What’s the difference between PMS and PMDD?
- Medically Reviewed by: Dr. Aisha Wagner, Family Physician and Reproductive Health + Advocacy Fellow
Everything You Should Know About PMS & PMDD
Sore boobs, an achy vulva, and unexplained moodiness all rudely signal the beginning of our menstrual cycle. For most of us, the days leading up to our period are routine discomforts and inconveniences. It’s a signal to gather our electric heating pads, our favorite snacks, and period essentials. For others, an approaching period can be totally debilitating, bringing with it severe depression, heightened anxiety, and serious mood swings. And then there’s the lucky bunch that hardly notice that their period is coming at all.
Premenstrual symptoms exist along a spectrum. The symptoms themselves, the timeframe in which they are experienced, is the same, but it is the severity and frequency of the symptoms that makes all the difference.
In this guide, we’ll explain the range of premenstrual symptoms, where you fall within the spectrum, and what you can do to cope with your specific type of period blues.
What is PMS?
Learning about what PMS puts your body through can be the key to fighting the pain it brings.
“PMS” stands for “premenstrual syndrome.” It can start anytime after you ovulate and usually lasts until you get your period, or a few days after. (4) PMS affects your emotional and physical wellbeing. It’s a frustrating baffling state to be in, considering all the different ways it can throw your daily activities off-track. Symptoms can include breast tenderness, acne, food cravings, cramping, nausea, joint pain, constipation, and weight gain. Some of us even get “period brain.” Suddenly we can’t concentrate on anything, burst in tears for no reason, dwell on dark or negative thoughts, or become more anxious. (5) And the list goes on…
If any of these sound familiar, you are not alone. As many as 3 of every 4 menstruators have experienced some form of premenstrual syndrome. (3) Our bodies really go through a lot with each cycle!
Why it happens:
Scientists aren’t entirely sure, but most signs point to hormone changes. The hormones estrogen and progesterone race through your insides like two loopy roller coasters during your cycle, and these fluctuating levels can produce physical and mood-related PMS symptoms. (3)
What is PMDD?
PMDD, or premenstrual dysphoric disorder, is a more severe form of PMS. (4,6) The symptoms can look the same as PMS from the surface, but those with PMDD experience these things in a greater degree, to the point that it interferes with their daily life. People with PMDD have the unpleasant monthly challenge of fighting off physical and mental discomfort, including depression and suicidal thoughts. Like PMS, PMDD symptoms are cyclical. They appear any time post-ovulation, and cool down when (or not long after) you start bleeding again. (4,6) The cyclical nature of PMDD is what distinguishes it from other disorders.
If you’re reading through this and thinking, “Damn, I knew my period was up to no good,” you’re definitely not alone. About 5% of ovulators experience PMDD during their childbearing years, but the true number is probably higher because it’s so underdiagnosed. It wasn’t until 2013 that PMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, aka the DSM-V — a mental health dictionary that psychiatrists and psychologists use to diagnose their patients.
Before then, some health experts thought PMDD was a myth. A 2002 article in Monitor on Psychology cites a few naysayers. “PMDD does not exist,” says the article’s sources, “that it can be confused with other mental health disorders, such as depression.” Health experts who were against the recognition of PMDD argued that women shouldn’t have to claim that they were depressed in order for the general public to take PMS symptoms seriously. They also thought that PMDD were trivial first-world problems that should take the backseat for the big mental health illnesses.
So all this bad press is probably the reason you haven’t heard of this disorder before. Thankfully, the premenstrual dragon that is PMDD is now out in the open. Knowledge is power, and what we know about this disorder can help improve the quality of life for those who feel its symptoms.
Why it happens:
Scientists aren’t entirely sure what causes PMDD, but here are a few possible explanations:
- Hormonal fluctuations during the menstrual cycle — and the way certain bodies react to those fluctuations. (6,7,8,9)
- People with PMDD don’t necessarily have higher amounts of hormones circulating in their bodies, but they might be more sensitive to hormonal changes associated with the menstrual cycle. (10)
- Underlying conditions such as depression and anxiety don’t cause PMDD, but they may play a role in exaggerating premenstrual symptoms due to a drop in serotonin levels. Serotonin is a neurotransmitter that increases feelings of happiness. Additionally, those who have a history with depression may be more likely to have PMDD. (9)
What are Molimina?
Compared to PMS and PMDD, molimina are minor physical and emotional changes that people with periods experience thanks to hormonal changes before menstruation. (3) Instead of feeling the raging symptoms of PMS and PMDD, molimina welcome the menstrual flow with gentle little nudges. Molimina can also include physical signs like breast tenderness, fluid retention, cramps, acne, increased appetite, and/or behavior changes, such as negative moods. On the spectrum, this is the least severe way that people experience the arrival of their periods. (3,5)
Why do some people react more strongly to hormonal fluctuations than others?
OBGYN Dr. Heather Bartos says, “We honestly don’t know why. For some, it can certainly be stress, diet, exercise (or lack thereof).”
Family Medicine Doctor and Reproductive Health & Advocacy fellow Dr. Aisha Wagner explains that there is some evidence that those who experience PMS or PMDD usually have lower levels of circulating serotonin. And Dr. Bartos adds that progesterone, the hormone that rules the second half of the cycle, can have a depressing effect. The combination of higher progesterone and lower serotonin levels can really throw some of us off-balance.
Am I experiencing molimina, PMS or PMDD?
Here are some helpful guides to see where you fall within the spectrum:
- PMS diagnostic criteria from the American Academy of Family Physicians (AAFP)
- PMDD diagnostic criteria from the American Psychiatric Association (APA). A person has to have at least 5 out of the 11 symptoms to be diagnosed with PMDD.
No matter where you fall on the spectrum, it’s important to know that you’re not exaggerating the debilitating effects of your period. We see you, and we know your pain is valid. If your symptoms are disruptive and uncomfortable, seek support.
Helpful Tips for Dealing with PMS + PMDD
We rounded up these treatments from health professionals and real people who have experienced PMDD and manage to cope with its debilitating symptoms. The severity of your symptoms should let you know where to begin. If you are experiencing severe depression, anxiety, and/or suicidal thoughts, talk to your healthcare provider or mental health professional ASAP.
Track your cycles and symptoms.
- Having a record of your symptoms makes PMDD much easier to diagnose and treat. You’ll want to track the following data:
- Your emotional and physical symptoms on the days preceding your period
- When these symptoms happen, how severe they are, and how long they last
- When you actually get your period
Apps like Me vs. PMDD can help you track your symptoms in easy, user-friendly terms.
Once you know when your symptoms happen and which ones to expect, you can come up with an individualized PMS/PMDD game plan with your provider.
Reframe the battle.
- It’s important to recognize that the pain you feel is valid. PMDD Warrior Brett Buchert shares that for years before her diagnosis, she thought her symptoms were “my fault and only felt so intense because I was weak.” Like many of us who have PMDD, she blamed herself. “I finally realized that this bag of PMDD hell was just dropped on me, not my fault, and I am wickedly strong to still be breathing under its weight.” Something as simple as a diagnosis can help you understand what your body is going through, and remember that it’s only temporary. Even though it’s hard, your period will end eventually, and these symptoms will pass.
- Nutrition is so important to your hormonal health. Researchers are finding that your gut microbiome — the chemical environment in your digestive system, influenced by your diet — acts like “a conductor of an orchestra, leading your symphony of hormones.” Changing your diet can be a lifesaver. Check out programs like Alisa Vitti’s Floliving and Nicole Jardim’s Fix Your Period. They’ve helped menstruators curb their PMDD and PMS symptoms with diet and supplements alone.
- Like we said earlier, lower serotonin levels can aggravate PMS/PMDD symptoms. This is why SSRIs (antidepressants) can provide the support you need for your mental health. You may only need to take antidepressants between ovulation and the start of your period. (4)
- Birth control can also help regulate these symptoms, as these synthetic hormones may be able to help you surf the crimson wave with ease. Depending on the type, you may experience shortened periods — or choose not to have periods at all — both of which can reduce symptoms. If the medication route is the right choice for you, the FDA has approved the birth control pill Yaz to treat PMDD. Just remember that birth control comes with its own side effects, so be sure to keep checking in with your body to see what it needs.
These are the two most popular routes, but there are other medications out there. Do your research so that you can have an informed discussion with your medical provider.
Take supplements and herbs.
- Evidence claims that certain nutritional supplements and herbal remedies might alleviate PMS/PMDD symptoms. Taking 1,000 milligrams of calcium per day (as part of your diet or in the form of a supplement) could decrease PMS/PMDD symptoms for some people. (14) Other supplements like Vitamin B6, magnesium and L-tryptophan could help with symptoms as well. (14)
- Naturopathic doctor and women’s health expert, Dr. Erica Matluck shares that Vitex is her favorite herb to treat PMS and PMDD. It helps balance progesterone levels, so it can mitigate a variety of symptoms.
Check in with your healthcare provider before taking any herbal remedies or nutritional supplements.
- It sounds straight out of Goop, but some people swear by it. Seed-cycling is a way to balance your hormones by eating different types of seeds at different points of your ovulation/menstruation cycle. While there is little scientific evidence to back it up, holistic providers, like Naturopathic Doctor Dr. Jolene Brighten, say it’s the real deal. It starts with four seeds: flax, pumpkin, sunflower and sesame seeds. The general idea is that eating these seeds at different points during the month can enhance or inhibit the production of estrogen and progesterone in the body to relieve symptoms.
- For those with premenstrual symptoms, exercise can really boost mood and energy levels. (15) A small study shows that twelve weeks of yoga improved menstrual pain and physical function, including significantly decreased abdominal swelling, cramps and breast tenderness, and enhanced general health perception, energy levels, and mental health. (16)
Find a supportive community.
- Severe PMS or PMDD can feel pretty isolating. Thankfully, online networks allow us to connect with people who understand how we’re feeling while we’re waiting to bleed. Here are some places to go for support:
The International Association for Premenstrual Disorders (IAPMD)
IAMPD is a nonprofit that provides different kinds of free support (peer and group), resources, and community-building services in various languages to help people with premenstrual disorders.
- Reid, Robert L. “Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome).” In Endotext, edited by KR Feingold. South Dartmouth, MA: MDText.com, Inc. Accessed March 20, 2020. https://www.ncbi.nlm.nih.gov/books/NBK279045/.
- "Premenstrual Syndrome." In New Harvard Guide to Women's Health, The, by Karen J. Carlson, Stephanie A. Eisenstat, and Terra Diane Ziporyn. Harvard University Press, 2004.
- “Premenstrual Syndrome (PMS).” Mayo Clinic. Mayo Foundation for Medical Education and Research, February 7, 2020. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780.
- “Premenstrual Dysphoric Disorder (PMDD): A Severe Form of PMS.” Mayo Clinic. Mayo Foundation for Medical Education and Research, November 29, 2018. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315.
- “Premenstrual Syndrome (PMS).” ACOG. American College of Obstetricians and Gynecologists. Accessed April 2, 2020. https://www.acog.org/patient-resources/faqs/gynecologic-problems/premenstrual-syndrome.
- Hofmeister, Sabrina, and Seth Bodden. “Premenstrual Syndrome and Premenstrual Dysphoric Disorder.” American Family Physician 94, no. 3 (August 1, 2016): 236–40. https://www.aafp.org/afp/2016/0801/p236.html.
- Halbreich, Uriel. “The Etiology, Biology, and Evolving Pathology of Premenstrual Syndromes.” Psychoneuroendocrinology 28 (2003): 55–99. https://doi.org/10.1016/s0306-4530(03)00097-0.
- Hammarbäck, Stefan, Torbjörn Bäckström, Juhani Hoist, Bo Von Schoultz, and Sven Lyrenäs. “Cyclical Mood Changes as in the Premenstrual Tension Syndrome during Sequential Estrogen-Progestagen Postmenopausal Replacement Therapy.” Acta Obstetricia Et Gynecologica Scandinavica 64, no. 5 (1985): 393–97. https://doi.org/10.3109/00016348509155154.
- Kumar, Pratap, and Alok Sharma. “Gonadotropin-Releasing Hormone Analogs: Understanding Advantages and Limitations.” Journal of Human Reproductive Sciences 7, no. 3 (2014): 170. https://doi.org/10.4103/0974-1208.142476.
- Potter, Julia, Jean Bouyer, James Trussell, and Caroline Moreau. “Premenstrual Syndrome Prevalence and Fluctuation over Time: Results from a French Population-Based Survey.” Journal of Women’s Health 18, no. 1 (2009): 31–39. https://doi.org/10.1089/jwh.2008.0932.
- “Premenstrual Dysphoric Disorder Differential Diagnoses.” Premenstrual Dysphoric Disorder Differential Diagnoses. MedScape, November 9, 2019. https://emedicine.medscape.com/article/293257-differential.
- Wittchen, H.-U., E. Becker, R. Lieb, and P. Krause. “Prevalence, Incidence and Stability of Premenstrual Dysphoric Disorder in the Community.” Psychological Medicine 32, no. 1 (2002): 119–32. https://doi.org/10.1017/s0033291701004925.
- “The Etiology of Premenstrual Dysphoric Disorder: 5 Interwoven Pieces.” MGH Center for Women's Mental Health. Massachusetts General Hospital, May 29, 2018. https://womensmentalhealth.org/specialty-clinics/pms-and-pmdd/the-etiology-of-pmdd/.
- Harvard Health Publishing. “Will Prozac Help My Premenstrual Depression?” Harvard Health. Harvard Medical School. Accessed March 27, 2020. https://www.health.harvard.edu/womens-sexual-health/ask-the-doctor-will-prozac-help-my-premenstrual-depression.
- Harvard Health Publishing. “Treating Premenstrual Dysphoric Disorder.” Harvard Health. Accessed April 8, 2020. https://www.health.harvard.edu/womens-health/treating-premenstrual-dysphoric-disorder.
- Tsai, Su-Ying. “Effect of Yoga Exercise on Premenstrual Symptoms among Female Employees in Taiwan.” International Journal of Environmental Research and Public Health 13, no. 7 (2016): 721. https://doi.org/10.3390/ijerph13070721.