If you have a menstrual cycle, you may notice changes in your mood, body, or sleep habits leading up to your period. These may be signs of premenstrual syndrome (PMS), but they could also be premenstrual dysmorphic disorder (PMDD). Read on to learn about the differences between these issues and how to tell which you have.

The symptoms of PMS are bothersome but don’t get in the way of everyday life. PMDD is different. The symptoms are more extreme.

PMD causes major emotional distress. It affects your relationships and your ability to focus at school or work. Talk to your doctor if you think you have PMDD.

Lifestyle changes, therapy, medicines, or a mix of these can help reduce PMDD symptoms and improve your life.

Do I Have PMDD?

Symptoms of PMDD overlap with those of other health issues. Symptoms may be similar to those of depression, post-traumatic stress disorder, or thyroid issues.

But with PMDD, your symptoms mostly occur in the week before your period. PMDD symptoms last an average of six days, often peaking two days before their period. They typically go away around the time your period begins.

It’s possible to get PMDD even if you don’t bleed during your cycle due to medicines or not having a uterus. That’s because PMDD relates to hormone changes that happen after ovulation. This can still occur without a uterus as long as you have ovaries.

For those without a period, the symptoms usually start about a week after ovulation, but every cycle is different.

People with PMDD experience at least five symptoms; at least one needs to be mood-related. Mood symptoms are the main requirement of PMDD. Mood-related symptoms of PMDD include:

  • Depression.
  • Feelings of hopelessness.
  • Low self-worth.
  • Anxiety.
  • Feeling very sensitive.
  • Mood swings.
  • Feeling angry or irritable.
  • Little interest in activities or hobbies you otherwise enjoy.
  • Difficulty focusing.
  • Sleeping much more than usual.
  • Feeling overwhelmed or out of control.

Other physical signs of PMDD can include:

  • Fatigue.
  • Difficulty sleeping.
  • Overeating.
  • Food cravings.
  • Breast tenderness.
  • Headaches.
  • Joint or muscle aches.
  • Bloating.

If you only have physical symptoms without mood changes, you don’t have PMDD.

If you’re wondering if it’s PMDD or PMS, the main difference is symptom severity and how they affect your life. Unlike PMS, PMDD causes problems with relationships or makes it difficult to function at school or work.

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What Are the Risk Factors for PMDD?

People who are more likely to get PMDD include:

  • People who smoke.
  • People who have existing anxiety or depression. (Their symptoms get much worse before a period).
  • People who have had major trauma in their lives, like living through violence or abuse.
  • People who are overweight. Excess adiposity (fat stores) can impact hormone levels. The risk of PMDD rises along with body mass index, so people who are obese have the highest risk.

What Causes PMDD?

PMDD happens due to hormone changes. When the ovary releases an egg, estrogen levels drop, and progesterone levels rise. Progesterone drops again right before your period.

Hormone levels in people with PMDD are similar to those without it. Experts think people with PMDD are more sensitive to regular hormone changes during their cycle.

The reason for this increased sensitivity isn’t clear. Genetics, diet, lifestyle, and body weight play a role.

How Will My Doctor Diagnose PMDD?

There is no test for PMDD. Instead, doctors diagnose PMDD based on your symptoms and their timing. Your doctor may ask you to keep a symptom diary to track how they change with your cycle.

Your doctor may test you for other problems that could explain your symptoms. They may check your thyroid hormone levels, for instance.

How Is PMDD Treated?

You can improve PMDD with diet and lifestyle changes and medicine. Often a mix of both. Talking to a cognitive behavioral therapist can also help you respond to mood symptoms of PMDD.

Lifestyle changes that help PMDD include:

  • Eat healthy food like whole grains, fruits and vegetables, and lean protein.
  • Limit salt and sugar.
  • Limit alcohol, which can worsen depression symptoms.
  • Limit caffeine, which can increase anxiety and disrupt sleep.
  • Exercise regularly.
  • Foster good sleep habits. Go to bed at the same time each day and avoid screens two hours before bed.
  • Embrace meditation or other stress-relieving activities.

Medicines that help PMDD include:

  • Anti-depressants, including selective serotonin-reuptake inhibitors.
  • Birth control pills with drospirenone.
  • Medicine to stop ovulation. Stopping ovulation can cause menopause-like symptoms, including hot flashes and unwanted hair growth, so they’re only used in severe cases.

PMDD Can Be Serious, So Don’t Be Afraid to Seek Help

Many women dismiss mood and physical changes that flux with their cycle. They may feel they don’t need medical help because the symptoms are temporary. Or, they may think PMDD is natural, and there is nothing they can do.

But no one should feel extreme sadness, anger, or irritability, even briefly. Plus, PMDD can cause problems with friends and romantic partners and affect school grades or work performance.

Finding the best mix of lifestyle changes, therapy, and medicine for you may take time. But these treatments work. If you think you might have PMDD, start a symptom diary and plan a visit with your family doctor, therapist, or gynecologist.

If you experience thoughts of suicide, call or text 988 or go to 988lifeline.org to chat with someone online. You can also get counseling and support by calling 1-800-273-8255.

American Academy of Family Physicians. Premenstrual dysmorphic disorder. Link

MedlinePlus. Premenstrual dysmorphic disorder. Link

Office on Women's Health. Premenstrual dysmorphic disorder. Link

Dr. Sanskriti Mishra et al. Premenstrual dysmorphic disorder. StatPearls. Link

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