PMDD vs. PMS: What’s the Difference, and How Can You Feel Better?

January 15, 2025  By: Women's Health Team

Sad and depressed woman sitting on sofa at home.

Content medically reviewed by Michael Kassing, MD

If you get a regular period, you likely have experienced premenstrual syndrome (PMS). More than 90% of women of childbearing age say they notice signs of PMS, such as mood swings, bloating, and cramping. But if your symptoms are so extreme that they are debilitating, you might have a more serious condition called premenstrual dysphoric disorder (PMDD).

“It’s very common to feel irritable or have physical changes like fatigue or headaches a week or two before you get your period,” said Dr. Michael Kassing, OB/GYN at Essentia Health. “However, if you notice a pattern of having severe depression or anxiety or other symptoms that seem worse than normal PMS, it could be PMDD. The good news is that available treatments can help.”

What Causes PMDD and PMS?

No one knows for sure what causes PMS or why some women have PMDD. Researchers believe certain hormonal changes that happen during the menstrual cycle may play a part. PMS may also be more likely if you have a personal or family history of depression or if you are under a lot of stress.

When it comes to PMDD, a chemical in the brain called serotonin may also be involved. Serotonin, which fluctuates throughout your menstrual cycle, regulates mood, behavior, and other functions. Some women may be more sensitive to its changing levels.

Researchers believe other factors may also put some women at higher risk for PMDD. These include –

  • Anxiety
  • Family history of PMDD
  • Seasonal affective disorder (SAD)
  • Sedentary lifestyle
  • Severe depression
  • Thyroid disorders
  • Being of a higher weight

The Differences Between PMDD and PMS

“Symptoms of PMDD and PMS are similar, which can make it more difficult to tell if you have PMDD,” Dr. Kassing said. “But in general, PMDD causes more severe symptoms that have a greater effect on your daily life, particularly your mental health.”

Both PMS and PMDD can cause physical and emotional symptoms. Your symptoms can also change as you get older. Physical symptoms may include –

  • Breast tenderness
  • Changes in bowel habits (constipation or diarrhea)
  • Cramps
  • Feeling gassy or bloated
  • Headaches or backaches
  • Less tolerance for light or noise
  • Tiredness or lack of energy

Emotional symptoms may include –

  • Appetite changes or food cravings
  • Anxiety
  • Depression or feelings of sadness, sometimes with bouts of crying
  • Irritability
  • Loss of interest in sex
  • Mood swings
  • Sleep problems (getting too much or not enough sleep)
  • Trouble with concentration or memory

With PMS, you might get some physical or emotional symptoms, but not necessarily both. They usually begin about five to 11 days before your period starts and stop when it begins. In general, PMDD symptoms are more debilitating than those of PMS. In addition to the symptoms above, PMDD might cause –

  • Anger that affects other people
  • Binge eating
  • Feeling out of control
  • Hopelessness and thoughts of suicide
  • Panic attacks

With PMDD, symptoms begin the week just before menstrual bleeding and improve a few days after your period starts.

How Your Doctor Diagnoses PMDD

“No test can definitively diagnose PMDD,” Dr. Kassing said. “Before you see your provider, record your symptoms in a journal, including when they occur. This can help your provider rule out other causes and determine the best treatment plan.”

When you see your provider, they may –

  • Talk with you about your symptoms and health history
  • Perform a physical exam, including a pelvic exam
  • Test your thyroid hormone levels

Your provider may also refer you for a psychiatric evaluation. The goal is to rule out other possible causes of your symptoms. If you have at least five symptoms of PMDD, including one related to your mood, and no other cause can be found, you may be diagnosed with PMDD.

PMDD Treatment Options

Your provider can help you manage PMDD symptoms with different treatment options. These include medications, lifestyle changes, and stress management. Medications that can help PMDD include –

  • Anti-depressants. Selective serotonin reuptake inhibitors (SSRIs) work by changing the levels of serotonin in your brain, which can help relieve symptoms of depression. The Food and Drug Administration (FDA) has approved three SSRIs for PMDD: sertraline, fluoxetine, and paroxetine HCl.
  • Birth control pills. An FDA-approved pill that combines drospirenone and ethinyl estradiol can offer relief to some women with PMDD.
  • Pain relievers. Over-the-counter pain medications, including ibuprofen, aspirin, and naproxen, can help with cramps, headaches, breast tenderness, and other physical symptoms.

Making lifestyle changes is also an important part of managing PMDD. Your provider may suggest –

  • Following a healthy diet. This includes eating plenty of fruits, veggies, and whole grains and limiting sugar, salt, caffeine, and alcohol.
  • Getting physical activity. Exercising regularly can help reduce the severity of your symptoms. Aim for at least 150 minutes of moderate-intensity aerobic exercise every week.
  • Developing good sleep habits.Try to get seven to nine hours of quality sleep every night.

For some people, cognitive behavioral therapy (CBT) can also help with symptoms of anxiety and depression. This usually involves about 10 visits with a mental health provider over a period of weeks or months. CBT, which can be done along with anti-depressants, can help you change your patterns of thinking and give you the tools to better manage anxiety and stress.

Stress can also play a big role in PMDD. Relaxation techniques, such as massage, breathing exercises, meditation, and yoga can help you release stress and improve symptoms. Spending time doing activities you enjoy can also be a helpful way to manage stress.

“For some women, treatment might change throughout the month as symptoms change,” Dr. Kassing said. “Your provider will help you find the right combination of treatments that can help cure or greatly improve PMDD.”

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