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!