When is PMS not just PMS? A deep dive into PMDD

By Nikki Michelsen

Oct 3, 2022

When is PMS not just PMS? A deep dive into PMDD
[CW: brief mentions of su*cide/SI, discussion of Mental Health]
What is PMDD? And, for that matter, what actually is PMS? Contrary to what you may have been led to believe, they’re not the same thing. PMDD stands for premenstrual dysphoric disorder and it is a mood disorder closely linked to the menstrual cycle.
This month is PMDD awareness month; next month is mental health awareness month. So it seems like a pretty apt time to talk about one of the most overlooked but serious period-related disorders.
PMDD is often conflated with PMS, or premenstrual syndrome, in that it shares many of the same symptoms showing up at similar points of the menstrual cycle…
Hold up - what is PMS?
PMS doesn’t always look the same to everyone. While there’s no denying that in the luteal (pre-bleeding) phase, many of us do experience symptoms such as mild mood swings, anxiety, irritability, tender boobs, bloating, and a drop in sex drive, PMS is not considered a ‘condition’ in the way PMDD is. These symptoms (provided they’re not totally derailing your life - but we’ll get onto that) can mostly be attributed to hormonal imbalances and a confluence of lifestyle factors with said hormones levels. Developing healthy, regular exercise and eating habits, avoiding stressors (way easier said than done these days, I know), and having a regular sleeping schedule can, combined, result in experiencing little to no PMS symptoms at all.
What’s the difference between PMS and PMDD?
The key difference between run-of-the-mill PMS and PMDD is that the symptoms of PMDD tend to be far more severe and have a greater impact on the life of the person suffering from the condition than anyone who experiences PMS. If you find that your ‘PMS’ symptoms are preventing you from living your daily life as normal or negatively affecting your relationships, you may in fact be suffering from PMDD.
PMDD is thought to affect anywhere between 3% and 8% of women. Conversely, 75% of women report experiencing symptoms of what we know of as PMS.
One of the characteristic signs of having PMDD is feeling out of control - from mood swings so extreme they can’t be overlooked, to uncharacteristically picking fights with your loved ones, to not being able to motivate yourself to do things that are important or that you’re normally passionate about.
What are the symptoms of PMDD?
PMDD has varying and wide-ranging symptoms. Typically, PMDD symptoms are experienced during the luteal and menstrual phases of the menstrual cycle, aka they start in the run up to your period and last throughout your bleed before tapering off.

The key symptoms of PMDD are: 

  • Intense mood swings including feelings of irritability and anger
  • Intense feelings of sadness and/or depression
  • Suicidal thoughts
  • Extreme anxiety and even panic attacks
  • Loss of interest in hobbies, activities, and even relationships
  • Fatigue
  • Inability to concentrate and feeling out of control
  • Cramps
  • Bloating
  • Sleeping problems
  • Headaches
  • Joint pain
  • Muscular pain
  • Hot flushes
  • Unexplained, dramatic changes in appetite
What causes PMDD?
No one knows for certain, but it is thought to be an abnormal reaction to the hormone fluctuations that occur naturally throughout the menstrual cycle. Some studies have shown a link between PMDD and serotonin; serotonin levels fluctuate throughout the menstrual cycle and some people who experience periods may be more sensitive to changes in serotonin levels.
It is possible to suffer from another mental health problem such as depression and for changes in hormones to make the symptoms and emotions of that condition more severe.
What should I do if I think I might have PMDD?
If you think you have Premenstrual Dysphoric Disorder, you should see a doctor. Before you go, you should track your cycle. This means keeping a daily (or near-daily) record of your mood, physical symptoms, and blood/discharge for 2-3 cycles. Your menstrual cycle starts with the first day of your period and ends the day before your next one starts.
How is PMDD diagnosed?
Your doctor will ask you to keep a record of your symptoms, as mentioned above (which is why doing this before going to a doctor can help speed the process up). If you have five or more of the above symptoms that cannot be explained by another condition and which interfere with your quality of life, you may be diagnosed with PMDD. Typically, one or more of these symptoms needs to be mood-related (see feelings of sadness or anxiety above) to warrant a PMDD diagnosis.
Your doctor may first try to rule out other gynaecological conditions such as Endometriosis or fibroids.
How is PMDD treated?
While SSRIs (Selective serotonin reuptake inhibitors, AKA antidepressants) are approved to treat PMDD in the US, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) does not yet approve any such medications for PMDD treatment. Other treatments may include oral contraceptives such as the combined oral contraceptive pill. This is because the pill prevents ovulation from occurring, which means the body does not go through the same hormonal cycle, easing the effects of fluctuating hormone levels on the body.
Other treatment options may include lifestyle changes such as changes to your diet and exercise routine and attempts to mitigate stressors. It may also be recommended that you take standard over-the-counter medications for pain, anti-inflammatory medications, or diuretics for water retention.
Talking therapies are also often recommended for these kinds of mood disorders. In the UK, it is possible to get counselling on the NHS but there is typically a long waiting list; if you can afford a private therapist it is highly recommended to go down this route.
Do I need to be worried about PMDD?
We all know about the google effect - you read about an illness, condition, or disease and start to get completely freaked out that you have it too. While we’re not in the business of freaking you out and definitely don’t want to be sending you off to the doc’s in a panic unnecessarily, the tricky thing with gynaecological conditions is that a) they frequently go seriously underdiagnosed and b) we’ve been conditioned to put up with extraordinary levels of pain in a society that has, for millennia, labelled us ‘hysterical’ if we dare complain. Misogynistic bias in the medical industry means our pain (be it physical or mental and/or emotional) is downplayed and even completely ignored; as a result many of us tend to downplay our own pain, too, suffering in silence and buying into the notion that this is just part of our lot in the world as humans who happen to have uteruses.
It’s not.
If you are suffering with pain before or during your period, extreme mood swings, depression and anxiety (especially if you are thinking of harming yourself or having panic attacks), or otherwise suffering to the extent that your symptoms are interfering with your work, quality of life, and/or relationships, please see a doctor. Know that this is not something you have to put up with and that there is help out there.
Got questions? Don’t hesitate to hit us up on email or DM about anything and everything that’s on your mind. And, as always, let us know if there’s anything you wanna see covered next here on fem space. We’ve got your back.
Ohne Team
Image credit Maria Orlova from Pexels