Do I Have PMS, or Is This PMDD?

Many women feel different a week or so before they get their periods. They may get depressed, cry often, feel angry, get acne, have tender breasts, feel sleepy, have less energy, and feel heavy or bloated.

If you have these problems around the same time every month and they go away when your period starts, you likely have premenstrual syndrome (PMS).

But if your PMS symptoms are so extreme that they stop you from doing the normal things that you do at work or at home, or if they affect the way that you relate to the people in your life, you may have premenstrual dysphoric disorder (PMDD), which is a more severe form of PMS.

Signs of PMS vs. PMDD

Up to 75% of women who have their periods may have mild PMS, but PMDD is much less common. It affects only between 3% and 8% of women. Women with mild PMS may not need a doctor’s help to cope with the symptoms. But women who have PMDD might need to talk to their doctor about ways to improve their issues.

At first glance, PMS and PMDD may seem to be the same because they have many of the same symptoms, including:

But PMS and PMDD are different in several ways. For example:

Depression. If you have PMS, you may feel depressed. But if you have PMDD, your sadness may be so extreme that you feel hopeless. You might even have thoughts about suicide.

Anxiety. You could feel anxious when you have PMS. But with PMDD, the anxiety you feel is probably on a very different level. Some women with PMDD describe feeling very tense or on edge.

Mood swings. When you have PMS, you can get moody. You feel happy one minute and upset or angry the next, and you’re more likely to cry. But with PMDD, your mood swings will be much more severe. You may become very angry, and things are likely to irritate you that wouldn’t normally bother you. You might pick fights, even if this isn’t your usual style. You may also cry about things that wouldn’t usually upset you. You may feel out of control of your life.

Feelings about your life. If you have PMS and feel depressed, you may feel a little detached from your usual routine. But if you have PMDD, you’re likely to stop caring about your job, your hobbies, your friends and family -- anything that otherwise might put you in a good mood.

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Causes

No one knows the exact causes of PMS or PMDD, but changes in hormone levels are thought to play a part. Genetics may also play a role. Depression is also linked to PMS and PMDD, although one doesn’t cause the other to happen. The changes in hormone levels may make mood disorders like depression worse, though.

Diagnosis

There are no formal tests to diagnose you with PMS or PMDD. A doctor, usually a gynecologist, can tell you whether you have PMS or PMDD after you discuss your symptoms.

She might ask you to fill out a chart for several weeks to confirm that the timing of your symptoms fits the profile of PMS or PMDD. Your symptoms need to be present 1 to 2 weeks before your period, then go away when you get your period for at least two menstrual cycles

Treatments

Whether you need treatment depends upon how mild or severe your condition is.

Some women with mild PMS can manage their symptoms with lifestyle changes, including exercise, a change in diet, quality sleep, and reduction in stress. Others may need over-the-counter medicine, or drugs their doctors prescribe.

If you have PMDD, these lifestyle changes may help somewhat, but your doctor will likely prescribe you medication, as well. There are two types of drugs that have been shown to help reduce symptoms in women with PMDD:

SSRI antidepressants. Because PMDD affects mood and can cause depression, doctors often prescribe selective serotonin reuptake inhibitors (SSRIs). These are antidepressant that can affect a chemical in your brain called serotonin. Taking these can likely to help relieve many PMDD symptoms that affect your mood.

Birth control pills. When you take birth control pills, you don’t ovulate (release an egg from your ovary each month), which will likely reduce the symptoms of PMDD. Birth control pills often relieve physical symptoms like aches and pains, as well. One such pill, drospirenone and ethinyl estradiol (Yaz) is FDA-approved to help with PMDD.

WebMD Medical Reference Reviewed by Renee A. Alli, MD on November 10, 2018

Sources

SOURCES:

Office On Women’s Health: “Premenstrual syndrome (PMS) fact sheet.”

UpToDate: “Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the basics).”

American College of Obstetricians and Gynecologists: “Premenstrual syndrome (PMS).”

Mayo Clinic: “What’s the difference between premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS)?”

Bhatia, SC and Bhatia, SK. American Family Physician, October 2002.

American Academy of Family Physicians: “Premenstrual dysphoric disorder.”

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