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Is It PMS—or Do You Actually Have PMDD?

Many who have PMDD may think they just have PMS, but the two are different.


First and foremost, “just” PMS is a bit of a misnomer. Anyone who has experienced, as the Mayo Clinic so helpfully reminds us, anxiety, depression, crying spells, mood swings, irritability, anger, appetite changes, food cravings, insomnia, poor concentration, change in libido, and, a personal favorite, “social withdrawal”—more commonly known as isolating with Netflix all day—knows that PMS is not “just” anything, except maybe just horrible.

But PMS has a cruel cousin, PMDD (premenstrual dysphoric disorder), which is a more intense syndrome that can cause damage to little things like your personal relationships and your work life. So we tapped Kecia Gaither, MD, MPH, FACOG, the director of perinatal services at NYC Health + Hospitals/Lincoln, who is double board-certified in OB/GYN and maternal fetal medicine, for a little more info about the differences between PMS and PMDD—and how to find out what you have and what to do about it.

“PMDD is a severe form of PMS which can potentially negatively impact a woman’s ability to function,” Gaither tells us. “The main distinguishing factor between PMS and PMDD is the dominance of specific emotional and behavioral symptoms.” While PMS certainly has emotional symptoms—anyone who’s spent a perfectly good Tuesday on a crying jag for no good reason the day before their period knows this all too well—PMDD carries with it more debilitating emotional and behavioral disturbances.

Gaither tells us these include “anger, anxiety, restlessness, crying spells, irritability, paranoia, suicidal ideation, feeling out of control, forgetfulness, moodiness.” At first glance, that list sounds an awful lot like the PMS laundry list from the Mayo Clinic—anger, anxiety, crying spells, moodiness, irritability, check, check, check, check, check.

But where PMDD diverges from PMS is in the fiercer symptoms: paranoia, suicidal ideation, feeling out of control. These are feelings that, even just once, can be dangerous or even life-threatening, but monthly occurrences could be truly unmanageable.

PMDD goes hand in hand with other mood disorders, Gaither says. “It’s thought that these symptoms are secondary to monthly hormonal changes exacerbating an already underlying psychological issue,” like depression or anxiety, she says.

With PMDD, it’s not just emotional and it’s not just physical—it’s the whole package. “These emotional symptoms in relation to the physical changes normally seen in PMS—bloating, breast tenderness, cramps, gastrointestinal issues, painful periods—are exacerbated to the extent it gets in the way of daily activities of living,” Gaither says.

If you suspect you might be dealing with PMDD, it’s a good idea to “see both a psychiatrist and an OB/GYN in tandem,” she says. “There’s no specific test to assess for PMDD and no single treatment.” Rather, your doctors will need to hear your symptoms and evaluate accordingly.

“Physicians will consider a diagnosis if you experience at least five of the emotional symptoms seven to 10 days prior to the onset of menses,” Gaither says. But there is a bit of good news: There is treatment for PMDD, so if you’re suffering, you don’t have to be.

“Treatments range from seeing a therapist, engaging in cognitive behavioral therapy, exercising, avoiding stresses, decreasing foods high in sugar and salt, and eating foods high in tryptophan,” Gaither says. In particular, she suggests eggs, fish, nuts, chicken, whole grains, pineapples, tofu, and turkey.

“Tryptophan, an amino acid, helps to increase serotonin in the body,” Gaither says. “Serotonin is a chemical messenger in the body which is felt to act as a mood stabilizer. It’s known that tryptophan depletion is seen in many mood disorders like depression and anxiety.”

If you’re experiencing even just a few of the debilitating symptoms of PMDD, it likely won’t be enough to just eat more nuts and fish and call it a day. But it’s encouraging to be reminded that we really are what we eat, and the nutritional choices we make really do affect what’s going on with us, not just physically but emotionally, too.

As with any medical issue, it’s best to hit up your doctor sooner rather than later to get a full sense of what’s really going on—these symptoms could also be the sign of something more serious than PMDD. In the meantime, knowledge is power, and if one person out there is learning more about their health—and the difference between the dreaded PMS and even more terrible PMDD—that’s good enough for us. 

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