Is it PMS or PMDD?

Gary Brunvoll, DO

For most women, the symptoms of PMS, or premenstrual syndrome, are all too familiar. But have you ever heard of PMDD? 

PMDD, or premenstrual dysphoric disorder, is similar to PMS in some ways, but more severe. Because it can sometimes be difficult to know whether you’re experiencing PMS or PMDD, we’d like to offer some insight about the condition.

Gary Brunvoll, DO, OB-GYN at Erlanger Center for Women, offers answers to some common questions about PMDD:

Q: What is PMDD?

A: Premenstrual dysphoric disorder is a condition in which a woman experiences severe symptoms in the five to 10 days or so before her period begins. Symptoms may include depression, irritability, extreme mood changes, hopelessness, anxiety and tension, among others.

While researchers aren’t quite certain what triggers PMDD, symptoms usually begin as hormone levels start to fall following ovulation. There’s some thought that symptoms occur as serotonin levels in the brain fluctuate during the menstrual cycle.

Q: How is PMDD different than PMS?

A: The two conditions have similar symptoms and both are related to the menstrual cycle. But PMDD symptoms are much more severe than those associated with PMS.

A few of the symptoms are mentioned above, but there are many different symptoms that may be caused by PMDD, including:

  • Extreme, noticeable anger
  • Decreased interest in usually enjoyable activities
  • Fatigue
  • Change in appetite
  • Sleep problems
  • Tension or irritability
  • Mood swings
  • Sadness or despair
  • Panic attacks
  • Trouble concentrating
  • Cramps
  • Bloating
  • Breast tenderness
  • Headaches

Many of these symptoms are also common with PMS, but when a woman has PMDD, the symptoms are more serious and obvious. In most cases, the mood-related symptoms are intense enough to disrupt work and cause difficulties in relationships.

Of the two conditions, PMS is much more common, affecting one in three women, while PMDD occurs in only around 5 percent of menstruating women.

Q: How is PMDD diagnosed and treated?

A: If a doctor suspects you have PMDD, he or she will thoroughly review your health history and perform a physical exam. During the exam, your doctor will talk through and rule out other potential causes for your symptoms, including underlying medical conditions like endometriosis or fibroids.

You may also be asked to keep a diary of your symptoms over time to share with your doctor.

The condition is diagnosed if you have five or more of the symptoms outlined above, including at least one emotional or behavioral symptom.

If a woman is diagnosed with PMDD, treatment may come in two different types — aimed at either preventing or minimizing symptoms. Depending on a woman’s individual symptoms and health needs, treatment may include:

  • Antidepressants from a class called “selective serotonin reuptake inhibitors” or SSRIs. These act by changing serotonin levels in the brain. Since dips in serotonin levels seem to contribute to PMDD, this can help minimize the condition.
  • Birth control pills taken continuously or with a shortened pill-free interval. Because PMDD is thought to be triggered by hormonal fluctuations during the menstrual cycle, taking oral contraceptives in a way that suppresses ovulation and a normal period may help some women find relief.
  • Over-the-counter or prescription pain relievers. These can help women find relief from the physical symptoms of PMDD, such as headaches or cramps. Be sure to talk with a doctor about which medication might work best for your needs and with any other current medications.
  • Nutritional supplements. Some research has found that getting at least 1,200 milligrams of calcium daily can help reduce symptoms. Vitamin B-6 and magnesium have also been shown to help in some cases.
  • Lifestyle changes. Taking good care of your body can help limit or eliminate some symptoms of PMDD. Exercise regularly, limit alcohol consumption, don’t smoke, cut back on caffeine, get plenty of sleep and limit stress as much as possible.

Your doctor can help you determine what treatment or combination of treatment methods will work best to alleviate your symptoms.

If you’re experiencing period-related symptoms that are disrupting your quality of life, talk with your OB-GYN about your symptoms. At Erlanger Center for Women, Dr. Brunvoll and other providers offer a full spectrum of medical care with women’s unique needs in mind. Call (423) 648-6020 to schedule an appointment.