Premenstrual dysphoric disorder (PMDD) is similar to premenstrual syndrome (PMS), but symptoms are more severe. Symptoms include emotional, behavioral, and physical symptoms in the week or two leading to a person’s period.

PMDD symptoms include depression, anxiety, or severe irritability a week or two before a period. Over 90% of females report some form of PMS before their period, and symptoms may include swollen and tender breasts and a loss of interest in sex.

This article breaks down the differences between the two conditions and outlines symptoms, treatment, and diagnosis.

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People with either condition may experience physical, behavioral, emotional, or affective (psychological) symptoms that change the way they think and feel. However, the frequency and severity of these symptoms vary between the two conditions.

PMDD symptoms

PMDD symptoms are more severe than those of PMS and have a more significant impact on a person’s day-to-day life. Doctors and other experts classify PMDD as a depressive order.

According to the Office on Women’s Health, a doctor diagnoses PMDD when a person experiences five PMDD symptoms, including a mood-related symptom.

Affective, or psychological, symptoms include:

  • mood swings
  • sudden sadness
  • increased sensitivity to rejection
  • anger
  • irritability
  • sense of hopelessness
  • self-critical thoughts
  • tension
  • anxiety
  • depressed mood
  • suicidal thoughts

Physical and behavioral symptoms include:

  • difficulty concentrating
  • change in appetite, food cravings, and overeating
  • diminished interest in usual activities
  • easily tired and decreased energy
  • feeling overwhelmed or out of control
  • breast tenderness
  • bloating
  • weight gain
  • joint or muscle aches
  • sleeping too much or not sleeping enough

Learn more about the symptoms of PMDD here.

PMS symptoms

A person with PMS may or may not experience any affective or psychological symptoms. People with PMS may experience the following symptoms.

Mental and emotional symptoms include:

  • fatigue or feeling tired
  • irritability
  • problems with sleeping too much or too little
  • changes in appetite
  • mood swings
  • issues with memory or concentration
  • anxiety
  • decreased sex drive
  • tension
  • feeling sad, frequent crying or depression

Physical symptoms may include:

Learn more about PMS symptoms here.

Experts do not know the exact cause of PMDD and PMS. But research suggests that fluctuations in hormones may be responsible. A person’s sensitivities to these fluctuations could determine whether they experience PMDD or PMS.

Hormone fluctuations may cause a serotonin deficiency. Known as the happy hormone, serotonin is a neurotransmitter that can affect both mood and physical symptoms associated with PMDD and PMS.

In a 2016 study, researchers suggested that a person’s sensitivity to estrogen and progesterone may have links to PMDD and PMS. Other factors. such as stress and genetics, may also contribute to symptoms.

Learn more about female sex hormones here.

Treatments for PMDD and PMS are typically similar but depend on the severity of a person’s symptoms and whether they have any underlying health conditions.

PMDD treatments

Treatments for PMDD vary according to the symptoms, and some therapies work better for some people than others. If treatment does not succeed at first, a person should not give up and keep working on a treatment plan with their doctor.

A doctor may suggest one or more of the following to help alleviate PMDD symptoms:

  • increasing sleep
  • not smoking
  • eating healthily
  • acupuncture
  • oral contraceptives
  • selective serotonin reuptake inhibitors (SSRIs)
  • mood stabilizers
  • gonadotropin-releasing hormone (GnRH) agonists

Learn more about acupuncture here.

PMS treatments

In some cases, a person may be able to alleviate PMS symptoms at home with over-the-counter (OTC) pain relief medications, regular exercise, and a healthy diet.

According to the Office on Women’s Health, a doctor may recommend or prescribe:

Learn more about eating healthily here.

Home care is an integral part of PMDD and PMS management.

Though PMDD symptoms are more severe than PMS, a combination of home care methods and other therapies could help a person effectively manage PMDD.

Many people with PMS notice a difference in symptoms when they change aspects of their diet or practice stress management techniques.

Home care methods that help alleviate PMS or PMDD symptoms include:

  • not smoking
  • eating a healthy diet
  • getting regular exercise
  • managing stress
  • getting about 8 hours of sleep each night
  • OTC pain medications, such as ibuprofen

Learn more about natural treatments for PMDD here.

According to the Office on Women’s Health, there is no single test for PMDD or PMS. A doctor will likely ask several health-related questions to determine what symptoms a person is experiencing, how often they occur, and how severe they are.

For a doctor to diagnose PMDD, a person must have five or more PMDD symptoms, including at least one mood-related symptom.

A doctor may also take into account:

  • symptoms that interfere with home, school, or work-life
  • symptoms that are not related to or exacerbated by another medical condition

A person likely has PMS or PMDD if:

  • symptoms end a few days into the period
  • symptoms present 5 days before a period for at least three menstrual cycles in a row
  • symptoms prevent enjoyment or participation in everyday activities

The main difference between PMDD and PMS is the severity and type of symptoms a person experiences. For example, someone with PMDD may experience more affective symptoms more often than someone who doesn’t have it. These symptoms include depressed mood or mood swings days before their period starts.

A person should talk to their doctor if they are experiencing PMDD or PMS symptoms that interfere with their daily lives. A doctor should be able to help distinguish between the two conditions and suggest a treatment plan.

Keeping a journal of symptoms can help a doctor reach a diagnosis, especially if the symptoms are severe and regular enough to indicate PMDD.

A person should also talk with their doctor if their symptoms worsen or treatment is no longer effective, as they can make adjustments to the treatment plan.

If a person, family member, or friend expresses thoughts of suicide, they should contact emergency services or the National Suicide Prevention Lifeline immediately.

PMDD and PMS are similar conditions. PMDD is a more extreme form of PMS that may require additional therapy. Pain relief medication and hormonal birth control may help prevent or reduce some of the symptoms.

If a person’s life is adversely affected in the week or two leading up to their period, they should talk to their doctor about possible treatment options.

It may take a while for someone to find an effective treatment plan, so they must stay in touch with their doctor and provide updates on what works well and what does not.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Click here for more links and local resources.