PMS stands for Premenstrual Syndrome and refers to behavioral and physical symptoms that appear in a pattern every cycle. These symptoms can occur one or two weeks before the period begins and resolve when the bleeding starts. Some symptoms are breast tenderness, mood swings, depression, acne, bloating, and diarrhea. These symptoms can undergo a change over age and time. To understand what the exact symptoms of PMS are, a woman must note down the physical and emotional symptoms for a few months. Most symptoms will be recurring over a period of time, and the most common ones are the woman’s symptoms.

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PMDD stands for the premenstrual dysphoric disorder, and it is a more severe form of PMS. It affects around 1.8% to 5.8% of women, and it can be a disabling factor. This disorder includes somatic, affective, and behavioral symptoms that occur in the luteal phase in every cycle. It affects women of childbearing age, from teens to menopause. It may not affect pregnant women, those who are breastfeeding, or those who suffer from hypothalamic amenorrhea. The symptoms may onset around six days before menstruation, and women may not feel relief until a few days after menstruation ends.

Common symptoms between both disorders include depression, irritability, internal tension, and anger. These are severe and can interfere in day to day life. A mild form of PMS is common in 75% of women who have regular menstruation. PMDD affects around 3%-8% of women. This condition can affect women from any and all ethnic, cultural, or socioeconomic backgrounds. PMDD is a chronic condition and can seriously impact a woman’s quality of life. Self-care measures and various treatments are available to control the symptoms in most women.

Causes of PMS vs. PMDD

The tissues in the body are quite sensitive to hormone levels, which change throughout a woman’s menstrual cycle. Studies say that the changing levels of hormones such as estrogen and progesterone can influence chemicals in the brain – like serotonin, which can affect moods. It isn’t completely clear as to why some develop PMS or PMDD while others do not, even though the levels of hormones in the observed women are similar. However, it is believed that some women experience PMS or PMDD as they are sensitive to changes in hormone levels.

  • PMS

 PMS is usually linked to the luteal phase in a menstrual cycle, although its exact causes aren’t very clear. Changing hormone levels are considered as an important factor, but some say that the loss of progesterone, which is a depressant for the central nervous system, is at the base of PMS. Stress, emotion issues, chemical changes inside the brain are seen to make PMS worse, but not really cause it.

High alcohol sodium, caffeine levels, and low minerals and vitamin levels can exacerbate symptoms such as bloating and water retention. PMS is more common or more evident in women who are between the ages of 20-40, have children, family medical history of depression and have suffered from mood disorders or postpartum depression in the past. Some suggested causes of PMS include:

  • changes in carbohydrate metabolism
  • excessive aldosterone
  • hyperprolactinemia
  • progesterone-estrogen imbalance
  • low levels of blood sugar
  • progesterone allergy
  • PMDD

Researchers have concurred that PMDD as a disorder is actually a biological phenomenon as well. Women with sensitivity to normal cyclical changes in hormone levels could be more disposed to PMDD. If a gonadotropin-releasing hormone is administered, then the women with PMDD may see that their symptoms have resolved, but they do come back when there is hormone add-back.

Fluctuations in progesterone and estrogen cause effects on central neurotransmission like dopaminergic, noradrenergic, and serotonergic pathways. Evidence implies that the serotonergic system is the reason behind PMDD. Women with PMDD have abnormal serotonin neurotransmission and a low density of serotonin transporter receptors. These are thought to cause symptoms like carbohydrate craving, depressed mood, and irritability. GABA or gamma amino-butyric acid may also have a role in PMDD. Women who could be sensitive to hormones are also sensitive to related metabolites. It is also found that women deficient in GABAergic inhibition may be more susceptible to PMDD. 

Treatment Options

Treatments for PMS and PMDD differ as PMDD is quite severe. If the symptoms are mild, then it can be managed with changes in lifestyle. Quality sleep, a good diet, reducing stress, and daily exercise can bring a lot of changes. In the case of mild to moderate PMS, the following can be done:

  • Drinking sufficient fluids to ease bloating
  • Supplements like vitamin B-6, folic acid, magnesium, and calcium reduces mood swings and cramps
  • Attending cognitive behavioral therapy is also known to reduce the symptoms
  • Taking vitamin D also helps ease symptoms

As PMDD is more severe, the doctor may prescribe certain medications to manage it. They are:

  • SSRIs – These antidepressants are prescribed as women with PMDD often experience depression. The selective serotonin reuptake inhibitors affect the brain chemical serotonin, and taking these medicines can relieve symptoms that affect the mood.
  • Birth control pill – Women who are on birth control pills don’t ovulate, which will reduce the PMDD symptoms. They also reduce physical symptoms like pain and aches.
  • Nutritional supplements – 1200 milligrams of supplements such as calcium and L-tryptophan may also help. Consultation with the doctor is advised.
  • Hormone suppressants – Analogs with gonadotropin-releasing hormone also reduce the severity of PMDD symptoms. Examples of this are nafarelin, goserelin, and leuprolide.
  • CBT or cognitive behavioral therapy is also shown to reduce the severity of symptoms.
  • The removal of the ovaries is also an option through surgery in extreme cases.

Differences in the Severity

  1. The first difference between PMS and PMM are general symptoms.

PMS is known for the following symptoms:

  • Emotional symptoms such as depression, sadness, anxiety, irritability, social withdrawal, confusion, and poor concentration.
  • Physical symptoms like swelling, bloating, breast tenderness, food craving, fatigue, headache, abdominal pain, stomach upset, or changes in the skin.

PMDD has similar symptoms, but one can see that the severity is different.

  • Sudden and exaggerated changes in emotion or mood.
  • A woman being overly critical of self and has feelings of hopelessness.
  • Increase in relationship conflicts, anger or irritability
  • Noticeable hardship in concentration.
  • Decreasing interest in normal activities.
  • A high lack of energy and severe fatigue.
  • Drastic and sudden changes in appetite, including overeating or cravings.
  • Feeling out of control or overwhelmed.
  • Inability to sleep or excessive sleeping.

2. Women may usually experience physical or emotional changes before they begin their period. The symptoms experienced depend on the woman’s environment and biology. The greatest difference between PMDD and PMS is the severity, and PMDD is defined as a very severe form of PMS. The changes are highly intolerable, causing significant negative impacts on a woman’s life.

Major Differences Between PMS and PMDD

As shown above, PMS and PMDD are quite similar, but in the case of PMDD, the severity of symptoms is too high. In PMDD, one of the following behavioral or emotional symptoms will stand out.

  • Marked anger or irritability
  • Tension or anxiety
  • Extreme moodiness
  • Hopelessness or sadness

If a woman needs to determine if she has PMS or PMDD, then the following questions may help.

  1. Is there a sudden change in the mood right before the period, like a few days before, and this seems to vanish once the period starts?
  2. Does one experience an overwhelming sense of hopelessness or feelings of depression before the period begins?
  3. Is there increased anger or irritability before the beginning of the period, and this feeling goes away when the period begins?
  4. Does one feel on edge or anxious just before the period?
  5. Is one unable to concentrate during this time?
  6. Does the woman not have an interest in regular activities prior to the period?
  7. Are there huge changes in eating habits at this time in relation to the period?
  8. Does one feel extremely tired prior to the period?
  9. Does the woman feel too overwhelmed before the onset of the period?
  10. Is there trouble sleeping right before the period starts?

If a woman has answered “yes” to more than five questions above, then she could possibly be suffering from PMDD. The best course of action is to visit a women’s healthcare specialist for proper diagnosis and treatment.