After years of having a period, you may have grown accustomed to all the emotional and physical side effects that come with it before and during. In many cases, this could be premenstrual syndrome (PMS) as you know it, but read on to discover if what’s ailing you is just PMS or its more debilitating, severe, and overlooked extension: premenstrual dysphoric disorder (PMDD). 

Similarities between PMS and PMDD 


Premenstrual syndrome (PMS) refers to a group of physical and behavioral symptoms that occur in a cyclic pattern during the second half of the menstrual cycle. Premenstrual dysphoric disorder (PMDD) is the severe form of PMS. Common symptoms include anger, irritability, depression, and internal tension that are severe enough to interfere with daily activities. 

Those who have either PMS or PMDD may have similar symptoms ranging from the emotional, to physical, behavioral, and psychological. Individuals who have either condition may usually experience these symptoms around a week before they actually get their periods, and see them dissipate before their cycle ends. 

On the physical side, PMS and PMDD may cause cramps, fatigue, bloating, breast tenderness, and changes in sleep or appetite. However, what sets PMDD apart is its amplification of behavioral, emotional, and psychological symptoms that can cause a disturbance in relationships, career, and daily life. Individuals who have PMDD experience these symptoms more frequently and severely. 

Studies have shown that around 90% of women of reproductive age suffer mild to acute premenstrual symptoms. Breaking it down further, an estimated 20–40% of these women experience PMS, and 2–8% of them may be diagnosed with PMDD.

More on PMDD

PMDD can be so disabling and debilitating that it could significantly impact your quality of life. Extreme and intense moodiness, sadness, anger, and irritability could be signs of PMDD and set it apart from PMS. If you suspect that you have PMDD or have been diagnosed with it, you’ll find a stark contrast in your emotional and mental state leading up to your period and in the early days of it compared to any other time. 

PMDD symptoms can fluctuate and worsen during some menstrual cycles compared to others. Anxiety, elevated irritability, drastic moodiness, difficulty concentrating, depression, hopelessness, sadness, and sleep disturbance are characteristic of PMDD. 

Distinguishing PMDD

It’s easy to mistake PMDD with other mental health conditions, namely bipolar disorder, anxiety, or depression. However, one way to distinguish it from these conditions is to know that symptoms should disappear after your menstrual cycle comes to an end. Should you notice that they linger longer and continue to affect your daily routine, it’s best to consult with any of our mental health professionals, such as a psychologist or psychiatrist for an official diagnosis and proper management that suits your concerns and lifestyle. 

It’s also important to take note of any other physical symptoms that occur simultaneous to the period before or during your menstrual cycle: pelvic or bladder pain, migraines, chronic fatigue syndrome, or irritable bowel syndrome (IBS) in order to determine if you also suffer from another health condition.

Causes of PMDD

Unfortunately, there is no exact cause for PMDD as it involves numerous factors like timing, hormones, and hormone sensitivity levels: 


For some, PMDD symptoms may indicate underlying mood disorders, namely anxiety and depression. When you experience PMDD symptoms at specific times during your menstrual cycle, there may be some relationship to hormones.

Hormones and neurotransmitters

Fluctuating levels of hormones like progesterone, serotonin, and estrogen may have an effect on the onset of PMDD symptoms, especially since body tissues are affected during the menstrual cycle. 

Hormone sensitivity

Since PMDD is not as common as PMS, some studies suggest that on an individual level, people who suffer from the former may be more sensitive to hormone fluctuations than the latter.

Additional risk factors for PMDD do not include biology, as evidence to support this is still lacking. Some determined risk factors, on the other hand, include obesity, smoking, and past trauma. 

Treating PMDD



While there is no singular test for diagnosing a chronic condition like PMDD, book an appointment with an OBGYN the moment you notice that your symptoms are more severe than those of PMS – particularly the behavioral ones. Keep a journal to record and track symptoms that occur during each of your cycles. Doctors may diagnose PMDD if these are consistent for at least 3–6 menstrual cycles.

Some things you can expect from your treatment plan are the following:

Birth control pills

Depending on your needs and profile, a doctor will determine if going on birth control may help alleviate behavioral and physical symptoms of PMDD or PMS. 

Serotonin reuptake inhibitors (SSRIs)

Those with more severe cases of PMDD may be prescribed serotonin reuptake inhibitors (SSRIs) daily or on an intermittent basis depending on their doctor’s advice. Patients who take them intermittently can do so during the 14 days before ovulation, ending during the beginning of menstruation.

Cognitive behavioral therapy (CBT)

Your doctor may also refer you to a mental health professional as talk therapy may be beneficial in understanding and managing your emotions.


Exercise is often recommended to help appease the physical and in turn, mental symptoms of conditions like PMS and PMDD. 

Lifestyle changes

It is advised to cut back on alcohol, sugar, caffeine, and smoking as these can exacerbate symptoms.


To go the natural route, a number of vitamins and dietary supplements, including primrose oil, vitamin B6, vitamin E, calcium, and magnesium, have been studied as therapeutic agents for PMS; More recently, Vitex agnus castus (chasteberry) is a popular herbal remedy that appears to be an effective treatment option for women with mild premenstrual symptoms.

If you feel that you resonate with the signs and symptoms of PMDD, feel validated in knowing that it’s not just in your head! Premenstrual dysphoric disorder is a serious chronic condition, and just because it’s not often talked about or easily dismissed as mood swings does not make it any less real. 

The best thing you can do for yourself is to seek treatment so that you can establish a sense of control when you feel that things are escalating. You are not alone! Receive the help you need today and book on