Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

On this page:
Differences between PMS and PMDD
Signs & symptoms
Treatment options
Print resources
Online resources

Some women experience discomfort with the monthly onset of menstruation. These symptoms (referred to as premenstrual syndrome or PMS) can range from general moodiness to severe bloating and cramping. For some women, however, the symptoms of PMS can take on a much more severe form and actually be related to another condition, called premenstrual dysphoric disorder (PMDD). It's important to differentiate between these two conditions. PMDD can be quite disruptive if left untreated.

If you think your monthly symptoms are more intense than regular PMS, you may want to discuss the possibility of PMDD with your health care practitioner.

Differences between PMS and PMDD

PMS is experienced by about 40% of women in their child bearing years. It can cause physical and/or emotional symptoms that appear 7 to 10 days before menstruation. In contrast, only 3% to 5% of menstruating women have PMDD.

Causes of PMDD
A few studies suggest that women with a personal or family history of postpartum depression, unipolar depression, and mood changes brought on by oral contraceptives may be at greater risk of developing PMDD.

Signs and symptoms of PMS

• Bloating
• Headaches
• Irritability
• Weight gain
• Food cravings
• Mood swings
• Fatigue
• Breast tenderness
• Tearfulness

Every woman affected by PMS will present a different combination of some of these symptoms. Their symptoms may also differ from month to month.

Signs and symptoms of PMDD:
Unlike PMS, PMDD symptoms are very severe, completely disrupting the lives of the women affected by it. Women diagnosed with PMDD usually present 5 or more of the following symptoms:

• Very depressed mood, feelings of hopelessness
• Anxiety, tension, feelings of being "on edge"
• Mood shifts (e.g., suddenly feeling tearful or extremely sensitive)
• Persistent anger or irritability or increased interpersonal conflicts
• Decreased interest in usual activities (e.g., work, school, friends, hobbies)
• Difficulty concentrating
• Fatigue, tiredness, loss of energy
• Change in appetite, overeating, food cravings
• Insomnia (difficulty sleeping) or sleeping too much
• Feeling out of control or overwhelmed
• Physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain, "bloating," weight gain.

These symptoms do not necessarily occur every month, but they are present in the majority of months. Some months may be worse than others.

For an accurate diagnosis of PMDD, it is important to keep a Mood Chart, also known as a Daily Record of Severity of Problems (http://www.pmdd.factsforhealth.org/drsp/drsp_month.pdf) for at least two consecutive months. Also, it is important to have a complete medical evaluation and laboratory tests in order to rule out other possible medical problems.

Treatment options

There are 3 main approaches that can be used to alleviate the symptoms of PMDD.

Psychological

• Stress reduction
• Cognitive-behaviour therapy
• Relaxation techniques

Healthy Life Style

• Dietary changes
• Reduce or stop smoking
• Exercise
• Vitamin therapy

Medications

• Antidepressants
• Anti-anxiety medication
• Hormone therapy

For a list of places where you can get treatment and/or find a doctor, click here.

If you aren't sure where to begin, you can learn more about your choices and figure out which treatments might be best for you. To learn more click here.

 

Print resources

1. Concise Guide to Women's Mental Health by Vivien Burt and Victoria Hendrick, American Psychiatric Publishing Inc., Second Edition, 2001.
2. DSM-IV-TR - Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Fourth Edition, 2000.
3. PMDD: A guide to coping with Premenstrual Dysphoric Disorder by James E. Houston and Lani C. Fujitsubo. New Harbinger Publications, Inc., First Edition, 2000.
4. The PMDD Phenomenon by Diana L. Dell and Carol Svec. McGraw-Hill, 2002.

 

Online resources

Centre for Research in Women's Health
www.crwh.org

PMDD and Menstruation
www.pmdd-and-menstruation.com

Facts for Health
www.pmdd.factsforhealth.org

 

Sources

1. Burt, Vivien and Hendrick , Victoria , Concise Guide to Women's Mental Health. American Psychiatric Publishing Inc., Second Edition, 2001.
2. DSM-IV-TR - Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Fourth Edition, 2000.
3. Houston, James E. and Fujitsubo, Lani C., PMDD: A guide to coping with Premenstrual Dysphoric Disorder. New Harbinger Publications, Inc., First Edition, 2000.
4. Medem - Medical Library
   http://www.medem.com   (keyword search: PMDD)
5. Facts for Health - PMDD
   www.pmdd.factsforhealth.org