Many women experience some type of pesky symptom or another before they get their period, like breast tenderness, cramps, or irritability.
But what happens if you feel severely depressed, anxious, or even suicidal when it’s almost time for your period every month? Experiencing these feelings could potentially be a sign of premenstrual dysphoric disorder (PMDD).
So what exactly is PMDD? Premenstrual dysphoric disorder is a condition that affects 3% to 8% of women (or people who were assigned female at birth) during their reproductive years. Those with PMDD may experience symptoms related to the disorder until they go through menopause.
PMDD results in monthly physical and mental symptoms correlating with the menstrual cycle. You can look at it as a severe form of PMS, or premenstrual syndrome, says Tahara DeBarrows, a licensed marriage and family therapist specializing in depression with Grow Therapy. PMS is more well-known and far more common than PMDD, affecting up to three out of four people with periods – but PMDD is more intense.
Here’s what you need to know about the signs, causes, and treatments for PMDD as well as how to tell it apart from other conditions.
What Are the Symptoms of PMDD?
Premenstrual dysphoric disorder causes a wide variety of symptoms that affect both mental health and physical health. PMDD symptoms – ranging from breast tenderness to suicidal thoughts – occur during the “luteal phase” of the menstrual cycle, says DeBarrows. The luteal phase comes after ovulation but before your period. More specifically, PMDD symptoms typically occur during the week before your period starts, DeBarrows says. For some people, the signs might start to show as early as 10 days before menstruation. Everyone is different, but it’s usually within the seven to ten-day window. Symptoms will subside within a few days maximum after you get your period.
Mental/emotional symptoms of PMDD include:
- Feeling sad
- Feeling angry or irritable
- Feeling tense or anxious
- Having suicidal thoughts
- Having mood swings
- Crying frequently
- Having panic attacks
- Losing interest in activities and things that you once enjoyed
- Having trouble staying focused or thinking
- Experiencing food cravings and binge eating
- Having difficulties with sleep
- Feeling like you are not in control
Physical symptoms of PMDD include:
- Bloating
- Breast tenderness
- Cramps
- Headaches
- Joint pain
- Muscle pain
- Tiredness
The specific diagnostic criteria for PMDD has been outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). In order to get a formal diagnosis of PMDD from a mental health professional, you need to exhibit at least five signs of PMDD during most menstrual cycles throughout the previous year. Additionally, other medical conditions that could possibly cause similar symptoms must be ruled out.
What Are the Causes of PMDD?
The exact cause of premenstrual dysphoric disorder is unknown, but there are a few factors that may play a role in the development of this condition. For example, DeBarrows says the changing levels of the hormones estrogen and progesterone could trigger symptoms. While anyone with a period experiences changes in levels of estrogen and progesterone throughout their cycle, people with PMDD might be more sensitive to these hormonal fluctuations.
Additionally, hormonal changes can affect serotonin, which is a neurotransmitter or chemical messenger that plays a vital role in mood. Recent research compared the brains of women with and without PMDD and found that there is a significant difference in brain activity related to serotonin between the two groups, which could contribute to symptoms like depressed mood during the luteal phase.
On top of this, some people are more likely than others to develop this disorder. DeBarrows says having a history of anxiety, depression, or trauma can make you more likely to develop PMDD. Having a family history of PMDD or even PMS can also increase your risk.
Ultimately, though, more research needs to be conducted to fully understand the exact cause or causes of PMDD.
What’s the Difference Between PMDD and PMS?
Premenstrual syndrome, more commonly known as PMS, is very common, affecting up to 75% of women. There is a lot of overlap between PMS symptoms and PMDD symptoms, which can make it confusing for someone who’s trying to determine which condition they might have.
Mental/emotional symptoms of PMS include:
- Feeling depressed
- Feeling anxious or tense
- Feeling angry or irritable
- Crying
- Mood swings
- Experiencing food cravings and changes to appetite
- Having difficulties sleeping
- Having trouble concentrating
- Withdrawing from social situations
- Changes to sex drive
Physical symptoms of PMS include:
- Acne
- Bloating
- Breast tenderness
- Cramps
- Changes to alcohol tolerance
- Constipation
- Diarrhea
- Headaches
- Water retention and weight gain
- Joint pain
- Muscle pain
- Tiredness
As you can see, many symptoms are the same for PMS and PMDD. However, the critical difference lies within the severity of symptoms and the impact that these symptoms have on your life.
“People experience PMS and PMDD symptoms during the week leading up to menses, and may have similar complaints,” says Julia Preamplume, a licensed clinical social worker specializing in depression with Grow Therapy. “However, when someone experiences PMDD, these symptoms cause significant distress and may interfere with work, school, relationships, and other important aspects of a person’s life.”
Furthermore, PMDD mood symptoms are typically more intense than PMS mood symptoms would be, with more extreme mood shifts, too, says DeBarrows. Also, suicidal ideation is only linked with PMDD, not PMS.
In a nutshell, PMS will likely cause less debilitating symptoms, and won’t cause too much interference with day-to-day functioning, unlike PMDD.
What’s the Difference Between PMDD and Depression?
When people talk about depression, they are usually talking about the mood disorder formally known as major depressive disorder (MDD). This disorder is linked to ongoing feelings of sadness and a loss of interest and joy in activities. Just as there are similarities between PMS and PMDD, there is also significant overlap between depression symptoms and PMDD symptoms.
Symptoms of major depressive disorder include:
- Depressed or sad mood
- Lack of interest and pleasure with activities or things you used to like
- Difficulty sleeping or sleeping excessively
- Appetite and weight changes
- Fatigue
- Moving or speaking slowly
- Experiencing guilt
- Feeling like you’re worthless
- Having trouble with concentration, decisions, and thinking
- Thinking about death
- Having suicidal thoughts
While both depression and PMDD can result in symptoms like sadness and suicidal thoughts, the main difference is the relation to the menstrual cycle. PMDD follows a predictable pattern where the depressive symptoms come on before the period and are relieved when menstruation starts or shortly after – but with depression, symptoms are not improved with menstruation, Preamplume says. This is because there are more contributing factors to depression than hormones.
Additionally, for a mental health professional to make a diagnosis of major depressive disorder, a person must have symptoms significant enough to impact their functioning for a duration of at least two weeks. Due to the hormonal and cyclical nature of PMDD, symptoms do not last more than two weeks consecutively, rather, the symptoms will last for a week or so each month.
How Can PMDD Affect Your Mental Health Overall?
Even when someone who has premenstrual dysphoric disorder isn’t in their luteal phase, it’s possible for PMDD to affect their overall mental health and well-being. For example, they might live each month in fear of what’s to come when their period rolls around.
“If someone is anticipating these symptoms every month, that could lead to anxiety about their menstrual cycle,” says Preamplume. “Some of my clients with PMDD have described themselves as feeling ‘crazy’ during certain periods of their menstrual cycle, which can lead to an underlying feeling that something is wrong with them, ultimately affecting their self-worth.”
Plus, people with PMDD might avoid obligations or doing certain things during the week before their period, and severe symptoms during this time can interfere with their functioning at work or school, Preamplume says. Because of this, someone’s job performance or grades could take a hit, which may affect them in a broader sense.
Additionally, DeBarrows says interpersonal relationships may be affected due to PMDD symptoms like mood swings and irritability. Depending on the severity of these symptoms, relationships could be harmed.
This is why it’s so important to seek treatment for PMDD – to improve all aspects of life and mental health that may be suffering due to the disorder.
What Is the Treatment for PMDD?
There are various treatment options that can help relieve the symptoms of premenstrual dysphoric disorder. There isn’t a one-size-fits-all treatment or a specific drug to take for PMDD. Rather, your team of healthcare providers (such as your OB/GYN, therapist, and psychiatrist) will come up with a plan that best suits your personal needs and addresses all of your concerns.
A variety of PMDD treatments include:
Antidepressants: Your doctor might prescribe antidepressants to improve your PMDD symptoms and overall quality of life. Most commonly, selective serotonin reuptake inhibitors (SSRIs) are the class of antidepressants used for PMDD. The FDA has approved three SSRIs for this indication. They are:
- Fluoxetine
- Paroxetine
- Sertraline
Antidepressants may be prescribed in two ways for PMDD. Depending on the doctor’s instructions, these meds can be taken all the time or just during the luteal phase. Exact dosing will vary based on the individual.
Birth Control Pills: OB/GYNs may prescribe oral contraception, or birth control pills, to people with PMDD. Research has found that combined hormonal contraceptives containing drospirenone and ethinyl estradiol are the most effective for treating PMDD. Birth control can help regulate your hormone levels, not only helping with the mental symptoms of PMDD, but the physical premenstrual symptoms, too.
Holistic Remedies: Some people may see benefits from vitamins or supplements, says DeBarrows. Examples include calcium, magnesium, and vitamin B6. However, you should always check with your doctor before taking any new vitamins, supplements, or herbs. Consulting with a naturopathic doctor who specializes in holistic remedies can be beneficial here, too.
Therapy: Therapy can help people with PMDD learn to manage their symptoms and improve overall mental health. For people with any type of depressive disorder, including PMDD, mental health therapy can help tremendously. A qualified therapist can teach stress management and coping skills that can help you deal with all the difficult emotions and feelings that pop up every month surrounding your period. DeBarrows says that cognitive behavioral therapy (CBT) may be particularly helpful for people with PMDD to learn about the interactions between their thoughts, feelings, and behaviors, allowing them to reframe negative or irrational thoughts to be more helpful. Various other talk therapy modalities are also helpful for depression and anxiety-related symptoms, as well.
Lifestyle Changes: Small tweaks to lifestyle can make a big difference in how people with PMDD feel. For example, Preamplume says adding things like regular exercise, yoga, deep breathing, and meditation into your daily life may help reduce symptoms and improve mood. Additionally, don’t forget the basics of getting enough sleep and eating a healthy diet, as DeBarrows says quality sleep and eating well can benefit overall well-being.
Coping Skills for PMDD
It is possible to find relief from your PMDD symptoms. The following coping skills can help.
Tracking and Journaling
Keeping track of your symptoms is beneficial for your research of triggers and symptoms. It is important to make note of the onset, triggers, frequency, and intensity of symptoms. Throughout your monthly cycle, log your symptoms on a daily basis. A pen and paper work fine, but there are phone apps, computer programs, and many other options available to make tracking your symptoms that much easier.
“If someone suspects they may have PMDD, I encourage them to use a mood tracking app or track their mood using a journal for several weeks and note the days they are menstruating,” Preamplume says. “They can use this to identify any patterns and share that information with a medical or mental health professional.”
As the month progresses, you can watch your symptoms and notice any changes. Emotional symptoms have a way of sneaking up on you, causing uncertainty and making you feel as if the depression or the anxiety will never go away. These are the times when you can refer to your journal and see that the feelings you have aren’t “out of nowhere,” but are signaling your period is on its way. Sometimes that simple reminder is all we need to snap us back to reality and be a comforting form of support.
Healthy Lifestyle Changes
Maintaining a healthy lifestyle can be the difference between having tolerable or unbearable symptoms. Making healthy decisions include taking a walk to a store instead of driving, eating an apple instead of chips, or taking part in something active with friends. Every positive change can ease the physical symptoms (bloating, fatigue, abdominal cramps), as well as the emotional ones.
You always hear that exercising has positive health benefits, and coping with PMDD is no different. By taking part in physical activity, you are decreasing bloating and excessive water retention, easing abdominal cramps, and the extra endorphins will ease irritability and moodiness.
By limiting (or excluding) sugar, excess sodium, processed foods, caffeine, and alcohol from your diet, you will be replacing the “junk” with healthier alternatives, giving your body the proper energy to fight off your negative symptoms. Supplementing your diet with vitamins can also help while you are transitioning to healthier eating. For example, calcium, vitamin D, omega-3 fatty acid, and B-6 are all said to reduce symptoms such as bloating, cramps, food cravings, breast pain, irritability, and hormone-related depression.
Making healthy lifestyle choices may seem overwhelming, but every little bit helps. Using your tracking system is crucial while you are making your healthy life changes. Make sure you write down your regular eating and exercise routine, and then as you replace your routine with healthy lifestyle alternatives, make note of how this has impacted your symptoms. This will be a positive reinforcement that you are on taking the important steps to feel better.
Relaxation
Stress is the culprit of many things, including the effect of your PMDD symptoms. When you first begin tracking your symptoms, it is important to identify any factors that may be exacerbating your specific symptoms, such as a stressful presentation at work or an argument with a loved one. As you are monitoring your symptoms, begin participating in daily relaxation techniques to help you cope while your emotions feel out of control. They can also help you reduce the symptoms as well. Relaxation techniques include yoga stretches, meditation, breathing exercises, progressive muscle relaxation, and journaling to release any feelings you have onto paper.
You can also take part in a hobby, such as reading a book by your favorite author, spending time with loved ones, pampering yourself by getting a massage or a pedicure, catching up on your favorite TV show, or doing something crafty. Whatever outlet you choose, make sure it releases endorphins and causes you to stay calm and peaceful. After you have found what relaxation method works for you, make sure you utilize your tracking system as a guide to observe the intensity of your emotional symptoms, which can also be beneficial in deciding what methods are helpful based on the decrease of your symptoms after you engage in that activity.
Seeking Support
When holistic methods of treatment are not helpful on their own, there are a variety of options to consider when coping with PMDD. Having a support system is crucial in finding the best course of treatment. Spending time with friends and family may be helpful in building courage to brave through your symptoms. PMDD has been said to have a hereditary link, but whether or not this is true, oftentimes family members may have the same symptoms and intensity and have tips on how to ease the same pain you are experiencing.
Another avenue to take is finding a therapist who is understanding of women’s issues, can help you make rational decisions, and motivate you to cope with your symptoms when your hormones are pulling you in all different directions. There are also online and community support groups for women struggling with PMDD and severe PMS. Often times hearing how other women have been living with PMDD can provide unique insight and advice that has worked for them, as well as the support to push through your symptoms every month.
Talking to the primary care physician or gynecologist who diagnosed you can also provide medical options to help manage your symptoms when therapy and other holistic methods need to be supplemented. Treatment can include oral contraceptives and/or balancing your hormones in other ways. Psychiatrists, who can prescribe medication, could also assist you with emotional struggles, which include irritability, anxiety, depression, mood swings, and anger. Many times emotional disorders are often exacerbated by hormonal imbalances, which could be diagnosed to help you understand what you are going through.
It is important for every woman to understand that even though we all go through menstruation, the severity and coping mechanisms are different for everyone. While finding out what works for you, remember that it is your body, and you have the right to be assertive about the care you need. Every woman deserves to have the best quality of life, and that involves the lowest possible amount of menstrual pain and discomfort.
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If you think you could have PMDD, remember that you are not alone. There are people out there who know exactly the way you feel, and there is hope to feel relief from your symptoms. PMDD is a women’s health condition that can cause severe symptoms and greatly impact someone’s quality of life – but with various treatment options, it’s possible to have a much more pleasant menstrual cycle and improved mental health overall. You can stop PMDD from controlling your life and take your well-being into your own hands.
