Premenstrual Dysphoric Disorder: Different from PMS

Women are used to living with emotional turmoil every month during their periods. Crying often, irritability, acne, bloating, and feeling low are normal symptoms women go through before their periods are about to arrive. Such emotional and physical discomfort is technically termed Premenstrual Syndrome or PMS. Broadly, PMS is the reason why no one is excitedly looking forward to that time of the month. With all its physical and emotional symptoms, it can make the days before your periods disgusting and unpleasant. 

This is one thing, but there’s more. 

PMS is common but there is a severe form of this condition that just 3-8% of women go through in their reproductive years. Known as Premenstrual Dysphoric Disorder or PMDD, this debilitating condition makes the days before periods so stressful that it affects the overall well-being of women and gets in the way of doing even simple routine things at home or work.

 But what creates a bar between these two? Let’s have a look. 

What is Premenstrual Dysphoric Disorder (PMDD)?

PMDD is a severe and chronic form of PMS caused due to hormonal alterations. 

Despite the lack of concrete explanations for PMS and PMDD, contemporary research implies that the occurrence of symptoms is linked to the production and variation of hormones such as estrogen, allopregnanolone, and progesterone. 

Research further reveals the role of central neurotransmitters like Gamma-aminobutyric acid, Serotonin, Glutamate, and Beta Endorphins in causing PMDD. 

As per John Hopkins Medicine, a lack of Serotonin induced by hormonal fluctuations affects blood flow and induces the symptoms of PMDD. 

What Differentiates PMDD from PMS? 

While the symptoms and signs of both Premenstrual Dysphoric Disorder and Premenstrual Syndrome coincide, they are not the same. PMDD requires medical evaluation and treatment. 

Symptoms of PMS

The symptoms associated with PMS aren’t the same for every woman. The degree differs with age and even changes for women of the same age group. However, the PMS-related symptoms generally disappear within four to five days after the start of the menstrual cycle. 

Physical symptoms 

  • Cramps 
  • Headaches 
  • Acne 
  • Breast tenderness 
  • Fatigue 
  • Weight gain 
  • Abdominal and body pain

Emotional symptoms 

  • Extreme moodiness and irritability 
  • Food cravings 
  • Anxiety and stress 
  • Social withdrawal 
  • Poor concentration 
  • Changes in sexual desire 
  • Anger outbursts and frustration 
  • Insomnia 

These are some general signs that can vary from ‘slight’ to so’ intense’ that it sets things off. But Premenstrual syndrome or PMS won’t very severely affect your day-to-day activities. Women with mild PMS may not need to visit a doctor since they become accustomed to these changes occurring every month. It can be prevented through medications and some lifestyle changes, including prevention of smoking, regular exercise, and a protein-rich diet. 

Symptoms of PMDD 

The premenstrual dysphoric disorder is a listed depressive disorder under the DSM-5-TR Diagnostic and Statistical Manual of Mental Disorders. PMDD is often marked by mood, behavior, and somatic changes in females. PMDD is an advanced level of PMS. Like PMS, PMDD too has similar signs and symptoms

Physical Symptoms

  • Breast tenderness
  • Headaches 
  • Swelling
  • Bloating
  • Low energy
  • Muscle aches
  • Increased sensitivity
  • Overeating

Emotional Symptoms

  • Crying spells
  • Anxiety 
  • Severe Mood Changes
  • Subjective sense of overwhelm
  • Marked Anger 
  • Interpersonal conflicts
  • Hypersomnia 
  • Insomnia

PMS tends to have more physical symptoms while PMDD is majorly associated with mental health disorders. In PMDD, however, the changes in mood and emotional symptoms are significantly more drastic, severe, and harder to manage. 

For example, if you have PMS, you might get stressed and anxious about small events but PMDD makes you feel like you’re on an emotional rollercoaster: self-doubt, depressing and suicidal thoughts, hopelessness, and loss of interest in normal activities. It affects your relationship with others, work responsibility, and social activities making you feel extremely panicky and uncomfortable. 

  • During the menstrual cycle, tissues become more sensitive and this influences mood. 
  • Past traumas, mental health issues, and exposure to stress are also related to PMDD. 
  • It is important to note that the symptoms of PMDD would start before 5-6 days of your period and would stay only till some days after it. 
  • A person feeling acute symptoms like depression for the whole month should be checked for chronic depression and not PMDD. 

When to reach out to a doctor? 

PMDD, distinct from PMS, is not a condition to be underestimated. It will be better that you track the symptoms yourself using free applications or if not, consult a doctor for the same when you feel that the symptoms are affecting your lifestyle severely and are making days terrible for you. 

Treatment for Premenstrual Dysphoric Disorder

While PMS can get better with lifestyle, fitness, and dietary changes oneself, PMDD requires proper treatment from a gynecologist or a mental health provider. Here are some common techniques suggested to help women with PMDD:

Cognitive-behavioral therapy: A talk therapy aimed to refrain you from the emotional imbalances and hopelessness experienced due to PMDD. Patients are asked to maintain a symptom diary that records the frequency and magnitude of the symptoms experienced. 

SSRIs: Antidepressant medications like selective serotonin reuptake inhibitors have proven to be an excellent option in reducing depression and fatigue. These pills can be taken throughout your cycle or only on days after ovulation. The doses are changed following the improvements shown.

Birth control pills: This is like treating the trouble at the source to avoid any mess since these pills stop ovulation itself and women only experience occasional bleeding. Many find the trade-off of intaking drospirenone worth it to ease the symptoms of PMS and PMDD. However, this is not actively recommended. 

Other habits at an individual level too can help: Exercise, acupuncture, dietary supplements, Vitamin B6 tablets, practicing Page 2 of 3 positivity, etc. 

Conclusion: It is essential to acknowledge the changes and be able to differentiate between PMS and PMDD. Timely medical treatment, self-care, healthy food habits, and a proper exercise routine are critical to minimize the effects of PMDD. Further, using a period pain relief device can be helpful in mitigating the effects of both–Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD).

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