For many women, the days leading up to their period come with a mix of physical and emotional symptoms. Premenstrual disorders, like premenstrual syndrome (PMS), are often behind these symptoms. PMS symptoms can often be easily managed, but premenstrual dysphoric disorder (PMDD), a much more severe subset of PMS, can be debilitating.
What is PMS?
Premenstrual syndrome, or PMS, refers to a range of physical, emotional, and behavioral symptoms that occur in the luteal phase of the menstrual cycle—the time between ovulation and the start of menstruation. PMS symptoms often include:
- Physical symptoms: Bloating, breast tenderness, headaches, and food cravings.
- Emotional symptoms: Mood swings, irritability, and mild depression.
These symptoms are associated with changing hormone levels, which means that for most women, they appear around a week before their period starts and subside once their menstrual period begins. Lifestyle changes like regular exercise, healthy eating, and stress management can often help alleviate PMS symptoms, and most women can easily find ways to cope during this time.
What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that affects about 5% of menstruating women. While the symptoms of PMDD overlap with PMS, they are far more intense and can significantly disrupt daily life. Women with PMDD may experience:
- Emotional symptoms: Severe mood swings, feelings of hopelessness, anxiety, and irritability.
- Behavioral symptoms: Difficulty concentrating, fatigue, or conflict with others.
- Physical symptoms: Intense bloating, joint or muscle pain, temporary weight gain, and severe breast tenderness.
The emotional symptoms of PMDD, like depressed mood, often have the most significant impact, interfering with relationships, work, and overall well-being.
What causes PMS and PMDD?
The exact cause of PMS and PMDD is not fully understood, but hormonal fluctuations during the menstrual cycle are believed to cause symptoms of PMS and PMDD. The luteal phase sees fluctuations in estrogen and progesterone, which can affect serotonin levels in the brain. Since serotonin helps regulate mood, these changes may explain the mood symptoms associated with both conditions.
For some women, these changes become even more pronounced during perimenopause, the time when the ovaries stop working and the body transitions to menopause. The decrease in progestin during this time can lead to amplified PMs or PMDD symptoms. Healthcare providers may recommend hormone replacement therapy (HRT) or other treatments to manage these shifts.
Other risk factors that may contribute to PMDD include:
- Genetics: A family history of mood disorders, severe PMS, or postpartum depression increases risk.
- Lifestyle factors: Smoking, poor diet, and high stress levels may exacerbate symptoms.
- Chemical sensitivity: Women with PMDD may have heightened sensitivity to hormonal changes.
Diagnosing PMDD
PMDD is diagnosed based on a woman’s symptom history and how these symptoms align with her menstrual cycle. To make a diagnosis, a Dr. Aliabadi will typically:
- Review your medical history and conduct a physical exam.
- Ask you to track symptoms over two or more menstrual cycles, noting the prevalence and severity of your premenstrual symptoms.
- Confirm the presence of at least five PMDD symptoms, including one related to mood changes, such as sadness or irritability.
This careful evaluation helps rule out other conditions, such as depression or anxiety, that may mimic PMDD.
Treatment Options for PMS and PMDD
While there’s no cure for PMDD, there are effective treatments that can help manage symptoms and improve quality of life. PMDD treatment options include:
1. Medications
- Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), like Prozac or Zoloft, can help with severe symptoms related to mood.
- Oral contraceptives: Birth control pills can regulate hormonal fluctuations and reduce symptoms.
- Pain relievers: Over-the-counter medications like ibuprofen can ease cramps and muscle pain.
2. Lifestyle changes
- Regular exercise: Physical activity can reduce stress and improve mental health.
- Dietary adjustments: Cutting back on caffeine, salt, and sugar while increasing intake of protein and vitamins can help reduce bloating and food cravings.
- Supplements: Magnesium, calcium, and vitamin B6 may be beneficial for headaches and fatigue.
3. Therapy and emotional support
- Counseling: Therapy can help women manage the emotional toll of PMDD and develop coping strategies.
- Stress management: Techniques like yoga, meditation, or mindfulness can alleviate anxiety and mood swings.
When should you seek help?
If PMS or PMDD symptoms are interfering with your life, it’s important to seek help. A symptom diary can help you and a healthcare provider identify patterns and develop a personalized treatment plan.
Concerned About PMS/PMDD side effects? Talk to Dr. Aliabadi
Dr. Aliabadi is an expert OB/GYN who is knowledgeable in all aspects of women’s health and well-being. Dr. Aliabadi and her caring, supportive staff are available to support you through menopause, childbirth, infertility, or even just routine gynecological care.
We invite you to establish care with Dr. Aliabadi. Please make an appointment online or call us at (844) 863-6700.
The practice of Dr. Thais Aliabadi and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
PMS and PMDD FAQs
What is the difference between premenstrual syndrome and premenstrual dysphoric disorder?
Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS. Physical symptoms of PMDD are similar to those of PMS, but women also have more severe mental health symptoms that can disrupt their daily lives. Additionally, PMS is more prevalent, affecting up to 75% of menstruating women. Alternatively, PMDD is believed to affect just 3-8%.
Is there medicine for PMDD?
Different kinds of medications may be used to treat PMDD, such as antidepressants, hormonal birth control, or Gonadotrophin-releasing hormone (GnRH) analogues. But, to date, fluoxetine and sertraline are the only SSRIs with U.S. Food and Drug Administration (FDA) approval for the treatment of PMDD.
What are the most common premenstrual dysphoric disorder symptoms?
The most common symptoms affect mental health and mood, including extreme sadness, hopelessness, irritability, or anger, increased anxiety, tension, and excessive sleeping or difficulty sleeping.
Sources
Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome). https://www.ncbi.nlm.nih.gov/books/NBK279045/
Premenstrual syndrome (PMS). https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome
Premenstrual Dysphoric Disorder: Epidemiology and Treatment. https://pmc.ncbi.nlm.nih.gov/articles/PMC4890701/
