What Is PMDD, and How Is It Different From PMS?

If you've ever experienced extreme fatigue, bloating and mood swings right before your period, you may have had premenstrual syndrome, or PMS.

PMS is a common condition, affecting about 3 in 4 people who menstruate in the U.S. at some point in their lifetime, per the U.S. Department of Health & Human Services' Office on Women's Health. Generally, most people say PMS symptoms are mild and they are still able to get through their day.

There is, however, a more severe form of premenstrual syndrome called PMDD, or premenstrual dysphoric disorder, that affects about 10 percent of people who menstruate, per the Cleveland Clinic.

PMDD is much more disruptive to daily living and is characterized by several different physical and mental symptoms. In fact, the condition is recognized in the Diagnostic Statistical Manual of Mental Disorders (DSM-5), and it's often diagnosed by your gynecologist or a psychiatrist.

Here, learn about the symptoms and causes of PMDD, how it's different from PMS, treatments for PMDD and how to find support.

PMDD is a more serious form of premenstrual syndrome that causes physical and emotional symptoms the week or two before your period, according to the Cleveland Clinic. Once your period arrives, you begin to feel better.

PMDD is technically a mental disorder caused by certain hormone fluctuations right before your period begins.

Technically, this disorder is a mental disorder, which arises in the presence of certain natural hormone fluctuations right before your period begins.

In people who menstruate, progesterone and estrogen are constantly fluctuating throughout their menstrual cycle.

"In your luteal phase, which comes right before your period, your levels of progesterone significantly increase, while estrogen decreases, leading to many unwanted symptoms like bloating and headache," says Annelise Skor Swigert, MD, board-certified ob-gyn at Premier Ob-Gyn of MN and Clinical Advisor at Frame Fertility.

This fluctuation of progesterone may directly alter the level of another important hormone in your brain — a neurotransmitter called serotonin — which regulates mood, hunger and sleep, per the Cleveland Clinic.

"Once you do get your period, progesterone begins to decrease again, which can often feel like a weight lifted off your chest," Dr. Swigert says. "It offers relief from mental and physical symptoms."

Hormone fluctuations may cause a decrease in serotonin levels in some people, leading to PMDD symptoms — but experts are not exactly sure why.

"Some people are simply more sensitive to the natural hormone fluctuations happening in their body than others," Dr. Swigert says.

You are more at risk of developing PMDD, however, if you have the following, per Johns Hopkins Medicine:

• A family history of PMS or PMDD
• A personal or family history of depression and postpartum depression
• Another mental illness

There are also some studies that suggest a link between trauma (particularly early childhood trauma, sexual trauma or abuse) and developing PMDD later in life, per a February 2022 review in ‌Psychiatry Research‌. However, more research needs to be done on this connection.

"The symptoms of PMDD are often emotional and physical, and similar to PMS in nature," says Perri Shaw Borish, MSS, LCSW, a clinical social worker at Whole Heart Reproductive Mental Health in Philadelphia.

Some common mental symptoms may include the following, per Johns Hopkins Medicine:

• Irritability
• Nervousness
• Impulsivity
• Insomnia
• Difficulty concentrating
• Depression (and, sometimes, suicidal ideation)
• Severe fatigue
• Anxiety
• Confusion
• Forgetfulness
• Poor self-image
• Paranoia
• Crying spells
• Mood swings

Some physical symptoms could include the following, per Johns Hopkins Medicine:

• Swelling of the ankles, hands and feet
• Bloating
• Breast tenderness and pain
• Vision changes
• Cramping
• Constipation
• Nausea
• Vomiting
• Pelvic pressure
• Backache
• Acne
• Itchy skin
• Appetite changes (and food cravings)
• Hot flashes
• Nighttime sweating
• Headache
• Dizziness
• Decreased coordination
• Diminished sex drive
• Painful menstruation

You may not feel all these symptoms every time, and some months may feel harder than others, as life circumstances like stress, work and home life can exasperate symptoms, Borish adds.

One of the biggest differences in the two is the ability to carry on your daily life, Dr. Swigert says. If you struggle with your work, social life, family life or other relationships, or daily activities like sleeping, eating or exercising are a challenge, then you're likely experiencing PMDD rather than just PMS.

Often, PMDD will cause severe mental issues that are often mistaken for major depressive disorder and even bipolar disorder in psychiatric settings. Some people even experience suicidal ideation during this time, per Harvard Health Publishing.

Another potential difference between PMS and PMDD is the method with which PMDD is diagnosed. This can look different depending on if you're being diagnosed by your ob-gyn or a mental health professional.

Dr. Swigert will often use forms such as the Patient Health Questionnaire 9 (PHQ-9) for depression and the Generalized Anxiety Disorder 7 (GAD-7) form for anxiety to have patients rank the severity of their symptoms.

If you go to a psychiatrist about PMDD, they will use the DSM-5's criteria for diagnosis, which includes:

• Experiencing at least five symptoms before your period for the last year
  
• Symptoms occurring in the final week before your period
• Symptoms improving within a few days after menstruation begins

"When you look at mental health, it's often on a continuum, and when you look at pre-menstrual syndrome, it's often the same," Dr. Swigert says. "All people who menstruate experience the same kinds of symptoms to varying degrees. If it's significantly interfering with your life, (in other words, PMDD), then it's time to discuss treatment options."

While more research needs to be done regarding specific medications for PMDD and its symptoms, there are a few treatment options that are considered the front lines of defense for people dealing with the condition. They include:

SSRIs — or selective serotonin reuptake inhibitors — are a class of antidepressant medications that are considered one of the best treatment options for PMDD, per Harvard Health Publishing.

Common SSRI medications include Prozac, Lexapro, Paxil, Zoloft and Celexa.

These medications are typically prescribed to people experiencing depression, anxiety or obsessive-compulsive disorder (OCD), but they can also be given to those experiencing hormonal issues and pain, per the Mayo Clinic.

Another upside: If you're taking them for PMDD, you may not need to take them every day. "You can treat patients with SSRIs during just the luteal phase of their cycle, meaning they would take medication in the week or two leading up to their period, and then stop until next month," Dr. Swigert says.

Another option for treating PMDD is getting on hormonal birth control.

Depending on the method you choose, birth control medication may stop you from ovulating and/or menstruating, leveling out the fluctuations of hormones you'd typically experience (which is what causes PMDD symptoms), per the Mayo Clinic.

"More than half of the time gynecologists prescribe birth control, it is to manage other symptoms that are hormonally driven," Dr. Swigert says. This includes heavy bleeding, painful periods or a mood dysfunction.

In fact, two birth control pills are specifically FDA-approved to treat PMDD: Yaz and Yazmin, per the Mayo Clinic. Dr. Swigert says they're made with a type of progesterone — called drospirenone — that is highly effective.

"Getting people on a birth control pill that stabilizes hormones often goes a long way in helping to get relief," she adds.

"We know without question that lifestyle changes surrounding this time of month can go a long way in alleviating symptoms," Dr. Swigert says.

Caffeine and alcohol significantly exacerbate PMS and PMDD symptoms, Dr. Swigert says, so cutting back on both during this time can help.

You can also aim to eat foods high in calcium, like yogurt or almonds, to help with symptoms, per the Academy of Nutrition and Dietetics.

Exercise is another addition that can significantly improve your mood and alleviate mental and physical symptoms. Even if you're particularly fatigued, Borish suggests trying light movement.

"Yoga or just going for a walk could help," she adds.

One of the best ways to help cope with a PMDD diagnosis (or any medical diagnosis, really) can simply be talking it out.

"That's why therapy — especially cognitive behavioral therapy — is recommended," Borish says. "This can help you identify and decrease stressors in your life, which will help reduce overwhelm and anxiety."

If you prefer to take a more natural approach to treatment, there are a few options you can try. Just make sure to talk with your doctor prior to trying any herbs or natural remedies to make sure they're safe for you.

And keep in mind that the FDA does not regulate vitamins or herbal supplements, so you'll want to keep an eye out for any red flags that a supplement is unsafe or ineffective before purchasing.

‌Magnesium‌

Magnesium may relieve breast tenderness and soreness associated with PMDD. You may notice symptom relief if you take magnesium supplements up to two weeks before your period, per the Cleveland Clinic.

‌Vitamin B6‌

Some studies have suggested that taking 100 milligrams of vitamin B6 daily can help alleviate premenstrual syndrome, per Mount Sinai.

Vitamin B6 is known to help brain health and development, including making neurotransmitters — the chemical messengers in the body like serotonin and dopamine, per the Cleveland Clinic. This could be why it's thought to be a potential treatment.

‌Chasteberry‌

Chasteberry is a fruit from the chaste tree, and it's considered a natural remedy for PMS that has been used for thousands of years. It's believed to work by reducing inflammation and balancing hormones, per the Cleveland Clinic.

While research is limited, one January 2001 study in the ‌BMJ‌ found that taking a daily 20-milligram chasteberry tablet for three months was associated with reduced PMS symptoms. (Note: This study is old. More research needs to be done to prove causation.)

This is why chasteberry is considered for PMDD treatment, too.

‌St. John's Wort‌

This herbal supplement is often taken to relieve depression. And although it hasn't been studied for treating PMDD specifically, some research suggests St. John's Wort may alleviate premenstrual issues like mood swings, depression and anxiety, per the Cleveland Clinic.

The typical dosage of St. John's Wort is 300 to 400 milligrams in capsule form, but you can also find the herb in tincture, tea, ointment or gel form, per the Cleveland Clinic.

‌Acupuncture‌

One July 2011 review in the ‌British Journal of Obstetrics and ‌‌Gynaecology‌ found that acupuncture shows potential in relieving PMS symptoms like pain and bloating. But more research is needed to prove this effect.

That said, acupuncture is fairly low risk and could be a great way to relax. Any body work, like massage or stretching, could potentially help ease pain and soreness you feel before and during menstruation.

Finding a doctor that specializes in treating PMDD may not be easy, but it is certainly possible.

To start, you can Google search "PMDD specialists near me" and locate some nearby practitioners (whether gynecologists, primary care doctors or psychiatrists) and contact them. You can also check out a provider's reviews online from other patients prior to making your decision.

Typically, doctors will mention in their online bio that they specialize in premenstrual syndrome or PMDD, but if not, you can call their office to ask.

Often, people with PMDD will see multiple doctors or specialists to treat their physical and mental symptoms.

If your insurance does not cover this type of care, you can call local community health centers, community mental health centers or your local Planned Parenthood chapter to see if they provide free or low-cost care.

PMDD can feel like an isolating experience, but there are online resources and forums where you can connect with other people going through the same thing. Some websites that offer support include:

• IAMPMD.com, which has video support groups you can join
• Vicious Cycle: A patient-led project bringing awareness to PMDD
• MevPMDD App: A symptom tracker with more resources
• PMDD Facebook Group

"It's important to remember there is help out there and you are not alone," Borish says. "It's really worth talking to your doctor about how you're feeling and figuring out a plan to help you feel better and thrive."