PMS or PMDD? Navigating the Spectrum of Premenstrual Symptoms
Navigating the spectrum of premenstrual symptoms can be a confusing and often frustrating journey for many women. From mood swings and bloating to more severe emotional challenges, understanding the difference between PMS and PMDD is crucial for finding the right approach to relief. In this blog, we’ll explore the similarities and differences between the two and identify causes and options for intervention.
What is PMS?
Premenstrual Syndrome (PMS) is a group of physical, emotional and behavioral symptoms that 70-90% of women experience in the days or weeks leading up to their period. PMS is not in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is not considered a psychological disorder.
Typically, these symptoms begin during the luteal phase of the menstrual cycle (also referred to as the infradian cycle) and continue into the menstrual phase. PMS can vary in severity ranging from mild discomfort to severe symptoms that interfere with daily life and tasks. While PMS is common, the symptoms, intensity and duration can differ significantly from woman to woman.
Causes of PMS
Like most things, PMS does not have just one root cause. It is believed to be related to the complex interplay of hormonal changes occurring within the infradian menstrual cycle, particularly fluctuations in estrogen and progesterone levels. Several factors including: hormonal fluctuations, neurotransmitter changes, lifestyle factors, genetics and underlying physical and mental health conditions, contribute to the development of PMS.
Symptoms of PMS
Symptoms are varied person to person and can be categorized into physical, emotional and behavioral. These symptoms typically begin a week or two before menstruation and usually resolve within a few days after the onset of menstruation.
Physical Symptoms:
Breast tenderness
Bloating
Headaches or migraines
Fatigue
Cramps
Joint or muscle pain
Weight gain
Digestive issues
Acne
Emotional and Behavioral Symptoms:
Mood swings
Anxiety
Depression
Irritability
Difficulty concentrating
Sleep disturbances
Appetite changes
Social withdrawal
Energy changes
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that affects approximately 23-30% of women (however keep in mind statistics come from reported, recorded and diagnosed cases, so the percentage women suffering from PMDD is likely higher).
PMDD involves more intense emotional and physical symptoms that significantly impair daily life, relationships and work. Unlike PMS, which is uncomfortable but generally manageable, PMDD can be debilitating.
Also unlike PMS, PMDD is considered a psychological disorder and is currently listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as a separate entity under depressive disorders, with the criteria for diagnosis as follows:
Criterion A - At least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) need to be present for diagnosis:
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, feelings of being “keyed up” or “on edge”
Marked affective lability (extreme and sudden changes in mood or emotional state)
Persistent and marked anger or irritability or increased interpersonal conflicts
Decreased interest in usual activities (ex: work, school, friends, and hobbies)
Difficulty concentrating
Lethargy, easily fatigued, or marked lack of energy
Marked change in appetite, overeating, or specific food cravings
Hypersomnia or insomnia
A subjective sense of being overwhelmed or out of control
Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.
Criterion B - Symptoms are severe enough to interfere significantly with social, occupational, sexual, or academic functioning.
Criterion C - Symptoms are specifically related to the menstrual cycle and are not related to or an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although the symptoms may be superimposed on those of these disorders).
Criterion D - Criteria A, B, and C are confirmed by daily ratings during at least 2 consecutive menstrual cycles. The diagnosis may be made provisionally before this confirmation.
Causes of PMDD
The exact cause of PMDD is unclear, but is thought to involve either an abnormal response to the hormonal changes, or more significant hormonal changes occurring during the menstrual cycle that more profoundly affect neurotransmitters like serotonin. Research has revealed certain risk factors like trauma, cigarette smoking, genetics and obesity to be correlated with the development of PMDD.
Symptoms
PMDD symptoms are similar to those of PMS but are much more severe, particularly in terms of emotional and mental health. These symptoms typically begin one to two weeks before menstruation and subside a few days after the period begins.
Emotional and Behavioral Symptoms:
Severe mood swings
Irritability, anger or rage
Severe depression or hopelessness
Severe anxiety or tension
Increased relationship strain and/or conflict
Inability to concentrate, focus or think clearly
Severe fatigue
Sleep problems
Appetite changes
Physical symptoms
Management of PMS and PMDD
While PMS can often be better managed and alleviated with lifestyle changes and coping tools (which we go over in our blog titled “Harnessing the Power of the Menstrual Cycle: Using Cycle Tracking and Cycle Syncing for Better Mental Health and Overall Well-Being”), PMDD typically requires more intensive intervention involving lifestyle modifications, medication (antidepressants (SSRIs), hormonal treatments, nonsteroidal anti-inflammatory drugs (NSAIDs)) and psychotherapy.
When you’re navigating the spectrum or premenstrual symptoms, whether it’s PMS or PMDD, it’s important to remember that every experience is valid and deserves attention. Understanding the difference between these conditions can empower you to seek the right kinds of support and treatment. Even though it can be challenging in a patriarchal society, try your best to tune into your body’s signals and advocate for your health because it is possible to manage symptoms better and improve your overall well-being. And remember, you don’t have to go at this all alone - we are here for you. We get what it’s like to be negatively affected by premenstrual symptoms and as holistic, somatically trained therapists we would be honored to walk alongside you in journey to experiencing better health and wellness. Just head to the contact tab in the upper righthand corner of our website, submit a contact form and we will be in touch with you ASAP!