How To Tell If Your PMS Is Actually PMDD — And Why You Should Know The Difference

by Kyli Rodriguez-Cayro
BDG Media, Inc.

There's no way around it: having your period can flat out suck, especially if you're experiencing premenstrual syndrome (aka, PMS). No, I don't mean the sexist version of PMS — where men use your time of the month to invalidate your emotions or ability to think rationally — I'm talking about the cramps, moodiness, headaches, fatigue, and all that jazz. For some people, however, their PMS symptoms can actually be debilitating, and may even require a different diagnosis altogether. Premenstrual Dysphoric Disorder, or commonly referred to as just PMDD, is PMS' close counterpart, but there's a pretty big difference between PMDD and PMS — and knowing that difference can be key to managing your health.

"PMDD is a more severe case of PMS," Dr. Sheila Loanzon, a board-certified OB-GYN and author of Yes, I Have Herpes, tells Bustle. "When anger, irritability, and internal tension symptoms are severe occurring a few days prior to the period, this is premenstrual dysphoric disorder."

According to the Office of Women's Health (OWH), PMS symptoms usually occur right after ovulation, and right before menstruation. Symptoms of PMS include bloating, headaches, moodiness, fatigue, aching breasts, and other various physical and mental health symptoms. While PMS symptoms can definitely put a damper on your day, most people continue to participate in there daily activities without interruption. PMDD, on the other hand, may keep you from being able to participate in your planned day.

PMS-ing before your period is commonplace: Healthline reported nearly 85 percent of menstruating people experience PMS. PMDD is more rare: The Gia Allemand Foundation, which raises awareness about reproductive mental health disorders, estimated only two to ten percent of women of reproductive age are affected by PMDD. The percentage of trans and non-binary folks who also live with PMDD is unclear.

PMDD shares symptoms with PMS, but the disorder is known for making up irritability brought on by PMS to extreme mood swings. And PMDD can amp up the pain and severity of physical symptoms of PMS. In some cases, PMDD can negatively impact your interpersonal relationships and life by causing intense depression, anxiety, and panic. The physical symptoms may also interfere with your ability to work or participate in other activities.

The simplest to distinguish between if you are experiencing PMDD versus PMS is to determine if your symptoms are disabling. According to Dr. Loanzon, to receive a diagnosis of PMDD, you have to meet the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) — a guide developed by the American Psychiatric Association to properly diagnose mental health issues. Unlike PMDD, PMS is not included in the DSM-5.

"To meet the criteria definition of PMDD, your clinician will determine if you have at least physical, behavioral, psychological symptoms with one of them being mood swings, anger, irritability, sense of hopelessness or tension, anxiety," Dr. Loanzon explains. "These symptoms must interfere with usual activities such as work, school, social life to be considered PMDD."

Furthermore, another way to discern between PMS and PMDD is by being aware of the frequency and timing of your symptoms. "PMS symptoms begin any time after [someone] has periods, usually developing in the early twenties and continue while [the person] is having periods," explains Dr. Loanzon, saying some people experience more severe PMS symptoms in their thirties and forties. She adds that, "PMS resolves when you're menopausal, but PMDD can occur at anytime on this spectrum [of reproductive health]." Which means, unlike PMS, PMDD symptoms don't necessarily revolve around your reproductive health cycle, or stop when your period starts.

So, if you are diagnosed with PMDD, how can you manage the condition? Dr. Loanzon also suggests simple ways to alleviate mild symptoms of both PMDD and PMS include exercising regularly, making sure you have a balanced diet to decrease bloating, and decreasing stress, through skills like yoga or meditation. She adds that, "PMDD can be treated with a group antidepressants such as SSRIs (selective serotonin reuptake inhibitors)," as well as birth control pills. "Both birth control pills and SSRIs can be prescribed at the same time based on severity of symptoms," says Dr. Loanzon.

Katie Bressack, a wellness coach who specializes in hormonal health, pregnancy, and menopausal nutrition, also tells Bustle that food is an important tool in decreasing the severity of PMDD symptoms. "Making some healthy changes to your diet can really help to alleviate some of the pain associated with PMDD. The first step I always take with my clients is looking at what's on their plate," Bressack says. "We can often reduce or even eliminate period pain by making some healthy diet upgrades, since what we eat has a direct impact on our hormones, which in turn determines our mood, energy and general sense of well being. The first step for eating to support your hormones is balancing your blood sugar levels, which is done through combining healthy fats, proteins and fiber at every meal."

Dr. Loanzon tells Bustle speaking with your health care provider or OB-GYN about symptoms you're having — whether it is PMS or PMDD — is key to keeping your reproductive health and mental health in check. It may be tricky at times to differentiate between these two disorders, but being aware of when your symptoms occur and how severe they are are will help you seek the proper medical attention.