Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) produce a constellation of physical and emotional symptoms associated with menstruation. Although the exact cause of PMS and PMDD remains uncertain, research studies indicate that factors such as hormonal surges and fluctuations in brain chemistry play key roles in both disorders.
Two key differences highlight the distinction between PMS and PMDD: PMDD is less common than PMS, and PMDD symptoms are more severe than PMS symptoms. Women diagnosed with PMDD experience mental and physical symptoms that significantly reduce their ability to function at work and at home. Alternately, women with PMS can, for the most part, continue functioning normally by taking pain relievers, adjusting their schedules, and resting frequently during the day.
Psychological and Physical Symptoms of PMS
Most women start feeling the onset of PMS symptoms during the luteal phase of their menstrual cycle. This phase follows ovulation and continues for about 14 days or until a woman begins menstruating. The first day of menstruation begins the follicular phase of the cycle. PMS symptoms should decrease during the follicular phase, which, similar to the luteal phase, spans approximately 14 days.
Common signs of premenstrual syndrome include:
- Mood swings
- Mild to moderate depression
- Fatigue
- Breast tenderness
- Bloating/water retention/swelled ankles and feet
- Headaches or migraines
- Cravings for salty and sweet foods
- Insomnia
- Skin breakouts/acne
- Joint or muscle aches and pains
- Nausea (but rarely vomiting)
Managing PMS symptoms involves making lifestyle and dietary changes and taking over-the-counter medication when necessary. Limiting sugar, caffeine, and alcohol intake, exercising, getting at least seven hours of sleep every night, and drinking plenty of water can help alleviate PMS. Keeping a PMS symptom diary may provide insight into triggers that exacerbate PMS issues.
Vitamins and Minerals for Managing PMS
Consuming more foods containing high amounts of vitamin B6, magnesium, chromium, and calcium may alleviate PMS symptoms for some women. Chromium has the potential to minimize cravings for sugary, high-carbohydrate foods by stabilizing insulin and blood glucose levels. Calcium may help regulate hormone levels, while magnesium may reduce headaches, migraines, bloating/fluid retention, and breast tenderness. Bananas, green leafy vegetables, nuts, seeds, and beans are rich in calcium and magnesium. Vitamin B6 aids in the production of neurotransmitters that play a role in regulating mood, appetite, and sleep.
Swelling in the feet, ankles, and abdominal area is caused by hormonal imbalances that interfere with your body’s ability to eliminate excess fluids. Taking calcium, vitamin B, vitamin C, and magnesium supplements can help reduce fluid retention (edema). Snacking on natural diuretics such as bananas, celery, tomatoes, and oranges can also reduce edema for women experiencing PMS. While caffeine is a diuretic, it is best to avoid it because it may promote anxiety, irritability, and insomnia.
Psychological and Physical Symptoms of PMDD
PMDD is a debilitating disorder impacting up to five percent of women between 18 and 45. It is also diagnosed more frequently in women of childbearing age who have an existing depression or anxiety disorder. Since symptoms of PMDD generally parallel signs of a mental illness, this disorder should be addressed by a gynecologist or other physician specializing in women’s reproductive health issues.
Psychological symptoms of PMDD include:
- Severe mood swings
- Intense depression/feelings of despair and hopelessness
- Anxiety/agitation/panic
- Heightened irritability/experiencing irrational anger or emotional outbursts
- Difficulty concentrating/brain fog/impaired memory
- Profound tiredness and lethargy/lack of motivation to do anything
- Insomnia or disrupted sleep patterns that worsen fatigue and exacerbate emotional symptoms
- Overeating or loss of interest in food
- Inability to deal with everyday stress
Physical symptoms of PMDD:
- Breast swelling and tenderness
- Abdominal bloating/swelling of the face, hands, ankles, and feet
- Intense headaches or migraines.
- Joint and muscle aches and pains
- Temporary weight gain due to fluid retention
- Nausea, vomiting, severe cramping, and constipation
- Dizziness/lightheadedness
If you think you have PMDD, talk to a medical professional with expertise in diagnosing and treating mental health problems, including PMDD. Some symptoms of PMDD are similar to symptoms of bipolar disorder, such as drastic mood swings, cognitive issues, and inappropriate emotional flare-ups. Receiving the correct treatment is critical to managing symptoms and improving your health and well-being.
Treatments for PMDD
In addition to adopting dietary and lifestyle changes recommended for reducing PMS symptoms, women with PMDD may be prescribed selective serotonin reuptake inhibitors (SSRIs). A class of antidepressants that increase serotonin levels in the brain, SSRIs such as sertraline, fluoxetine, and paroxetine HCI have been approved by the U.S. FDA to treat psychological symptoms of PMDD. The FDA has also approved oral contraceptives containing drospirenone and ethinyl estradiol for managing the mental and physical effects of PMDD.
Over-the-counter pain relievers, such as ibuprofen, naproxen, and aspirin, can help alleviate physical symptoms like cramps, joint pain, headaches, backaches, and breast tenderness. When OTC pain relievers do not provide pain relief, doctors may prescribe a low-strength, compound analgesic for migraines and cramps.
Some women with PMDD benefit from undergoing cognitive behavioral therapy (CBT), a therapeutic approach that helps identify and correct negative thought patterns associated with anxiety and depression. CBT also incorporates behavioral strategies to make it easier to manage PMDD symptoms, such as implementing lifestyle changes, developing effective stress management techniques, and establishing healthier coping mechanisms.
How are PMS and PMDD Diagnosed?
For a PMS diagnosis, your healthcare provider will verify that you experience at least one symptom associated with PMS within five days of your menstrual cycle and that symptoms resolve within four days after your period concludes. To meet the criteria for an official diagnosis, these symptoms should recur for at least consecutive menstrual cycles.
Doctors will also inquire about a woman’s medical history to determine if something else may be causing or contributing to PMS. Her family medical history will also be explored since certain conditions, such as mood and endocrine disorders, may have a genetic proponent. Before initiating PMS treatment, doctors will exclude conditions such as clinical anxiety, depression, perimenopause, Cushing’s disease, chronic fatigue syndrome, and thyroid disorders.
The DSM-5 lists the following criteria for diagnosing PMDD:
- Mood swings, feeling suddenly depressed, increased sensitivity to criticism
- Marked anger, hostility, or irritability
- Moderate to severe depressed mood, feelings of hopelessness and despair, and decreasing sense of self-worth
- Uncontrollable feelings of anxiety, tension, or panic
- Decreased interest in doing anything (anhedonia).
- Difficulty focusing and remembering
- Overwhelming fatigue
- Overeating, craving specific foods, or lack of appetite
- Hypersomnia or insomnia
At least five of these symptoms must be present during the last week before the onset of menses, start to improve within a few days of the onset of menstruation, and diminish or become absent during the week of the last day of menstruation, according to the DSM-5.
These symptoms must be severe enough to disrupt a woman’s capacity to work, attend school, sustain relationships, and, in certain instances, attend to her own well-being.
For an accurate diagnosis and to access appropriate treatment methods for PMS or PMDD, consult a healthcare professional specializing in women’s health, gynecology, or mental health to ensure you receive treatment plans tailored to your unique emotional and physical needs.
