When It’s More than PMS: The Signs You Shouldn’t Ignore

For many women, the week before our periods can bring on mood swings, cramps, fatigue, irritability – all common, though frustrating, symptoms associated with premenstrual syndrome (PMS). But for some of us, these symptoms can be so extreme that it can completely alter our quality of life. If your PMS symptoms are interfering with your ability to carry on with your day-to-day activities, you may have a more severe form of PMS, known as premenstrual dysphoric disorder (PMDD).

Unfortunately, the symptoms of PMDD may be overlooked or incorrectly diagnosed. But, thanks to women’s health advocates and dedicated researchers we now have a better understanding of how to diagnose and treat PMDD, offering hope for many who may have been suffering in silence.

What is PMDD?

For those who are living with PMDD, it’s often described as “hell week” when the symptoms hit. You feel like you become a completely different person for one week, every month. Your mood, personality, and outlook on life changes drastically. You can feel completely hopeless.

PMDD affects up to 8% of women during their reproductive years, with symptoms typically occurring during a woman’s twenties. PMDD is a hormone-based mood disorder that occurs during the premenstrual phase and subsides within a few days of menstruation.

The exact cause of PMDD is unknown, but it’s believed that women with PMDD are more sensitive to the hormone changes around their period. The increasing levels of estradiol and/or progesterone may trigger the negative symptoms associated with PMDD.

How is PMDD diagnosed?

Because the symptoms of PMDD so closely mirror PMS, it can be hard to diagnose. What’s different, however, is the severity to which these symptoms are felt. It can feel unbearable to cope. These symptoms can include:

• Depressed mood
• Anger or irritability
• Trouble concentrating
• Lack of interest in activities once enjoyed
• Moodiness
• Increased appetite
• Insomnia or the need for more sleep
• Feeling overwhelmed or out of control
• Other physical symptoms, including belly bloating, breast tenderness, and headache

PMDD may also appear similar to other mood disorders like major depression or bipolar disorder. However, what sets it apart is that it appears cyclically during the 1-2 weeks before your period (the luteal phase). Therefore, timing and the severity of symptoms are key factors in diagnosing PMDD.

While this is no formal test to diagnose PMDD, your provider may ask you to keep a journal that documents your symptoms. It’s important to track these symptoms each month, for at least two full menstrual cycles.

To meet the criteria for a PMDD diagnosis, as outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

• You must have five or more severe symptoms (as outlined above) between the time of ovulation and your period
• These symptoms must go away during your period and not return for at least another couple of weeks when your next luteal phase starts
• These symptoms must also interfere with your work or school, your relationships with family, friends, and/or coworkers and your usual social activities

What treatments are available for PMDD?

PMDD won’t go away on its own, but there are treatments that may be able to help.

Lifestyle changes like regular exercise, a healthy diet full of lean protein and complex carbohydrates, and stress-relief/relaxation techniques are often recommended as a first step.

Your provider may also suggest you meet with a therapist who can perform cognitive-behavioral therapy (CBT). CBT can give you the emotional resources needed to handle the difficult feelings associated with PMDD.

When it comes to medication, the treatment landscape is ever evolving. It’s important to note that there is no single treatment that works for everyone with PMDD.

Currently, the first line of treatment for PMDD is an anti-depressant, specifically selective serotonin reuptake inhibitors (SSRIs), that work to increase serotonin levels in the brain. These have been found to work well in many women. Alternatively, oral contraceptives (birth control pills) may be prescribed to help offer symptom relief by helping to regulate the fluctuation of hormones around your period.

Most recently, researchers have also been evaluating a newer class of treatment known as a progesterone receptor modulators, which are also used for the treatment of fibroids and endometriosis. In clinical studies, the treatment reduced the mental symptoms of PMDD with up to half of women resolving their symptoms completely.

Finding Support For PMDD

Having a strong support system is crucial when dealing with the mental effects of PMDD – whether that’s joining an online support group or sharing your experiences with close family/friends.

Organizations like the International Association for Premenstrual Disorders (IMPD) offer further information, support, and resources for women living with PMDD.

Most importantly, don’t doubt your symptoms, and don’t be afraid to speak up. If you’re feeling off, there could be a biochemical cause behind what you’re experiencing. And as always, let your provider know if you’re experiencing symptoms as they can work with you to determine the best course of treatment.