Premenstrual Dysphoric Disorder (PMDD): What Is It And How Is It Different From PMS?
- Megon Champion
- Jan 22
- 5 min read
Between 3% to 8% of women and people assigned women at birth do not experience the normal symptoms associated with Premenstrual Syndrome (PMS). These people have something called Premenstrual Dysphoric Disorder (sometimes known as premenstrual depression). A severe form of PMS, this combination of symptoms can affect their ability to function.
What is Premenstrual Dysphoric Disorder?
Simply put PMDD is a more severe form of PMS. However, the main difference is that PMDD is classified as a depressive disorder. The symptoms of PMDD only occur at the luteal phase of the menstrual cycle, the rest of the month the person does not suffer from any symptoms especially those of depression.
Symptoms Of PMDD And PMS. How They Are Different And How They Are The Same.
Because PMDD is a more severe form of PMS some of the symptoms overlap. However, PMDD does have some distinct symptoms and these are the symptoms that often affect women and people assigned female at birth with their ability to function.
Symptoms of PMS and PMDD that overlap:
Bloating.
Tender breasts.
Headaches.
Muscles/joint aches or pains.
Fatigue.
Trouble sleeping.
Food cravings.
Mood changes.
Symptoms that are exclusive to PMDD:
Feeling upset or tearful. (Feeling like people are rejecting you.)
Lack of energy.
Less interest in activities you normally enjoy.
Feeling hopeless.
Feeling angry/irritable.
Feeling tense or on edge.
Feeling overwhelmed or out of control.
Difficulty concentrating.
Trouble sleeping.
Food craving/binge eating.
Feelings of tension or anxiety.
Suicidal thoughts.
What Causes PMDD?
Knowing the symptoms of PMDD is a great place to start. However, knowing what causes PMDD can also help. Unfortunately, this is where we seem to hit a snag. Doctors are not sure what causes Premenstrual Dysphoric Disorder. It may be an abnormal reaction to hormone changes that affect the levels of serotonin released. Serotonin controls mood and can also cause physical symptoms.
Who Is At Risk Of PMDD?
Whilst we don’t know what causes PMDD, there may be some reasons as to why some people are more at risk of getting PMDD.
Genetics: increased sensitivity to changes in hormone levels may be caused by variations in your genes.
Trauma and Stress: PMDD may be linked to stressful and traumatic past events. Stress can also make symptoms worse.
Pre-existing depression or Anxiety Disorders.
Smoking: this may affect hormone sensitivity.
Getting A Diagnosis.
Unfortunately getting a diagnosis is a long process that can take anywhere between 3 months to a year. In the meantime make sure you surround yourself with a strong support system especially if you have suicidal thoughts.
There are a few steps that are followed to get a formal premenstrual dysphoric disorder, and they are as follows:
Blood Tests: there is no outright blood test to confirm PMDD, however, your doctor may run some blood tests to rule out any other medical conditions that may be causing the symptoms.
Family History: check to see if there is a family history of PMDD.
Medical History: check for mental or physical health conditions that may affect the diagnosis.
Lifestyle Questionnaire: this will check things like smoking habits, drinking habits, your general health etc., that may affect your diagnosis.
Period Tracker: this is the longest part of the diagnosis process as your doctor can ask for a period diary for anywhere from 3 months to 12 months. They will be looking for 3 to 5 of the symptoms consistently every month over the period.
Treatment Of Premenstrual Dysphoric Disorder.
There have been two main forms of treatment for PMDD that doctors have used. These are SSRIs and birth control pills. However, as we are slowly learning more about the condition, we are slowly adding more treatment options to the mix. Let's look at a few of them here.
SSRIs (selective serotonin reuptake inhibitors): these are usually used as antidepressants. They have a quick onset of action so a lot of doctors find them successful in the treatment of PMDD. Some doctors will only have you take them during the luteal phase.
SNRIs (serotonin and norepinephrine reuptake inhibitors): these are also a type of antidepressant. However, your doctor is more likely to offer an SSRI.
Combined Oral Contraceptives (the pill): taking the pill can control or stop your period. Without the drop in estrogen, there is evidence that the pill can help with the symptoms of PMDD. However, the pill comes in a variety of different hormone combinations, and therefore picking the right pill for you can take time.
Painkillers/Anti-inflammatory Drugs: your doctor can recommend which of these drugs can help with the physical symptoms of PMDD, such as muscle pains and headaches.
GnRH Analogue Injections (Gonadotropin-releasing hormone): these are medications that bring on temporary menopause. Because of the side effects of this medication, it is usually only offered for 6 months and only if no other options have worked. It is also prescribed with hormone replacement therapy (HRT) to prevent bone density loss.
Surgery: If all of the above has not worked and your case is extremely severe, there is the option of surgery. This would require you to have your womb, ovaries and fallopian tubes. This would stop your monthly cycle completely and therefore stop the symptoms of PMDD.
Other than medical treatment there are supportive treatments to help with the symptoms of PMDD.
Vitamins and Supplements: there is some evidence that these can help with the symptoms of PMDD. (Please check with your doctor before taking any supplements.)
Calcium carbonate: may help to reduce the physical and psychological symptoms.
Vitamin B6: may help to relieve stress symptoms.
Agnus castus (a herb known as chasteberry): may help reduce symptoms of irritability, anger, headaches and breast pain. It's not recommended if you're trying to get pregnant or are breastfeeding.
Regular Exercise: some evidence shows that regular exercise can help relieve the pain.
Meditation And Stress Exercises: meditation and breathing exercises have been shown to help with the symptoms of irritability, stress, tension and anxiety.
Talk Therapy: approaching a therapist and having regular sessions can help with feelings of hopelessness and suicidal thoughts.
Conclusion
Premenstrual Dysphoric Disorder (PMDD) is different from most mood disorders and premenstrual conditions because of the length of the symptoms and when they start. The treatment needs a team of carers that includes both doctors and therapists. And although getting a diagnosis can take a long time, it is worth preserving so that you can get the support you need.
If you feel suicidal at any point contact your care team immediately or How to Contact SADAG
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