What’s the difference between really bad PMS and PMDD?
Image: Claudia Wolff via Unsplash
We know that the premenstrual phase can be a tricky place to navigate for a whole host of reasons, but what about when it becomes unbearable? What’s the difference between having really bad PMS, and PMDD? And if you do have PMDD, what can you do about it?
As someone who’s passionate about the premenstrual phase and coaches clients to use their PMS as a potential tool for transformation, it’s important to distinguish these two experiences of the cycle. So firstly:
What is PMS?
For an in-depth answer, head to these blog posts I wrote a while back: A radical view on PMS and Your PMS is not a thing. Essentially, PMS is the experience of a set of symptoms that occur after you ovulate and before you get your period, i.e. the premenstrual phase. For some, this time of the cycle can feel awful physically, mentally, emotionally or all together, while for others this place feels really, really good. It’s a time in the cycle that’s governed by the progesterone hormone and is known as the luteal phase. It’s one of the longest phases, lasting anywhere between 10-17 days which can suck if you’re someone who struggles here.
PMS can be worked on with a number of approaches, including supplements, diet, exercise and mindset work with coaching (which is what I do and you can find more about here).
What is PMDD?
PMDD stands for Pre-Menstrual Dysphoric Disorder and is sometimes explained as a more severe version of PMS. Symptoms can be physical (like breast tenderness and bloating) but PMDD can seriously affect your ability to live, work and relate. Where someone might feel anger as part of their PMS, someone with PMDD might experience this as violent rage. Because of this, it can be classed as a mental health disorder whereas PMS isn’t. Other common symptoms include sudden sadness, depression (not just feeling ‘depressed’), anxiety and suicidal thoughts.
PMDD symptoms include:
Sudden sadness
Lethargy
Hopelessness
Suicidal ideation
Anxiety
Tension/feeing ‘on edge’
Lack of interest in normal life and activities
Rage
Paranoia
Forgetfulness
Panic attacks
Gastrointestinal issues like vomiting and diarrhoea
Difficulty concentrating
Insomnia or hypersomnia (sleeping constantly)
Change in appetite and/or overeating
Feeling overwhelmed
As you can see, the symptoms are similar to PMS, but it’s the severity and patterns that make the difference. Usually, the symptoms will feel unbearable and overtake the ability to live normally.
What causes PMDD?
Honestly, nobody knows yet. The current thinking is that sensitivity to hormones and the fluctuations could be behind it, but it is also thought to be genetic, with a heritability range between 30-80%. The change in hormones throughout the cycle can have a big impact on mood and physical signs and symptoms, especially when it comes to serotonin.
What about Premenstrual Exacerbation?
Just to add another thing to the mix, Premenstrual Exacerbation (PME) happens when someone who already has an anxiety or mood disorder. The hormonal changes in the premenstrual phase can create ‘extreme PMS’ which can then be confused with PMDD.
How is PMDD diagnosed?
Cycle tracking is crucial when it comes to getting a diagnosis for PMDD, because doctors will want to see these symptoms playing out for at least two cycles. Having at least 5 symptoms that show up in the 7-10 days before your period, that disappear within a couple of days of bleeding and are not present at other times in the cycle is a good indicator for PMDD.
How is PMDD treated?
For some, medical intervention will be necessary in the treatment of PMDD, such as anti-depressants. In some cases, doctors will also suggest hormonal options, most commonly the pill, because they flatten your hormonal fluctuations. Of course, when/if you decide to come off the pill, it may well be that the symptoms are still very much there. Therapy can also be a great option as part of treatment.
Like PMS, PMDD can be managed by looking at your lifestyle, overall health and wellness. Things like:
Movement and exercise
Cutting out processed/junk foods/sugars
Prioritising sleep
Reducing stress
Reducing alcohol and/or drugs
Menstrual Cycle Awareness and living cyclically
Mindset work
The severity of PMDD and the circumstances of your life will play a big role in what your treatment looks like. The most important thing to remember, is that help is available and you do not, and should not have to be crippled by your premenstrual phase.
How can Menstrual Cycle Awareness help?
Most of us do not live cyclically. We overpack our diaries, push wellbeing to the side and generally exert ourselves to the maximum. If it sounds wishy-washy to consider that living cyclically can help, its worth remembering that our hormones affect everything. And the more we can do to support them, the better our cycles will be. Learning to rest, to listen to your body, to work with your inner critic and inner world will do a LOT in relieving tension and frustration while helping you to create a life for yourself that supports your cycle.
I would recommend Menstrual Cycle Awareness as an absolutely integral part of treatment, alongside any talk therapy or medical treatment. While I’ve worked with clients who manage their PMDD with MCA alone, I do still think its a good idea to use it in tandem with something else,
What to do if you think you have PMDD
The first thing to do, is to tell your doctor. Be prepared that they may not know what it is, so go armed with information e.g. this page from the NHS. Start tracking your cycle and symptoms if you’re not doing this already, so that you can show them the pattern of it coming in your premenstrual phase and leaving with your period.
Most importantly, if you’re having thoughts about harming yourself or anyone else, call your emergency service, go to A& E or call a charity like The Samaritans. Remember that this is not you, it is a condition that can be treated.
If you’re struggling with your cycle and would like to see how coaching can help, schedule your free 30min call with me or check out my coaching space.