PMDD vs PMS: What’s the Difference?

Wondering if you’re dealing with PMDD or PMS? One is inconvenient, the other is life-altering. Learn how to tell the difference, manage symptoms, and find the right treatment.

Hormonal changes before menstruation can cause a range of physical, emotional, and behavioral symptoms. And while many people experience premenstrual syndrome (PMS), a smaller percentage suffer from premenstrual dysphoric disorder (PMDD)—a more severe and debilitating condition. Understanding the distinctions between these two premenstrual disorders can help in managing PMS symptoms and seeking appropriate treatment.

What is premenstrual syndrome (PMS)?

PMS refers to a group of symptoms that occur in the luteal phase of the menstrual cycle, typically resolving after menstruation begins. These premenstrual symptoms range from mild PMS to moderate and do not significantly disrupt daily life. Common PMS symptoms include:

• Mood swings and irritability
• Fatigue and sleep disturbances
• Bloating and breast tenderness
• Food cravings
• Headaches and muscle aches

What is premenstrual dysphoric disorder (PMDD)?

PMDD is a severe form of PMS that can significantly impact mental health, daily life, work, and relationships. It is classified as a mental disorder and requires medical intervention. In fact, it is often misdiagnosed as a mood disorder due to its severe emotional symptoms. Common PMDD symptoms include:

• Severe mood changes, including depression and anxiety
• Suicidal thoughts or feelings of hopelessness
• Intense irritability and anger
• Extreme fatigue and insomnia
• Severe physical discomfort, including body pain

PMS vs. PMDD: Key differences

Both PMS and PMDD affect individuals in the days or weeks leading up to their menstrual cycle, but they differ significantly in terms of severity, symptoms, and treatment. While PMS is common and often manageable, PMDD is a more serious and debilitating condition that can severely impact daily functioning. Here are some of the key differences between these conditions:

Severity 

PMS is generally characterized by mild to moderate symptoms that are manageable for most people. These symptoms typically include mood swings and physical discomfort, but they do not generally interfere with daily activities.

PMDD, on the other hand, is much more severe. The symptoms can be debilitating, significantly impacting a person’s ability to function in daily life. Individuals with PMDD often experience intense emotional and physical symptoms that can interfere with work, relationships, and other responsibilities.

Mood 

PMS typically involves mood swings and irritability, which can be uncomfortable but are usually not severe. These mood changes may include feelings of frustration or sadness, but they are usually short-lived and subside once menstruation begins.

PMDD is associated with much more severe mood disturbances. It can include extreme depression, anxiety, irritability, and even suicidal ideation. The intensity of these symptoms can be overwhelming and may persist throughout the cycle or worsen in the days leading up to menstruation.

Physical symptoms 

In PMS, physical symptoms are usually mild to moderate and may include bloating, fatigue, and headaches. These symptoms often improve once menstruation begins and are not typically incapacitating.

In PMDD, physical symptoms are far more severe. Individuals may experience debilitating fatigue, intense body pain, severe bloating, and insomnia. These physical symptoms can be exhausting and overwhelming, often requiring medical intervention to manage.

Length of condition 

PMS symptoms usually start a few days to a week before menstruation and end once menstruation begins. The condition is short-term and symptoms tend to resolve relatively quickly.

PMDD symptoms can persist for a longer period, extending beyond the typical premenstrual timeframe. For some, the symptoms can last for a significant part of the menstrual cycle, making it a chronic condition that requires ongoing management.

Diagnosis

PMS is diagnosed based on self-reported symptoms tracked over multiple menstrual cycles. There are no specific medical tests for PMS, but healthcare providers, including a family physician or primary care physician, may rule out underlying conditions such as thyroid disorders or anemia.

PMDD, however, is diagnosed clinically based on the criteria outlined in the DSM-5. This involves a thorough evaluation by a healthcare provider, who will assess the severity of the symptoms and their impact on daily life. This clinical diagnosis is necessary for determining appropriate treatment options, which may include medication or therapy.

What are the causes of PMS and PMDD?

Both PMS and PMDD are influenced by hormonal changes, but their causes differ in severity and complexity. Understanding these factors helps with diagnosis and treatment.

Causes of PMS

The primary cause of PMS is the fluctuation in hormones like estrogen and progesterone during the menstrual cycle. These hormonal shifts affect mood, physical well-being, and behavior, leading to symptoms such as irritability, bloating, and fatigue. Genetics may also play a role, as PMS tends to run in families. Additionally, lifestyle factors such as diet, exercise, and stress can worsen symptoms. Poor nutrition, stress, and lack of physical activity may intensify the discomfort associated with PMS. Neurotransmitter imbalances, particularly serotonin, also influence mood changes in PMS, with lower serotonin levels linked to irritability and depression-like symptoms.

Causes of PMDD

PMDD is thought to result from heightened sensitivity to hormonal changes, particularly fluctuations in estrogen and progesterone. Individuals with PMDD experience more severe reactions to these hormonal shifts, resulting in debilitating mood swings, fatigue, and physical discomfort. Neurotransmitter imbalances, especially with serotonin, also play a major role, as low serotonin levels are linked to severe mood disturbances. Genetic factors are significant, with a family history of PMDD increasing the likelihood of developing the disorder. Environmental factors, such as chronic stress, trauma, and poor nutrition, can exacerbate PMDD symptoms, making them more severe.

How to manage PMS?

Mild to severe PMS can often be managed through lifestyle changes and over-the-counter remedies:

• Regular exercise to reduce stress and improves mood
• Balanced nutrition, including adding in more magnesium, vitamin B6, iron, and calcium
• Stress management like mindfulness, yoga, and deep breathing exercises
• Over-the-counter medication, including NSAIDs for pain relief and diuretics for bloating
• Hormonal therapy, including contraceptive pills that regulate hormone fluctuations

How to treat PMDD?

PMDD typically requires a medical and therapeutic approach due to its severity. Here are some common treatment approaches:

• Antidepressants (SSRIs): First-line treatment for PMDD, addressing serotonin imbalances.
• Hormonal therapy: Birth control pills or GnRH agonists to stabilize hormone levels.
• Cognitive behavioral therapy (CBT): Helps manage emotional symptoms and stress.
• Dietary & holistic approaches: Anti-inflammatory diets, acupuncture, and mindfulness techniques may support symptom relief.

When to seek professional help

If PMS or PMDD symptoms interfere with daily life, seeking medical advice is essential. You should consult a healthcare provider, such as a family physician or primary care physician if you experience the following symptoms:

• Mood symptoms include suicidal thoughts or severe depression
• Symptoms persist beyond menstruation or worsen over time
• PMS or PMDD treatment options do not provide relief

How Charlie Health can help

If a premenstrual syndrome is affecting your mental health, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides mental health treatment for people dealing with serious mental health conditions, including anxiety, depression, trauma, and more. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With this kind of holistic online therapy, managing your mental health is possible. Fill out the form below or give us a call to start healing today.