Emotional, bloated, quick to anger, insatiable appetite for sugar or carbs … the signs of premenstrual syndrome or PMS are probably pretty familiar to most of us.

In fact, as much as 90 percent of us may deal with the monthly roller coaster of PMS, says the US Department of Health and Human Services, and most of us are able to ride it out with ibuprofen and some quality alone time.

However, around 5 percent of women have a much rougher time with a more aggressive form of PMS called premenstrual dysphoric disorder or PMDD. PMDD can be severe enough to disrupt work, daily life, and relationships.  

What’s happening in my body?

After ovulation, hormone levels decline. This week or two before the period are known as the “luteal” phase. This decline of hormones can trigger the physical and emotional symptoms that are the hallmark of PMS and PMDD.

During this phase, women may experience irritability, sadness, anxiety, mood swings, fatigue, poor concentration, sleep issues, and food cravings. Physical symptoms can include bloating, cramps, breast tenderness, acne, and headaches.

Usually the onset of menstruation signals the end of PMS or PMDD for now, and the cycle begins again.

How are PMS and PMDD different?

PMS and PMDD are very similar in the symptoms women can experience. What differentiates them is a matter of degree.

For most women, PMS is uncomfortable and unwelcome, but it’s manageable. Over-the-counter medications like Midol plus a hot water bottle and some patience are often enough to ride it out.

PMDD is characterized by the severity of symptoms and the disruption it causes in a woman’s life. Women suffering from PMDD are far more likely to need to miss work due to symptoms or to have difficulty in their relationships.

While the exact mechanism of PMDD isn’t really known, it’s thought that a small percentage of women are more sensitive to the hormonal changes going on in their bodies.  

How is PMDD diagnosed?

There aren’t really tests that tell a woman she’s experiencing PMDD; generally it’s diagnosed by the presence of symptoms and whether or not those symptoms occur regularly and at particular points in her cycle.

According to Hopkins Medicine, if a woman experiences at least five of the following symptoms, during “most” menstrual cycles, for one year, she is suffering from PMDD. [quoted from HopkinsMedicine.org]

  • 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, the most common being belly bloating, breast tenderness, and headache

Additionally, says Hopkins Medicine, symptoms interfere with a woman’s social, home, or work life and are not caused by or worsened by another medical condition, such as thyroid disease.

Perhaps the most important thing to understand is that PMDD is real and it is biological as well as psychological. According to the Massachusetts General Hospital (MGH) Center for Women’s Mental Health, women with PMDD may have an issue with neurotransmission during parts of their cycle. Feel-good neurotransmitter serotonin appears to be compromised in women with PMDD, and other brain chemicals are also suspected to play a role in the development of PMDD.

Is it really worse in perimenopause?

Both PMS and PMDD can worsen during the years of perimenopause. The symptoms may be more severe, and as periods become increasingly irregular, symptoms can be more frequent and certainly much less predictable, making PMDD harder to manage.

Fortunately, PMS and PMDD generally resolve in menopause, when hormones finally level out and the body adjusts to its new normal. However, that doesn’t mean women have to suffer with disruptive symptoms for years, waiting for the end of periods.

How to treat PMDD

There are lifestyle changes that help women with PMDD symptoms, and they’re the usual line-up: good sleep, no smoking, exercise (this is particularly important), and reducing alcohol, coffee, sugar and salt. Women are also encouraged to track their PMDD symptoms against their cycles, though in perimenopause, that may not be as useful as it is for women whose periods are still regular.

According to the MGH Center, adding supplements of calcium, Vitamin B6, magnesium, and Vitamin E may help ease symptoms. For those looking for herbal remedies, chasteberry seems to be the most useful.

For medications, the first option may be SSRI antidepressant, which can be effective against physical and psychological symptoms, even in low doses.

Alternatively, many women find relief with oral contraceptives like the Pill. As a last resort in very extreme cases, a doctor may recommend a hysterectomy with an “add-back” of the hormone estrogen.

If you’re experiencing new or worsening symptoms, and they’re impacting your quality of life, talk with a doctor. PMS and PMDD are very real medical conditions, and PMDD really should be diagnosed properly so you can determine a course of treatment.

Too often we dismiss or belittle women’s pain and suffering, and that’s neither right nor necessary. There are treatments and behaviors that can make a real difference to a woman’s experience of PMDD. Talk to your doctor or make an appointment to consult with one of genneve’s physicians or nurse practitioners via our telemedicine service.

Do you have PMDD? Did it get worse in perimenopause? If you had it previously, did it end with menopause? Tell us about your experience. Leave a comment below, on our Facebook page, or in midlife & menopause solutions, our closed Facebook page.


Shannon Perry

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