What is PMDD and How is it Different from PMS?

by | Oct 25, 2021

Premenstrual Dysphoric Disorder: When “That Time of the Month” Becomes Debilitating

Most women are adversely impacted by their monthly menstrual cycles on some level, but a small percentage may suffer disproportionately with a debilitating condition called premenstrual dysphoric disorder (PMDD). Unlike the fairly well known condition call premenstrual syndrome (PMS), PMDD symptoms mimic PMS but the symptoms are so extreme that they keep women from doing even the most basic daily tasks at work or at home. Or, the symptoms profoundly affect relationships and interactions. So in other words, premenstrual dysphoric disorder is a debilitating form of PMS.

PMS is so common that nearly 75% of women who have their periods may have mild PMS, but PMDD is far less common, affecting only between 3% and 8% of women. Women with mild PMS may not need a doctor’s help to cope with the symptoms, but for those women who suffer from premenstrual dysphoric disorder, it would be advisable and beneficial for them to talk to their doctor about ways to improve their symptoms and quality of life.

Failure to Recognize, Diagnose and Treat PMDD

But THAT is the fundamental problem. Premenstrual dysphoric disorder is not widely known to exist, so oftentimes, women are:

  • Undiagnosed and suffer alone
  • Misdiagnosed with PMS and treated with failed or ineffective care
  • Misdiagnosed with a mental health disorder

The fact that so many women are impacted by PMS makes it fairly well known and commonly diagnosed, but with PMDD, the condition is largely misunderstood or even worse – completely unknown and unrecognized.

PMDD vs. PMS – What’s the Difference?

Since PMS and PMDD share many of the following symptoms, they seem to be nearly identical:

  • Bloating
  • Tender breasts
  • Headaches
  • Muscle or joint aches and pains
  • Fatigue
  • Trouble sleeping
  • Food cravings
  • Changes in mood

But, that is where the similarities end. For those women who suffer from premenstrual dysphoric disorder, not only are the above symptoms severely more pronounced, these women also suffer from the following psychological conditions:

  • Depression. If you have PMS, you may feel depressed, but for those with PMDD, your sadness may be so extreme many also feel hopelessness. These extreme feelings may actually lead to thoughts of suicide.
  • Anxiety. While many women with PMS can sometimes feel anxious, women with PMDD feel anxiety on an entirely different level with some feeling uncontrollably tense and incapable of self-soothing.
  • Mood swings. PMS can likely cause moodiness; feeling happy one minute and upset or angry the next. However, with premenstrual dysphoric disorder, the mood swings are far more severe. Women with PMDD can become extremely angry and agitated by things that would likely not irritate them otherwise. These women also report picking fights, crying uncontrollably about things that wouldn’t usually upset them, and feeling generally out of control.
  • Disassociated feelings about everyday life. Women with PMS can feel depressed, and slightly detached from their usual routine, but women with PMDD are more likely to stop caring about everyday life, showing no interest in their job, hobbies, friends, and family — basically avoiding anything that might put them in a good mood.

PMDD Causes and Treatment

The exact causes of PMS or PMDD – or why some women are more impacted than others – are largely unknown. But, they are likely caused by changing hormone levels. Genetics may also play a role. And, while depression has been linked to PMS and premenstrual dysphoric disorder, it has not been identified as the cause. Rather, the changes in hormone levels may make mood disorders like depression even worse.

While women who suffer from mild PMS may be able to manage their symptoms with lifestyle changes such as exercise, diet, sleep, and stress reduction, this is not the case with women who have PMDD. For women with PMDD, these lifestyle changes may help, but it will not alleviate all symptoms or enable women to lead happy lives. Instead, women with PMDD will likely require medication prescribed by their doctor.

Prescription Medication to Treat Premenstrual Dysphoric Disorder

There are two types of drugs that have been shown to help reduce symptoms in women with PMDD. They are as follows:

  1. SSRI antidepressants. There has been success in treating women with premenstrual dysphoric disorder using serotonin reuptake inhibitors (SSRIs). Since PMDD affects mood and can cause severe depression, SSRIs (or antidepressants) have been helpful for some women as it treats their depression by increasing levels of serotonin in the brain. A rise in serotonin levels can improve symptoms and make women more responsive to other types of treatment. Taking these can help to relieve many PMDD symptoms that affect mood.
  2. Birth control pills. Birth control pills keep women from ovulating, so that means an egg is not released into the ovary each month. This causes a hormonal shift that likely reduces the symptoms of PMDD. Birth control pills can relieve physical symptoms, such as aches and pains, as well. One birth control called Yaz is so effective, it is actually FDA-approved to help with PMDD. The clinical trial showed that Yaz cut PMDD symptoms by at least half and that women taking Yaz reported twice as much improvement in PMDD symptoms as women taking inactive placebo pills. In fact, Yaz improved both physical and emotional symptoms of PMDD, including interpersonal relationships, work productivity, and enjoyment of hobbies and social activities.

Getting Help for Your PMDD

The first step to getting help with your PMDD is diagnosis. Reach out to a qualified and reputable OBGYN who will take the time to listen, learn, diagnose, and treat your PMDD. You can help your doctor throughout this process by keeping track of all of your symptoms using a menstrual cycle tracker or even writing down symptoms on paper.

In addition to seeing your doctor, search online for PMDD Support Groups and know that help is available and you are not alone.

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