PMS and PMDD

Premenstrual syndrome, or PMS, commonly affects women of childbearing age. It occurs during the luteal phase, the two weeks or so between ovulation and the start of your period, and typically resolves within a few days after your period begins. PMS naturally stops occurring after menopause, since it's tied to the menstrual cycle, though effective treatment is available in the meantime for women whose symptoms affect their daily life.

For some women, these symptoms become severe enough to significantly disrupt daily functioning, relationships, or work. When this happens, it may actually be a related but more serious condition called premenstrual dysphoric disorder (PMDD), which we'll cover in more detail below.

PMS symptoms vary considerably from woman to woman. Common symptoms include:

• Decreased alertness
• Mood swings
• Anxiety
• Irritability
• Depression
• Constipation or diarrhea
• Low sex drive
• Food cravings
• Sleep disturbances
• Breast swelling and tenderness
• Cramps
• Back pain
• Headaches
• Fatigue
• Bloating

While some women experience only a few of these symptoms, others experience many, and with greater severity.

PMDD shares many of these same symptoms, but with a much stronger emphasis on mood, and at a severity that significantly disrupts daily life, work, school, or relationships. To be diagnosed with PMDD, a woman must experience at least five symptoms in the week before her period, including at least one of the following core mood symptoms:

• Marked mood swings or sudden sadness
• Irritability or anger that affects relationships
• Depressed mood, hopelessness, or self-critical thoughts
• Anxiety or feeling on edge

These symptoms typically improve within a few days after menstruation begins and become minimal or absent the following week. If your premenstrual symptoms feel like more than "just PMS," especially if they're affecting your relationships, work, or overall well-being, it's worth talking to our team about whether PMDD may be a better explanation.

Researchers believe PMS and PMDD develop because of the body's response to hormonal changes during the menstrual cycle. Interestingly, women with PMS or PMDD typically have normal hormone levels, what differs is their sensitivity to the normal rise and fall of hormones like estrogen and progesterone throughout the cycle. This means the conditions aren't caused by a hormonal imbalance, but rather by how the body and brain respond to hormonal shifts that most women experience without significant symptoms.

Genetics also appear to play a role, as many women with PMS or PMDD have close relatives with the same condition. For PMDD specifically, research points to a connection with serotonin, a brain chemical that affects mood, which may help explain why certain mood-related treatments can be especially effective.

For many women with PMS, at-home changes can meaningfully reduce symptoms. Limiting caffeine, exercising regularly, and eating a nutritious diet may all help ease PMS symptoms. If symptoms persist despite these changes, or are severe, our team may recommend medication, such as certain types of birth control, to help regulate hormonal fluctuations.

PMDD often requires a more targeted approach, since lifestyle changes alone typically aren't enough to relieve its more severe symptoms. For PMDD, especially when mood symptoms like irritability, anxiety, or depression are the primary concern, antidepressants called SSRIs are often the most effective first-line treatment and can bring meaningful relief. Certain birth control formulations may also help. Because everyone responds differently, our team works with you to find the treatment, or combination of treatments, that brings you the most relief.

Some PMS symptoms occur regardless of preventive measures, but many patients notice improvement when they focus on their overall health through regular exercise, a nutritious diet, adequate sleep, and stress management. These same habits can offer some benefit for women with PMDD as well, though they typically aren't enough on their own to fully manage PMDD's more severe symptoms.

While PMS and PMDD can't always be fully prevented, tracking your symptoms over a few cycles can help you and your doctor identify patterns and determine the most effective treatment plan for you. If your symptoms are significantly affecting your daily life, don't hesitate to reach out, our team at The Women's Group is here to help you find relief.