The Difference Between PMDD & PMS, Explained

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We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions remain anonymous. This week’s topic: the difference between Premenstrual dysphoric disorder (PMDD) and PMS.

Q: I get really bad PMS. Like, so bad that I’m exhausted from the mood swings and can barely handle myself at work. I was looking online to try to see if there is anything I can do to make myself feel better so I can be a functional person my whole life instead of just three weeks out of the month, and I read something about PMDD. It sounds like me, but how do I know if I actually have PMDD? And if I do have PMDD, is there anything I can do to fix it?

A: First of all, I’m so sorry to hear you’re struggling like this. Even if you’re someone who rejoices in the coming of your period because it connects you deeply with your body and other uterus-owners in your community, feeling this terrible can really make you wish you could remove your reproductive organs and shelve them in a decorative jar until you want to have a baby (or is that just me?).

Many people feel a little off in the days leading up to their period, but if you have PMDD it really disrupts your life. Let’s learn about what this disorder is and some ways to help it.

What's The Difference Between PMS & PMDD?

At least 75 percent of people with menstrual periods also experience certain changes right before the time they bleed. These usually mild-to-annoying symptoms can be physical (like bloating or breast tenderness) or emotional (like mood swings, or crying at manipulative commercials involving puppies). This is premenstrual syndrome or PMS. You may have heard of it.

PMDD is basically PMS with the volume turned waaaay up — to the point where your life is disrupted because your symptoms are so bad. This disorder affects between two and 10 percent of menstruating humans, with those who have a history of depression at higher risk. It usually starts during your 20s, and can get worse over time.

What’s It Like To Have PMDD?

PMDD is an unpleasant confluence of psychological, physical, and behavioral symptoms. Psychological symptoms can include anxiety, mood swings, irritability, depression, feeling overwhelmed, feeling sensitive to being rejected, and experiencing social withdrawal. Physical symptoms might include bloating, tender breasts, increased appetite, headaches, fatigue, achy muscles or joints, and insomnia. Behavioral symptoms can include fatigue, and poor concentration, or forgetfulness.

When Does It Happen?

PMDD symptoms generally start around seven to 10 days before your period and last for the first couple days of your period. This is around the same timeframe as with PMS, except it can of course feel way longer because your symptoms are far worse.

Why Does It Happen?

Unfortunately, scientists don’t really know why some people experience PMS, others PMDD, and a few lucky ones, I don’t know ... constant bliss? What we do know is that PMDD is probably triggered by the hormonal changes that happen when your body is getting ready to shed its uterine lining, resulting in your period. Some researchers posit that these hormonal alterations can make existing depression and anxiety worse.

There’s also a correlation that’s been discovered recently between PMDD and low serotonin levels, which is the brain chemical that acts as a messenger between nerves and helps to control your mood, attention, pain, and sleep.

How Can I Figure Out If I Have It?

The symptoms of PMDD overlap with a lot of other conditions, such as chronic fatigue syndrome, migraines, irritable bowel syndrome, fibromyalgia, depression, and anxiety. So if you just read the PMDD symptoms and thought “Yikes that’s totally me,” talk to your doctor before self-diagnosing. She’ll be able to assess what’s going on with you to make sure it’s that and not any of these other conditions.

You can also do some work on your own to figure out if what’s going on with you is PMDD or something else. You can do this by charting your symptoms on a calendar, because if you have PMDD you will only have symptoms at certain times during your cycle. This doesn’t serve to officially diagnose you, but it can rule out PMDD if you notice that your symptoms are actually happening all cycle-round.

What Can I Do To Feel Better Without Medication?

If you are experiencing PMDD, the good news (assuming you’re in the part of your cycle where you can experience anything as good news) is that there are a bunch of things you can do to help mitigate your symptoms. Even better, you can do many of these on your own — as in, without a doctor’s prescription.

Lifestyle modifications you can try on your own include decreasing the amount of caffeine, sugar, sodium, alcohol, and nicotine you imbibe, and getting enough sleep and exercise. Researchers have found that taking calcium, Vitamin B6, magnesium, and Vitamin E may help as well.

Herbal remedies including agnus castus fruit extract, ginko bilboa, black cohosh, St. John’s Wort, and Kava Kava have also been found to be helpful. Definitely talk to your doctor before you start taking any new vitamins or herbal supplements, to make sure they don’t have dangerous interactions with anything you’re already taking.

And if you’re looking for something more involved, psychotherapy, counseling, or cognitive-behavioral therapy have all been shown to help ease PMDD symptoms.

What Are My Medication Options?

If none of the above options work, talk to your doctor about pharmacologic treatment. Selective serotonin reuptake inhibitor (SSRI) antidepressants help many people with PMS and PMDD alike — just know that these medications can also lower your libido. Other potential solutions include Xanax, oral hormonal contraceptives, and even hormonal interventions that work to suppress the functioning of your ovaries (although a word to the wise on these — they cause your estrogen levels to drop significantly, all the way to the levels you’ll get when you’re menopausal, so while your PMDD symptoms might be alleviated, you may end up with hot flashes, vaginal dryness, and a higher risk of osteoporosis).

The Bottom Line

If you’re living with PMDD, up to half of your life can be supremely difficult. If this is you, get care. Seriously, take care of yourself! Don’t let your menstrual cycle dictate whether or not you can live your life in the way you want (which I’m assuming doesn’t include locked in your house sobbing for two weeks out of the month). Talk to your doctor and figure out a solution that's right for you.

Images: Pexels, Giphy