Chances are, you’ve been there. That uncomfortable and cranky feeling, often accompanied by bloating, pimples, an aching back, sore boobs and more not-fun-at-all symptoms that usually creep up on you ahead of your period. Also known as PMS or premenstrual syndrome, it’s estimated to affect more than half of women, or possibly even as many as 7 percent, says Catherine Monk, director of research in the Women's Program in the Department of Psychiatry at NewYork-Presbyterian/Columbia University Irving Medical Center. But what happens when it’s a bit more? Not to be confused with PMS, PMDD, or premenstrual dysphoric disorder, is a very extreme form of PMS, affecting only 3 percent to 5 percent of women. Though sometimes similar in symptoms, the two disorders vary in intensity—and it’s really important to know the difference.
What Is PMS?
Monk explains, “Premenstrual syndrome is defined by its name, affecting women 10 to 14 days prior to their periods, in the luteal phase after ovulation.” Typically, it involves “both psychological and somatic/physical symptoms such as irritability, sadness, moodiness, bloating, breast tenderness, back aches, constipation, sleep disturbances, and altered food preferences and eating habits.” If you can relate, you’re not alone. As many as 3 out of 4 women experience PMS, which is often assuaged by the time your period starts.
Affecting a much smaller percentage of menstruating women, PMDD is extreme and needs to be diagnosed by a medical professional.
What Is PMDD?
Monk says, “To be diagnosed with this disorder, women experience marked moodiness and irritability, depression, or anxiety,” as well as some of the following:
- A decreased interest in activities
- Difficulty concentrating and low energy
- A sense of being out of control
- And the somatic symptoms of PMS
Unlike with PMS, Monk clarifies that a PMDD-affected woman’s ability to function is really compromised. “These symptoms must be present during the last week before the onset of menstruation and start to improve a few days after the woman’s period arrives,” she explains. Moreoever, the way a woman feels once her period starts should be significantly different than how she felt before, and symptoms of PMDD should be present during the majority of her cycles.
It is extremely important to note too, that PMDD is considered a depressive disorder (or mood disorder) while PMS is not.
Know the Difference
Though they may sound similar, knowing the difference between these two disorders is paramount. Monk says that PMDD “can so undermine the quality of a woman’s life, yet it is treatable.”
At the same time, she adds, “it is important to know the difference because the milder syndrome, while inconvenient and uncomfortable, is not a frank disorder; for some women, this is reassuring, Women with PMS, “do not have a health problem per se, and instead their bodies and brains are showing the signs of experiencing changes in hormones, what women for millennia have gone through.”
Treatments for both PMS and PMDD tend to overlap, but Monk stresses that the differences should be emphasized. “Regular exercise with an aim to continue one’s regimen throughout the PMS or PMDD period can alleviate symptoms—even if it is one of the hardest times to get motivated to go to the gym.” Relaxation techniques like mediation and breathing exercises might help, as might cutting out excess salt (chocolate and caffeine too, though Monk points out it may be hard due to cravings) to reduce bloating and swelling. Also, she says that some patients have found acupuncture to be effective.
Additionally, “birth control pills, especially ones that shorten or eliminate the typical ‘week off’ (during which women get their period)—in essence, putting the pause button on typically cycling—reduces both PMS and PMDD,” says Monk. “Some data suggests the most effective birth control pill is one that contains drospirenone, though it comes with a slightly increased risk of blood clots compared to birth control pills containing other amounts of hormones." Importantly though, she notes the risk of clotting is overall low in healthy women.
In managing the mood and emotional aspects of both PMS and PMDD, cognitive behavioral therapy is also effective by “reframing the experience, reducing negative thoughts and providing coping strategies.”
Regarding medications, serotonin reuptake inhibitors that are used to treat depression and anxiety can be very useful, according Monk. “One way women take SRIs to treat PMS or PMDD is to take it only after ovulation, those 14 or so days before getting one’s period when the symptoms are there and then to stop when menstruation begins,” she explains. While this is known as the “luteal-phase-only” treatment, patients may also opt to take it every day. Though, Monk stresses, “it is important to note that SRIs come with side effects, including ones that can matter a lot to the quality of life for women during their reproductive years,” including lack of sexual desire and daytime sleepiness.
If you’re experiencing what you think might be PMDD, it’s imperative to speak to your physician. In fact, Monk recommends discussing treatment options with more than one provider while reading up on your diagnosis. “There are different ways to treat PMDD and women should be supported in exploring the different options and viewed as informed health care recipients in the decision of which course to try first,” she says.
"We understand more than we use to about the underlying biology of PMS and PMDD—atypical response to normal fluctuations in hormones, an altered sensitivity of certain brain receptors to allopregnanolone (a neurosteroid), differences in serotonin regulation and stress responses—but we still do not know enough." She says that increased funding for women’s health (because these are women only disorders), ”could help us gain greater knowledge and improve treatments, and maybe even get us to know who is at risk for PMS and PMDD and thereby develop preventive interventions.”