PMS versus PMDD – What’s the Difference and Why It’s Important to Know

I had a very enjoyable long weekend…that is, up until Sunday night when all of a sudden I didn’t feel myself at all.  Then, come Monday, I really wasn’t myself, period.   My hubby and I went out to lunch at one of our favorite restaurants.  I was able to enjoy the food but as soon as I got home, I napped.  And I’m not usually one for napping, either.  I didn’t just nap for 30 minutes, I napped for over 2 hours.  After I got up, I felt myself start to go on this downward spiral of ultra sensitivity, where my feelings were easily hurt and I was quick to tear up or become angry.    I said to myself  “Whoa, I must be going through PMS.  This is one of the worst cases of fatigue and moodiness I’ve experienced in a very long time.  This is really unsettling.”  I don’t know for sure but would bet money that PMS was the culprit.  For someone who hasn’t had a single period since I lost my uterus three days after my daughter was born over 5 years ago, knowing when to expect PMS isn’t that easy anymore.  The average menstrual cycle lasts 28 days from Day 1 of a woman’s period until her next period begins.  That used to be the magic number for me.  I was so regular, that I used to be able to easily predict when my next period was going to be. 

Ever since I started reading up on postpartum depression (PPD), I’ve become very familiar with the risk factors.  One of the risk factors is a personal history of PMDD, or premenstrual dysphoric disorder.   Since I ended up with PPD after the birth of my daughter, I’ve asked myself whether I had PMS or PMDD all those years when I had my period.  Now, I know that what I had was PMS, not PMDD.  Nevertheless, I still developed PPD…..but that’s because of a number of other risk factors (see previous post) that played a part in why I succumbed to it.

Before each period, I used to only feel physical discomfort (bloated legs, swollen and painful breasts) and to some extent (nothing major) irritability, moodiness and occasional teariness.  A few days before my period, I tended to feel irritable for no particular reason at all or for very trivial things.  I would get teary easily from watching a slightly moving scene in a TV show or movie or from reading a newspaper article or book.  As soon as my period began, it almost felt like a physical weight was being lifted off my shoulders and I felt free again.  The shroud of irritability was lifted and I felt oh so much lighter!  I almost always had to take Advil for very bad cramps on the first 1-2 days of my period.  

I used to be unsure of what PMS truly was because I’d hear such varying degrees of physical and emotional symptoms from different women.  People always seem to joke about PMS (“it’s that time of month, watch out”), not realizing how much power hormones could wield on a woman’s psyche.  From the start of puberty, a woman’s life is predominantly under hormonal control from the time she starts puberty all the way through menopause.  In order to understand PMS, PMDD and PPD, you must understand and appreciate the extent to which a woman’s body will undergo physical and hormonal changes throughout her reproductive life. 

Knowing what I know now about the differences between PMS and PMDD, I now know that what I used to get–and what I occasionally still get today, even without a uterus–is PMS.  Anxiety never increased right before my period, nor did my premenstrual symptoms ever interfere with my day-to-day functioning.   

What is PMS?

Menstruation happens from estrogen levels dropping due to the lack of a fertilized egg implanting in the uterine lining. PMS is basically the physical, psychological and emotional symptoms that start up about two weeks before and end with the start of menstruation. The common physical symptoms of PMS include breast tenderness, abdominal bloating/cramps, swelling of extremities, and fatigue.  Common mood-related symptoms include irritability, tearfulness, mood swings, and angry outbursts.  Per Deborah Sichel’s and Jeanne Watson Driscoll’s “Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health” (pg. 123), studies have shown that 30-70% of women experience some degree of premenstrual symptoms, many of which are moderate and only mildly debilitating and which don’t amount to PMDD.

What is PMDD?

The symptoms of premenstrual dysphoric disorder (PMDD), on the other hand—experienced by less than 5% of menstruating women—include significant mood disturbances that are significant enough to interfere with your day-to-day functioning.  Physical symptoms and discomfort ranging from bloating, breast tenderness, headaches, hot flashes, malaise, and fatigue do not constitute PMDD unless there is also some kind of debilitating mood disturbance, such as despair, anxiety, loss of interest and motivation, loss of appetite, and/or sleep disturbance.  In fact, the symptoms of PMDD are similar to those of clinical depression and PPD, and those who experience PMDD may also experience mood disorders during pregnancy and postpartum. 

Hormones and Mood

All women experience hormone fluctuations during menstrual cycles, but only some women complain about PMS.  All women experience a significant drop in hormones at childbirth, but all women do not experience postpartum blues.  Much like the fact that dust, pollen and ragweed are in the air everywhere, everyone is not allergic to them.  What determines whether you are allergic is not the pollen or ragweed itself but the individual’s sensitivity to them. For some women, mood disturbances associated with the menstrual cycle and childbirth are believed to be triggered by hormonal fluctuations, and have a tendency to experience PMS (or in more serious cases PMDD when there is anxiety, insomnia and other symptoms of depression) and PPD, respectively.

Both adolescent girls and boys, in their transition to adulthood, experience physical and psychological changes in their appearance as a result of reproductive hormones.  The reproductive hormones estrogen and progesterone cause breasts, menstruation and sex drive to develop for girls, and testosterone causes sperm production and sex drive for boys.  All these changes occur in preparation for that transition from childhood to adulthood, which is referred to as adolescence, or puberty.  As Ruta Nonacs mentions in her book A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years, if you look at the facts—that the rates of depression in girls is comparable to that of boys until they increase between the ages of eleven and thirteen, which is when puberty begins, and by the age of fifteen girls are twice as likely to suffer from depression than boys—it’s no wonder scientists postulate a correlation between reproductive hormones and depression in women.  A woman remains at greater risk for depression than a man throughout her reproductive years.  Per Deborah Sichel’s and Jeanne Watson Driscoll’s “Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health” (pg 50): “A woman’s brain carries countless receptor sites for the female sex hormones estrogen and progesterone, where they can fasten and exert their effects far from the cells that made and secreted them.  There are estrogen and progesterone receptors all over the brain, but they can be found most densely in the limbic area [otherwise known as the control center for moods and emotions, as such] estrogen and progesterone can induce changes in all the neurochemical pathways involved in mood disturbances.”  It’s whenever the levels of estrogen and progesterone decline—i.e., 2 weeks prior to each menstrual period, at childbirth and postpartum, and menopause—that seems to have a correlation with mood disturbances and depression.   

To sum up, it’s the reproductive hormones—which come into play during the entire span of a woman’s reproductive life with puberty, menstruation, pregnancy, postpartum, breastfeeding, perimenopause and menopause—that set women apart from men and represent all of the key vulnerable times in a woman’s life. 

Importance of Early Education: 

Since there is a correlation between hormones and depression/anxiety, particularly during the adolescent years, high schools should have classes that educate young teenagers about the changes their bodies will go through and why.  Perhaps education can lower the number of teens who:

  • do not know why they are going through such emotional and physical changes
  •  feel isolated from ignorance about the changes they are going through
  •  experience a serious bout(s) of depression that will increase a girl’s risk for PPD later in life
  • commit suicide

Perhaps education will also, at the same time, lead to more teens knowing:

  • how and where to get help
  • none of this is their fault
  • they will get past this
  • they are not alone as there are many other teens who also experience what they’re going through

It is important to educate teenage girls on the difference between PMS and PMDD, how PMDD is a risk factor for PPD, and what is PPD.  It’s never too early to educate, especially when a person’s mental and physical wellbeing are at stake!

16 thoughts on “PMS versus PMDD – What’s the Difference and Why It’s Important to Know

  1. i never knew about PMDD but i just lost another job….and ive lost four husbands & countless other relationships….always around the time of my period; i never put the two together! i had my tubes tied after my second child, im almost 50 so experiencing premenapausal symptoms as well; so i chocked this all up to womens natural changes….but when i lost another job this week, and was so depressed i wanted to die, i started looking at other causes. why did i do those things, say those things, act that way, where it affects everything around me…losing my job, being distant from everyone……so im going to the doctor this week….its such a relief to know. dont wait!

    • Hi Julie, I am so sorry to hear about all the PMDD-related troubles you’ve been experiencing, but really glad to know you are going to see a doctor. Hope he/she can help you with your PMDD and now with your pre-menopausal symptoms. Hope things work out alright for you. All the best, Ivy

  2. You seem pretty educated about pmdd and I was wondering if you could help me figure out what is going on. I am 19 and getting married in december, and I have been having my normal pmdd problems, but it’s lasted for at least a month now and I took a test because my fiance asked me to when I told him I smelled my blood while donating last week, but it was negative.I’ve been increasingly nauxious, cramping down to my pelvic bone, I’m getting horrible migraines. I even missed class the other day because I couldn’t put a bra on. Then I looked in the mirror and one is a whole size larger. I haven’tmissed a period but last month was really light and I’m supposed to start this week, but so far it’s just been heavy discharge. Plus I can’t seem to lay off the fries and chocolate chip cookies, I might not fit into my dress. And if I have even a sip of caffeine or carbonation my stomach flips for hours and I get diarrhea… Probably tmi, sorry. I’m just worried. I’m in college, and about to be a newly wed. We don’t have the money for a baby right now. Plus if I am it would be nice to know so I can start eating better. And so I can get off my birth control. Any help is appreciated. Thanks.

    • Thanks for stopping by my blog. I am familiar with the differences between PMS and PMDD from all that I’ve read, but am no expert or a medical professional. So, did a doctor diagnose you as having premenstrual dysphoric disorder? Do you get depressed (insomnia, weight/appetite loss or gain, etc.) before your periods? All the symptoms you describe seem to describe PMS (bloating, food cravings, cramps, nausea, migraines, stomach upset). You may be experiencing some anxiety from your upcoming wedding? I think, bottom line, is that you need to be touching base with your doctor and/or OB/GYN about your concerns…..

      • I have been diagnosed with it, unfortunately female problems run in the family. I haven’t really talked to anyone because I don’t really have the money to talk to a dr and if my school finds out I could be expelled. I am transferring at the end of the semester, I am just worried if I call my dr my mom will find out, then my sisters, then facebook.

        • I don’t know how a school would expel you for talking to a doctor?! You really need to get your questions answered by a professional. That would really be of tremendous benefit for not just now, but down the road. A benefit for you, period.

  3. Hi Ivy,

    I am not sure if I although recently I have been feeling depressed and Im not sure what is down to physical and what is down to cirumstance.

    I am 38 son to be 39 I have a and I am a single mum to a 16 month old boy who is still very much breastfeeding. On off the reasons for this and the major on is that Im a petrified to go back to getting PMDD. I do feel that in all honesty I may well have PPD which is a struggle for me but I know that that is easier to deal with and get a way with at present as its ok to wake up late and stay in as my son is still younge enough for me to do that. However Im starting to feel the pressure of needing a part of my life back as much as I love my son and being a mother I am now needing space. Being a single mother is extreemly intense and I do not have any family around to take the load of and all my friends have not got a family of their own so they do not fully understand so getting a baby sitter is not always possible.

    I suffered pms with heavy periods and extreem cramps then when I was 21 I had an abortion and my friend said why didnt I get the pill jab??? It would stop the periods and prevent me from becoming pregnant. I got the jab and I got massive moods swings for the 1st couple of days and then was happy that finaly I had found something that would take my periods away (I was young!!). The jabs did make my hyperactive but I always had a good energy source and at that time I liked it as it amde me thin and I could do all this exercise too. I had to get the jabs every 3 months and each time I would get massive moods swings for 2 days then resume to normal (well as normal as it was going to be without a period). I got 3 jabs intotal over a 9 month stretch and it started to dawn on me that this was not natural so I stopped. I cant say exactly when the PMDD started but it was after that that I was getting extreem depression (there were other contributing factors and I was never sure what was period and what was the contributing factors). When I was 27 I started having a serious realtionship with an older man and our in common was the realtionship that we both shared with alcohol. One night after a night on the town so to speak we had a massive argument and I hit him!!! Up until then I had never realy hit someone like that and was shocked. I continued to hit him over the course of a year or 2 and have the most out rageous mood swings and then it came to me that this was not the way that I wanted to be and why was aI ok sometimes. I monitered it and realised that it was conected to my cycle and that it was starting 2 weeks before my period. I had gone and seen a Tibetan herbalist Doctor and he saoid that I had a sugar l allergy but I knew that it was more than that. I noticed that it was other dietry things that affeted me and that I wanted to drink more alcohol at that time (which inevitably made my life worse in the long term). That relationship ended and I carried on getting more and more depressed. I ended up having a major breakdown and made a very serious suicide attempt. This was not the 1st but this tiem I was serious. I met a guy who I realy liked and thougt finaly this is my life improving but the same happened with him, the violence and the mood swings etc. I couldnt find out what it was and had never met anyone who had it (PMDD). That relationship ended and I met my husband whom I have also had an extreemly dysfunctional relationship with we are seperated and I now have a 16 month old boy. I have been so much better and as I said even if I do have PPD I would rather that than the PMDD. I have considered having my overies removed or a full on hystorectomy as I have tried everything, anti-deppressants, vegge pa, homeopathy, watching my diet, exercise, abstaining from alcohol and nothing has helped long term. I am not a defeatist but enopugh is enough. I have researched and read lots and thankfully met another woman whislt in India learning yoga who was from Japan who had the same thing as me and it was threw meeting her that motivated me into finding out what the medical reason was behind this. MY doctor thought I was manic depressive, I knew otherwise and refused prozac. I did try cytropram but that only suppresses and life is dull. Anyway if you have any other solution let me know I would delighted to try anything to wean my son of the breast and live a comfortable life. Thank you for your blog it is always nice to share with a fellow PMDD or otherwise.

    • Hi Gini,
      Thank you for visiting my blog and I’m glad you find my blog helpful to you. Thank you also for sharing your story. I had a bit of a tough time following, though. There are some terms, like jab, that I don’t quite understand. I am far from an expert to the point of providing you advice that I think a psychiatrist/therapist is far more equipped to do. So that I don’t misdirect you in any way, I would highly recommend you pursue that route. Please visit the Postpartum Support Int’l website, which provides many helpful resources and names of local coordinators (if you’re in the UK, there are 2 in England and 1 in Scotland) that can provide you referrals to local resources that specialize in PPD. Here’s the link to the Int’l section of the PSI site:
      http://postpartum.net.gravitatehosting.com/Get-Help/Support-Resources-Map-Area-Coordinators/PSI-Locations-International.aspx

      All the best,
      Ivy

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  6. Excellent post Ivy!! I agree that there needs to be more education regarding these issues especially since PMS is a risk factor for PPD. Since having PPD, my symptoms get markedly worse a few days before my period begins. Sometimes it is hard to differentiate if I’m having a bad case of PMS or a flare of PPD. What helps me during this time is telling myself that it will get better and take it one day at a time.
    This post is fantastic!! I hope that you feel better soon. I’m always here if you need to talk.
    Kimberly

    • Glad you liked this post! Thanks for your words of encouragement & support. I feel much better today. My PMS only takes hold for a couple of days. But those couple of days are a real doozy sometimes, let me tell ya!

    • Kimberly,
      Not sure if you saw my comment on your blog thanking you for the When Life Hands You Lemons blog award. I just wanted to be sure you knew how grateful I am that you would think of lil’ ol’ me! =) Hope you are doing well. Had I been given that award by someone else, I would’ve thought of you, just as a number of others have done!
      All the best,
      Ivy

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