Millions of women worldwide experience mood changes and physical symptoms associated with their menstrual cycles. These changes, driven by hormonal fluctuations during the luteal phase (the period between ovulation and menstruation), impact both physical health and emotional well-being. While many women experience mild and transient symptoms, others face severe disruptions to their daily lives. Understanding the distinctions between Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) is crucial for accurate diagnosis and effective treatment.
PMS is a common condition involving physical, emotional, and behavioral symptoms that usually subside with the onset of menstruation. In contrast, PMDD is a more severe disorder, marked by intense psychological symptoms that can significantly impair daily functioning.
Although the two conditions share some similarities, they differ greatly in their intensity and impact on quality of life. Exploring PMDD vs PMS provides valuable insights into their mental health symptoms, causes, and treatment options, empowering individuals to seek appropriate care and support.
Menstrual Cycle and Mental Health
Premenstrual disorders encompass a range of psychiatric and physical symptoms that manifest during the luteal phase of the menstrual cycle, significantly impacting an individual’s daily functioning. These symptoms generally diminish shortly after the onset of menstruation. The luteal phase commences post-ovulation and continues until menstruation begins.
It is essential to differentiate between premenstrual symptoms (PS), premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD). Common premenstrual symptoms include a spectrum of physical, emotional, and behavioral changes, such as feelings of depression, irritability, anger, anxiety, confusion, social withdrawal, difficulty concentrating, sleep disturbances, and fluctuations in appetite and thirst. Physical manifestations may include breast tenderness and bloating.
A significant number of menstruating women experience various physical, psychological, and behavioral changes during the interval between ovulation and menstruation. This study aims to define and diagnose premenstrual disorders, clarifying the distinctions among premenstrual symptoms (PS), PMS, and PMDD. It underscores the prevalence of these conditions and their effects on women’s quality of life, encompassing social, occupational, and psychological dimensions.
Additionally, the study investigates the influence of physical activity, particularly aerobic exercise, on the management of premenstrual symptoms. Numerous systematic reviews indicate that consistent physical activity can substantially alleviate both physical and psychological symptoms associated with PMS.
The management of PMS requires a comprehensive approach, incorporating exercise, dietary changes, stress management techniques, cognitive-behavioral therapy, and pharmacological interventions. Aerobic exercise, in particular, has proven to be an effective non-pharmacological strategy for mitigating PMS symptoms and enhancing overall well-being. Nonetheless, further research is necessary to identify the most suitable types and intensities of exercise for women experiencing PMS.
What is Premenstrual Syndrome (PMS)?
Premenstrual Syndrome (PMS) refers to a set of physical, emotional, and behavioral symptoms that occur during the post-ovulatory phase of the menstrual cycle. These symptoms typically subside shortly after menstruation begins. PMS is a common condition, affecting approximately 75% of menstruating women to varying degrees.
Symptoms of PMS
The symptoms of PMS are diverse, varying in intensity among individuals. They can be categorized into psychological, physical, and behavioral symptoms.
- Mood swings
- Irritability
- Anxiety or feelings of tension
- Mild depression
- Trouble concentrating
- Bloating or water retention
- Breast tenderness
- Headaches
- Fatigue
- Muscle or joint pain
- Changes in appetite (cravings or overeating)
- Sleep disturbances
- Reduced interest in daily activities or hobbies
What is Premenstrual Dysphoric Disorder (PMDD)?
Premenstrual Dysphoric Disorder is a severe form of PMS that affects approximately 3-8% of menstruating women. Unlike PMS, PMDD is classified as a psychiatric disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). It causes significant impairment in daily functioning and is characterized by pronounced psychological symptoms.
Symptoms of PMDD
While PMDD shares some symptoms with PMS, its defining feature is the severity of psychological and emotional disturbances, which often overshadow physical symptoms.
- Severe depression, sometimes accompanied by suicidal thoughts
- Intense anxiety or panic attacks
- Extreme mood swings
- Overwhelming anger or irritability
- Feelings of hopelessness or worthlessness
- Debilitating fatigue
- Significant bloating or swelling
- Severe breast tenderness
- Joint or muscle pain
- Headaches or migraines
- Social withdrawal or isolation
- Difficulty performing daily tasks or maintaining responsibilities
- Changes in eating habits, such as binge eating
- Sleep disruptions, ranging from insomnia to excessive sleeping
PMDD vs PMS
Many individuals who menstruate encounter mild physical symptoms in the week leading up to the onset of their menstrual cycle. Additionally, some may experience slight emotional symptoms. This condition is referred to as premenstrual syndrome (PMS), which can manifest as symptoms such as breast tenderness, bloating, and increased appetite, along with emotional fluctuations like irritability or episodes of crying.
Although the severity of PMS can vary, it generally does not significantly interfere with daily life. It is not classified as a mental illness and typically does not necessitate extensive intervention.
In contrast, premenstrual dysphoric disorder (PMDD) is characterized by intense emotional symptoms, including anger, anxiety, depression, and mood swings, occurring one to two weeks prior to menstruation. It is estimated to affect approximately 6% of menstruating individuals and can severely disrupt daily activities, impacting work and interpersonal relationships. PMDD may even pose life-threatening risks, as those affected are at an increased risk for accidents and suicidal behavior.
Due to its severity, PMDD is recognized as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.
Causes of PMDD and PMS
While the exact causes of Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Syndrome (PMS) are not fully understood, they are believed to result from a combination of hormonal, chemical, and lifestyle factors.
Fluctuations in estrogen and progesterone levels during the menstrual cycle can trigger symptoms. These hormonal changes may affect neurotransmitters in the brain, such as serotonin.
Serotonin, a brain chemical that regulates mood, sleep, and appetite, may drop during the luteal phase. Low serotonin levels are linked to mood swings, depression, and fatigue.
Research suggests that genetics may play a role, as PMS and PMDD often run in families.
Chronic stress or underlying mental health conditions (e.g., anxiety, depression) can worsen PMS or PMDD symptoms.
High intake of caffeine, alcohol, salt, and sugar may exacerbate symptoms. Lack of regular exercise and poor sleep habits can also contribute.
Some women may be more sensitive to normal hormonal changes, which could trigger severe PMS or PMDD symptoms.
While PMS is relatively common and manageable, PMDD is a more severe form of PMS and may require medical intervention, such as therapy, medication, or lifestyle adjustments.
Ruling Out Other Psychiatric Illnesses
Diagnosing PMDD can be complex because its symptoms often overlap with those of other psychiatric conditions. Below are some disorders that may be mistaken for PMDD:
- Major Depressive Disorder (MDD): Persistent sadness, hopelessness, and lack of interest in activities, with symptoms present daily and unrelated to the menstrual cycle.
- Generalized Anxiety Disorder (GAD): Excessive, uncontrollable worry with restlessness, fatigue, and difficulty concentrating, occurring consistently and not limited to the luteal phase.
- Bipolar Disorder: Alternating episodes of elevated mood (mania or hypomania) and depression, independent of hormonal cycles.
- Borderline Personality Disorder (BPD): Emotional instability, fear of abandonment, impulsivity, and relationship challenges, not tied to premenstrual phases.
To accurately identify PMDD, healthcare providers often recommend tracking symptoms over multiple menstrual cycles. This helps establish whether the symptoms align with the luteal phase and subside after menstruation, a hallmark of PMDD. Comprehensive evaluations and, when necessary, collaboration between gynecologists and mental health professionals ensure accurate diagnosis and appropriate treatment.
Does PMDD Get Worse with Age?
A common question among women experiencing PMDD is whether it worsens with age. The answer varies:
PMDD symptoms may intensify during perimenopause due to erratic hormone levels. This transitional phase before menopause is marked by fluctuating estrogen and progesterone levels, which can exacerbate mood and physical symptoms.
As women age, they may become more sensitive to hormonal changes, amplifying PMDD symptoms.
Over time, life stressors and the burden of managing symptoms may contribute to a perception of worsening PMDD.
While some women experience worsening symptoms, others find relief as their menstrual cycles become less frequent approaching menopause.
Treatment for PMDD vs PMS
The management of PMS and PMDD focuses on alleviating symptoms and improving overall quality of life. Treatment approaches include lifestyle changes, medications, and therapeutic interventions.
- Regular Exercise: Physical activity can reduce stress, improve mood, and ease physical symptoms.
- Healthy Diet: A balanced diet rich in whole grains, lean proteins, and vegetables can help manage symptoms. Reducing caffeine, alcohol, and sodium intake may also reduce bloating and irritability.
- Stress Management: Techniques like yoga, meditation, or deep-breathing exercises can alleviate emotional distress.
- Antidepressants (SSRIs): Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine or sertraline, are often the first line of treatment for PMDD. They can be taken continuously or only during the luteal phase.
- Hormonal Therapies: Birth control pills, particularly those that suppress ovulation, can regulate hormonal fluctuations.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Medications like ibuprofen can alleviate physical symptoms like cramps and headaches.
- Diuretics: These can reduce bloating and water retention.
- Cognitive Behavioral Therapy (CBT): CBT can help women develop coping strategies and manage the emotional symptoms of PMS and PMDD.
- Support Groups: Sharing experiences with others who understand these conditions can provide emotional relief and practical advice.
For women with severe PMDD unresponsive to other treatments, surgical interventions like oophorectomy (removal of ovaries) may be considered. However, this is a last resort option and requires careful consideration.
Help is Available at Discovery Institute
Navigating the challenges of PMDD vs PMS can be overwhelming, but support is available. At Discovery Institute, we offer comprehensive care for women struggling with PMDD and PMS. Their multidisciplinary team specializes in evidence-based treatments that address both physical and psychological symptoms, empowering women to reclaim control over their lives.
With proper diagnosis and tailored interventions, it is possible to manage symptoms effectively and improve quality of life. If you or someone you know is experiencing distressing premenstrual symptoms, reach out to us today for compassionate, expert care.
Dr. Joseph Ranieri D.O. earned his BS in Pharmacy at Temple University School of Pharmacy in 1981 and His Doctorate Degree in Osteopathic Medicine at the Philadelphia College of Osteopathic Medicine in 1991. He is Board Certified by the American Board of Family Medicine and a Diplomate of the American Board of Preventive Medicine Addiction Certification. Dr. Ranieri has lectured extensively to physicians, nurses, counselors and laypeople about the Disease of Addiction throughout New Jersey and Pennsylvania since 2012.
