PMS vs. PMDD

You know it’s that time of the month when you’re on edge and everything around you acts as a ticking time bomb for your emotions. No, you’re not crazy. No, you’re not overdramatic. And no – you’re definitely not the only one because it happens to most of us women!PMS is a term that is often thrown around in general chit-chat and even is the feature of some memes. Some believe it to be a myth, others simply deny its existence altogether. The truth of the matter is that PMS – or premenstrual syndrome – is very real and the symptoms we face vary from person to person. When the symptoms are severe enough to affect day-to-day life, we call this premenstrual dysphoric disorder or PMDD.So, what is PMS anyway? As its name implies, premenstrual syndrome is a set of symptoms that arrives a few days prior to your period. Once you start menstruating, the symptoms slowly start to disappear and by the end of the period they’re completely gone.

Generally, PMS can start 5-10 days before the period arrives, during the luteal phase of the menstrual cycle. Low moods are probably one of the most widely known symptoms of PMS however PMS is more than just irritable mood swings; it is a set of different symptoms that can include:

• Breast tenderness
• Headaches
• Mood swings
• Poor concentration
• Weight gain
• Increase in certain food cravings
• Fatigue
• Muscle and joint pains
• Bloating

What causes PMS?

The medical community still are not sure as to what exactly causes PMS. It was once thought that PMS was associated with low levels of circulating estrogen and progesterone. However, this medical opinion has now changed and it’s agreed that PMS is caused by more than the fluctuation of certain sex hormones (although this is still a big factor). We now know that the neurotransmitter serotonin (a chemical messengers that go between nerves) and its low levels also play a major part in PMS as do other hormones such as the stress hormones, cortisol and adrenaline. All of these hormones are deeply intertwined to bring about the classic premenstrual syndrome symptoms – or at least that’s what we’ve found out till now! There is no exact cause established but that doesn’t make PMS any less real.

How do know if I have PMS?

Most women don’t need a formal diagnosis to know they are going through their PMS. In fact, your friends and family around you might be able to tell when you’re having PMS. Statistics show that 75% of women only have mild PMS symptoms so diagnosis can often be tricky. There is no scientific way to determine whether you conclusively have PMS apart from your menstrual cycle history. Your doctor will most likely be able to confirm if your symptoms are related to PMS or some other underlying problem through careful history and examination. Mild symptoms are often not worrisome and only last for a short time. But if your symptoms begin interfering with your daily life (see PMDD below!) it’s a good idea to visit your GP!

What is PMDD?

A small percentage of women experience more than just your average PMS symptoms. If you’re one of those few, you know what we mean. PMDD or premenstrual dysmorphic disorder is a much more severe form of PMS that can interfere with your daily life. Telling PMDD apart from PMS is often a challenge clinically but there are certain stark differences between the two. It’s often hard to differentiate PMDD from other mental health conditions such as depression but since PMDD is short-lived and the symptoms come about 5-11 days before your period depression and anxiety can be ruled out.

What causes PMDD?

Like PMS, the exact cause of PMDD is still a mystery. The cyclic hormonal changes and fluctuations in the brain neurotransmitters probably have a role in the development of PMDD as they have in PMS. More importantly, low levels of serotonin in response to the changes in a woman’s body probably have a more significant role in PMDD than PMS.

How is PMDD Different from PMS?

The spectrum of symptoms in both PMS and PMDD is largely the same but the most important difference between the two is an interference with daily life and normal activity in PMDD. Women with PMDD often have more severe feelings of hopelessness or depression, intense anger, tension, and a decrease in interest in usual activities. In PMS, however, the symptoms can be distressing but not severe enough to come between your daily activities. If you feel like your premenstrual symptoms are changing your perception of life, making you lose interest in work and your usual routine, you could be suffering from PMDD. Do go and speak to your doctor or psychiatrist if this is the case.

How is PMDD diagnosed?

Unfortunately, conditions like PMS and PMDD still pose a challenge in diagnosis. Because every woman feels and experiences symptoms on her own scale and mindset, it’s often difficult to understand the severity of the symptoms and rule out PMDD. One study suggests that the most telling signs to meet the criteria for PMDD include having at least five of the following symptoms: depression, decreased interest, anxiety, difficulty in concentrating, breast tenderness and swelling, irritability, food cravings, trouble sleeping and feeling out of control. To meet the above mentioned criteria, at least one mood symptom must be present and the symptoms should be severe enough to come in between your usual routine and daily activities

.Perhaps the most important way to differentiate between PMDD and depression is the fact that the low moods associated with PMDD come only at a certain time period (that is sometime between ovulation and the start of your period), and disappear in the first 14 days after your period (when you ovulate/release an egg)It’s a good idea to keep track of your symptoms with a monthly diary record since to fully establish the PMDD diagnose, a minimum of 2 months of recurring severe premenstrual symptoms are needed.

Is There a Way Out? How is PMS and PMDD Treated?

We get you – the mood swings and physical pains that come with PMS or PMDD are something that can be generally disturbing. Nobody wants to feel blue with sore breasts or joint pains. The good news is that the symptoms are temporary. Start by tracking your symptoms daily to understand when exactly are you experiencing physical, behavioural or mood changes. For example, it can help you remember that the week before your period, you were feeling more irritable than usual and had some pretty painful breast pain that you had to take some time off work. Tracking is also useful to share with your doctor and to track your improvement over time! If you suffer from only mild PMS symptoms the first step is to consider changing your lifestyle: taking up exercise, tweaking your diet, reducing caffeine and shifting to a healthier one might also improve your PMS symptoms. If you feel as if your symptoms are coming in the way of your daily life, you might want to turn to proper medical treatment. Along with modifying your lifestyle, visiting your local GP or a gynaecologist or a psychiatrist is a good idea.If you suffer from severely low moods and PMDD, anti-depressants might also help to improve your moods. A particular class of anti-depressant called, selective serotonin re-uptake inhibitors (SSRIs) are a class of drugs that increase the level of serotonin in your blood which has a direct mood-elevating effect

You’re Not Alone!

One thing’s for sure – PMS or PMDD are pretty real and not simply myths or excuses we use. It’s high time we acknowledge the symptoms and severity of this syndrome and act more compassionately towards those who are suffering from it. At the end of the day, we all know these symptoms can be pretty darn troublesome. Just remember that you’re not alone and we’re all in this together!

Sources:

1. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780
2. https://www.invivoclinical.co.uk/invivo-education/articles/pms–more-than-just-your-hormones
3. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
4. https://www.webmd.com/women/pms/pms-vs-pmdd#1
5. https://academic.oup.com/jcem/article-abstract/68/1/125/2653308
6. https://www.ncbi.nlm.nih.gov/pubmed/29386943
7. https://www.aafp.org/afp/2002/1001/p1239.html