come up with a treatment plan that works for you and your unique situation. 

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