PMS vs PMDD: Comparison of Symptoms, Severity & Help

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are terms describing a combination of symptoms affecting women who menstruate. Understanding the difference between PMS and PMDD is key to recognizing when monthly symptoms go beyond the norm. While both can bring physical and emotional changes, PMDD is a much more intense, often debilitating condition that deserves serious attention. This article breaks down how the two differ, what signs to look for, and how to manage them effectively.

What is PMS (Premenstrual Syndrome)?

Premenstrual syndrome (PMS) is a group of physical and emotional symptoms that many women experience one to two weeks before their menstrual period. PMS is quite common, with severity ranging from mild to moderate. Lifestyle changes and over-the-counter (OTC) pain medicine can manage the mild symptoms of PMS. PMS can cause a host of physical and emotional symptoms. Below are some common premenstrual symptoms:

• Bloating, feeling gassy, diarrhea, or constipation 

• Breast swelling or tenderness

• Headaches

• Backaches

• Joint or muscle pain

• Fatigue

• Difficulty sleeping

• Change in appetite, food cravings

• Mood swings

PMS symptoms generally go away once you get your period. 

Find out how long a period should last.

What is PMDD (Premenstrual Dysphoric Disorder)?

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that leads to both physical and emotional symptoms. Premenstrual dysphoric disorder (PMDD) symptoms occur in the late luteal phase of the menstrual cycle, just like PMS. Compared to PMS, PMDD symptoms are much more severe. 

In addition to typical PMS symptoms like bloating, headaches, and mood swings, PMDD can cause more intense emotional issues, including:

• Hopelessness or depression

• Worthlessness

• Self-criticism

• Sensitivity

• Anxiety 

• Decreased interest in usual activities

• Mental tension

• Anger or irritability

• Fatigue, lethargy, or lack of energy

• Difficulty concentrating

• Changes in appetite, such as overeating and food cravings

• Sleep changes, including excessive sleepiness (hypersomnia) or difficulty sleeping (insomnia)

• Physical symptoms, such as muscle pain and breast tenderness.

PMDD symptoms can be so severe that they can affect day-to-day life. Not only can PMDD disrupt work, school, and relationships, but it can also pose serious risks, including an increased likelihood of suicide, accidents, and injuries.

Call or text 988 for the Suicide and Crisis Lifeline if you have suicidal thoughts or self-harm ideations. The 988 Lifeline is available 24/7 and provides free and confidential support. 

How To Differentiate Between Conditions 

Both PMDD and PMS symptoms start 7-10 days before menstrual bleeding begins and continue for the first few days of the menstrual period. Symptoms that are present in both PMS and PMDD include breast swelling and tenderness, bloating, fatigue, joint or muscle aches, and changes in sleeping and eating patterns. 

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are not the same thing as dysmenorrhea (period pain) or menopausal symptoms. 

Period pain refers to pain during the menstrual period, including menstrual cramps (throbbing, cramping pain in the lower abdomen). This can be accompanied by symptoms such as lower back pain, headache, nausea, and diarrhea.

Menopausal symptoms occur in women who are at an age when regular menstrual cycles are about to stop. These symptoms include both mood and vasomotor symptoms such as hot flashes, night sweats, vaginal dryness, pain during sex, depression, and anxiety.

How Can You Tell the Difference Between PMDD and PMS?

When PMS symptoms become severe or are accompanied by serious mental or mood changes, it may be PMDD. In order to be diagnosed with PMDD, it’s important to keep track of your symptoms over a few months to find out when and how the symptoms occur.  Here is a comparison of PMDD vs PMS symptoms in terms of severity (+ means may be present, ++ means may be present and severe):

Note: All the above-listed PMS or PMDD symptoms may not be present in everyone. However, psychological symptoms (marked ++) are more pronounced in people with PMDD to the point that they affect daily life.

Causes  

While the exact causes are not known, scientists believe both estrogen and progesterone hormone levels play a role in the development of PMDD (premenstrual dysphoric disorder). Research suggests that too-high estrogen and too-low progesterone may cause PMDD.

Consult a healthcare provider if you are considering hormone therapy for PMDD. 

In addition, hormonal changes can also affect the level of serotonin, the brain chemical responsible for mood regulation, behavior, sleep, and appetite. Serotonin fluctuations can influence the emotional and physical symptoms associated with PMDD. 

Progesterone

Progesterone levels increase after ovulation in anticipation of a pregnancy. When the egg does not get fertilized, progesterone falls, and menstrual bleeding starts. 

This rise and fall in progesterone after ovulation is called the luteal phase of the menstrual cycle. PMDD symptoms usually occur in the luteal phase. Women with PMDD are more sensitive to progesterone and have increased emotions in response to this hormone. 

Estrogen

Throughout the menstrual cycle, estrogen rises and falls gradually, which can affect mood. Estrogen levels rise at mid-cycle and trigger the release of an egg from the ovary, called ovulation, causing a fall in estrogen levels. 

Save On Your PMDD Treatments With BuzzRx

Risk Factors

About 6% of women are diagnosed with PMDD, compared to over 90% of women who experience PMS. 

Certain risk factors can predispose a woman to PMDD, much like other mental disorders. 

• Women with a history of stress or trauma may be more likely to experience PMDD. 

• A current or past history of mental health conditions, such as anxiety, depression, postpartum depression, bipolar disorder, or some other mood disorders, is a risk factor for PMDD.

• The risk of PMDD is also higher in women who do not use oral contraceptives to control menstrual symptoms. 

• There is also an inherited risk - PMDD is up to 50% more likely in women whose mother experienced PMDD.

• Pregnancy history can also affect risk. Women who have never given birth have a slightly higher risk of PMS and PMDD.

How is PMS and PMDD Diagnosed?

PMS

PMS is diagnosed based on symptoms like bloating and breast tenderness. The cyclical nature of the symptoms (occurring 7-10 days before the menstrual period and continuing for the first few days of the period) points to a diagnosis of PMS. 

Physical examination and laboratory testing are not needed.

PMDD

There is no test for PMDD. Your healthcare provider will make a diagnosis of PMDD by evaluating your symptoms, reviewing your medical history, and ruling out other possible causes. 

A diagnosis of PMDD is made based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as follows:

• Presence of symptoms during the luteal phase (last week) of the menstrual cycle. Improvement in symptoms after the first few days, once the period starts. 

• Absence of symptoms by the end of the first week of the menstrual cycle. 

• Symptoms are severe enough to interfere with daily functioning. 

• Symptoms are present with all or most menstrual cycles.

Distinguishing Between PMS and PMDD

It is important to distinguish between PMS and PMDD because while PMS can be managed with over-the-counter medications and lifestyle changes, PMDD causes more severe symptoms that require a diagnosis and treatment from a healthcare provider. 

PMDD can be mistaken for physical health conditions such as thyroid disorders, chronic fatigue syndrome, and irritable bowel syndrome. It can also be mistaken for mental health conditions such as anxiety and depression. Getting a proper diagnosis is necessary for appropriate treatment and management of the condition.

PMS and PMDD Treatment Options  

Lifestyle Changes  

Some of the lifestyle changes that can help to relieve physical symptoms and emotional symptoms of PMS or PMDD include: 

• Getting regular exercise.

• Cutting down on caffeine.

• Avoiding alcohol.

• Stopping smoking (if you smoke). 

• Getting enough sleep.

• Using relaxation techniques, such as yoga, meditation, mindfulness, progressive muscle relaxation, and deep breathing. 

• Avoiding stressors and emotional triggers, for example, discussions or arguments with loved ones. 

Medications

Like other mood disorders, PMDD is treatable. Your healthcare provider may recommend the following treatments for PMDD:

• Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen) can be used to control physical symptoms such as breast tenderness.

• Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are effective in treating PMDD symptoms. Your healthcare provider may prescribe fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil) to manage your symptoms. 

• Birth control pills are used to manage symptoms such as breast tenderness, bloating, and acne.

• Diuretics (water pills) to manage fluid retention, bloating, and weight gain.

• Gonadotropin-releasing hormone (GnRH) agonists like leuprolide are ovarian suppression medications to initiate temporary menopause to reduce the symptoms of PMDD.

Psychotherapy, such as cognitive behavioral therapy (CBT), can also help in managing symptoms by teaching coping methods.

Nutritional Supplements and Herbal Remedies

Research suggests that taking calcium 1,200 mg daily may reduce the severity of PMS and PMDD symptoms. 

Other dietary and vitamin supplements you can discuss with your health care provider include magnesium, vitamin B6, and L-tryptophan.

Herbal products such as chasteberry (vitex agnus-castus) have shown some benefit in reducing emotional, behavioral, and physical symptoms in women with PMDD. However, there is no strong scientific evidence supporting their use. 

Alternative and Complementary Therapies  

Some women report improvement in PMS and PMDD symptoms with alternative and complementary therapies such as aromatherapy, massage, and acupressure.