Is it PMS or PMDD?

Many women feel different a week or so before they get their periods. They may get depressed, cry often, feel angry, get acne, have tender breasts , feel sleepy, have less energy, and feel heavy or bloated.

If you have these problems around the same time every month and they go away when your period starts, you likely have premenstraul syndrome  (PMS).

But if your PMS symptoms are so extreme that they stop you from doing the normal things that you do at work or at home, or if they affect the way that you relate to the people in your life, you may have premenstrual dysphoric disorder (PMDD), which is a more severe form of PMS.

 

Signs of PMS vs. PMDD

 In both PMDD and PMS, symptoms usually begin seven to 10 days before your period starts and continue for the first few days that you have your period. Both PMDD and PMS may also cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, at least one of these emotional and behavioral symptoms stands out:

• Sadness or hopelessness
• Anxiety or tension
• Extreme moodiness
• Marked irritability or anger

But PMS and PMDD are different in several ways. For example:

Depression . If you have PMS, you may feel depressed. But if you have PMDD, your sadness may be so extreme that you feel hopeless. You might even have thoughts about suicide 

Anxiety. You could feel anxious when you have PMS. But with PMDD, the anxiety  you feel is probably on a very different level. Some women with PMDD describe feeling very tense or on edge.

Mood swings. When you have PMS, you can get moody. You feel happy one minute and upset or angry the next, and you’re more likely to cry. But with PMDD, your mood swings will be much more severe. You may become very angry, and things are likely to irritate you that wouldn’t normally bother you. You might pick fights, even if this isn’t your usual style. You may also cry about things that wouldn’t usually upset you. You may feel out of control of your life.

Feelings about your life. If you have PMS and feel depressed, you may feel a little detached from your usual routine. But if you have PMDD, you’re likely to stop caring about your job, your hobbies, your friends and family -- anything that otherwise might put you in a good mood. 

**PMDD affects 3-8% of women in their reproductive years, with symptoms usually emerging during a woman’s twenties.These symptoms may worsen over time; for example, it has been observed that some women may experience worsening premenstrual symptoms as they enter into menopause.Less commonly, PMDD may begin during adolescence , with case reports suggesting that successful treatment options in adolescents with PMDD are similar to those used for adult women.

Causes

No one knows the exact causes of PMS or PMDD, but changes in hormone levels are thought to play a part. Genetics may also play a role. Depression  is also linked to PMS and PMDD, although one doesn’t cause the other to happen. The changes in hormone levels may make mood disorders like depression worse, though.

Treatments

  Treatments of PMDD is directed at preventing or minimizing symptoms and may include:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem, others) and sertraline (Zoloft), may reduce symptoms such as emotional symptoms, fatigue, food cravings and sleep problems. You can reduce symptoms of PMDD by taking SSRIs all month or only in the interval between ovulation and the start of your period.
• Birth control pills. Taking birth control pills with no pill-free interval or with a shortened pill-free interval may reduce PMS and PMDD symptoms for some women.
• Nutritional supplements. Consuming 1,200 milligrams of dietary and supplemental calcium daily may possibly reduce symptoms of PMS and PMDD in some women. Vitamin B-6, magnesium and L-tryptophan also may help, but talk with your doctor for advice before taking any supplements.
• Herbal remedies. Some research suggests that chasteberry (Vitex agnus-castus) may possibly reduce irritability, mood swings, breast tenderness, swelling, cramps and food cravings associated with PMDD, but more research is needed. The Food and Drug Administration doesn't regulate herbal supplements, so talk with your doctor before trying one.
• Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Cutting back caffeine, avoiding alcohol and stopping smoking may ease symptoms, too. Getting enough sleep and using relaxation techniques, such as mindfulness, meditation and yoga, also may help. Avoid stressful and emotional triggers, such as arguments over financial issues or relationship problems, whenever possible.

***Review your symptoms with your doctor. A thorough medical evaluation may determine if symptoms are due to PMDD or some other condition. If you're diagnosed with PMDD, your doctor can recommend specific treatments to help minimize symptoms.