What is PMDD?

Premenstrual Syndrome (PMS) is a familiar term for many who describe the range of emotional and physical symptoms experienced in the lead-up to their menstrual cycle. But for some, the symptoms are far more intense and debilitating, indicating a condition known as Premenstrual Dysphoric Disorder (PMDD). PMDD is not just "bad PMS"; it is a severe, chronic condition that requires attention and intervention. PMDD affects approximately 3-8% of women/people with uteruses of reproductive age. It is characterized by extreme mood disturbances and physical symptoms that significantly disrupt daily life, work, and relationships. Unlike PMS, the emotional symptoms of PMDD are so severe that they can lead to distress and impairment.

Is it PMS, or is it PMDD?

Both PMS and PMDD symptoms typically arise in the luteal phase of the menstrual cycle, after ovulation, and before menstruation begins. While symptoms are similar, there are significant differences between the intensity of PMS symptoms and PMDD symptoms. See below for a comparison.

Emotional/Behavioral Symptoms

PMS
+Mood Swings: Mild to moderate emotional changes.
+Irritability: Increased irritability but usually manageable.
+Depression: Mild depressive symptoms, typically short-lived.
+Anxiety: Mild to moderate anxiety.
+Difficulty Concentrating: Some trouble focusing, but not severe.
+Fatigue: General tiredness or low energy.
+Changes in Appetite: Mild changes, such as craving certain foods.
+Sleep Problems: Mild insomnia or oversleeping.

PMDD
+Severe Mood Swings: Intense feelings of sadness, hopelessness, or even suicidal thoughts.
+Extreme Irritability or Anger: Significant conflicts with others, feeling out of control.
+Severe Depression: Overwhelming feelings of sadness or despair.
+Intense Anxiety or Tension: Extreme feelings of being on edge or nervous.
+Panic Attacks: Sudden, overwhelming bouts of fear and anxiety.
+Difficulty Concentrating: Severe trouble focusing or staying on task.
+Extreme Fatigue: Debilitating tiredness, impacting daily functioning.
+Significant Changes in Appetite: Either overeating or losing interest in food significantly.
+Severe Sleep Problems: Difficulty falling or staying asleep or needing much more sleep than usual.
+Feelings of Being Overwhelmed: A sense of losing control over emotions or life.

Physical Symptoms

PMS
+Bloating: Mild to moderate swelling in the abdomen.
+Breast Tenderness: Mild soreness or swelling in the breasts.
+Headaches: Occasional headaches, typically mild.
+Joint or Muscle Pain: General aches and pains, usually manageable.
+Weight Gain: Mild, temporary increase in weight due to water retention.

PMDD
+Severe Bloating: Significant abdominal swelling.
+Intense Breast Tenderness: Severe soreness or swelling in the breasts.
+Migraines: Severe headaches or migraines.
+Severe Joint or Muscle Pain: Intense aches and pains throughout the body.
+Noticeable Weight Gain: Significant and noticeable increase in weight due to water retention.

Impact on Daily Life

PMS
+Symptoms are generally mild to moderate and do not severely impact daily functioning.
+Emotional and physical symptoms can cause discomfort but are usually manageable with lifestyle adjustments, rest, support, etc.

PMDD
+Symptoms are severe and can significantly disrupt daily life, work, and relationships.
+The emotional symptoms, in particular, can lead to severe distress and impairment, sometimes requiring medical and/or mental health intervention.

I think I could have PMDD. What do I do?

Identifying and managing Premenstrual Dysphoric Disorder (PMDD) begins with accurately tracking your menstrual cycle and symptoms. Understanding the timing and pattern of your symptoms can help distinguish PMDD from other conditions and help you seek appropriate treatment. Here’s a step-by-step guide to tracking your cycle and symptoms effectively.

1- Begin by understanding your menstrual cycle: While the average cycle has been coined to last 28 days, menstrual cycles typically range from 21 days to 35 days. The follicular phase starts on the first day of menstruation and lasts until ovulation. The luteal phase begins after ovulation and lasts until the start of the next period. PMDD symptoms typically occur during the luteal phase and subside a few days after menstruation begins.

2- Start tracking your menstrual cycles: Begin by noting the first day of your period. Continue to record the length of your period and the start of your next cycle. Over time, you’ll identify the average length of your cycle, which helps predict ovulation and the luteal phase.
+In the wake of the overturning of Roe v. Wade, using an app to track your cycle may not appeal to everyone. Read this article published by MIT to help you make the tracking choice that makes the most sense for you.

3- Log your daily mood and physical symptoms: Learn to recognize mood, behavioral, and physical symptoms/changes daily. Log this information when you are both on and off your period.

4- Track your cycle and symptoms consistently for at least three months to identify patterns: After tracking for at least three months, review your records to identify patterns. Look for the timing and severity of symptoms throughout your menstrual cycle. Remember that indicators of PMDD include:
+Symptoms occurring during the luteal phase (typically 1-2 weeks before your period).
+Symptoms significantly improving or disappearing a few days after menstruation begins.
+Emotional symptoms that are severe enough to interfere with daily life.

Treatment for PMDD

If you suspect you have PMDD, it’s crucial to seek help from a healthcare provider. Diagnosis usually involves tracking symptoms over several menstrual cycles and ruling out other conditions. Common treatment approaches for PMDD include stress management, therapy, medication, nutritional supplements, and support groups. Please consult with a medical and/or mental health professional to explore the treatment options that are most appropriate for you. Remember that everybody is different; finding the right balance might take time. Do not give up!

Period Equity

I want to end this blog entry by recognizing that there are bodies in this world that do not have equitable access to menstrual and other personal hygiene products. If you would like to help the women in Gaza, Sudan, and other countries negatively impacted by war, genocide, and other acts of political violence, click on the respective links.