PMDD (premenstrual dysphoric disorder) is often described as a more severe form of PMS (premenstrual syndrome). But I think that can be a bit confusing for some.

When we think of PMS we think of cramps, headaches, tender breasts, fatigue, but it also can include mood swings, irritability, and depression.

I’ve always gotten very irritable leading up to my period, but especially after having the boys it felt like it was more than just that (if that makes sense).

So how does PMDD differ from PMS?

Both have physical and emotional symptoms, but PMDD causes extreme mood shifts that disrupt your day-to-day life and relationships. It’s said that 5-8% of menstruating people have PMDD.

With PMDD at least one of these symptoms stand out:

sadness or hopelessness
anxiety or tension
extreme moodiness
marked irritability or anger

Those with PMDD will notice symptoms the week leading up to their period and can last a few days into your period. These symptoms are noticeably different than other times during your cycle.

Some of the most common symptoms:

PSYCHOLOGICAL SYMPTOMS:

Irritability
Lack of control
Agitation and anger
Insomnia and/or severe fatigue
Trouble concentrating
Depression
Confusion and forgetfulness
Anxiety
Poor self-image
Paranoia
Emotionally sensitive

FLUID RETENTION

RESPIRATORY ISSUES

EYE AND VISION PROBLEMS

GASTROINTESTINAL SYMPTOMS

Cramps
Bloating
Constipation
Nausea and/or vomiting
Backache
Pelvic pressure/heaviness

SKIN ISSUES

Acne
Inflammation and itching
Other skin disorders are aggravated

NEUROLOGICAL AND VASCULAR SYMPTOMS

Headaches
Dizziness and/or fainting
Numbness, tingling, prickling sensation
Bruise easily
Muscle spasms
Heart palpitations

OTHER

Worse coordination
Painful periods
Decreased sex drive
Appetite changes
Food cravings
Hot flashes

Personally, it was the psychological symptoms that were the worst.

I have always been extremely irritable before my period. Crying and moodiness seemed very normal to me. But after having kids I noticed other things. I was easily agitated and angered, felt depressed and a bit hopeless. But the wildest “symptom” was that I began to question whether I had made these huge life mistakes having kids, getting married, etc.

It was only during my luteal phase that I questioned very serious things like this. Then there was the immediate guilt, confusion, and sadness of thinking that because I love my boys and wouldn’t trade them for anything.

Poor self-image and paranoia, honestly I ticked most of the boxes in the psychological symptom list.

Okay, so how does PMDD get diagnosed?

Start with your general practitioner. Your symptoms will determine the route your doctor may take. But you’ll go over your medical history as well as an exam. Either they can evaluate you for mental health concerns or refer you to someone else.

I found it helpful to write down a list of all the things that I was experiencing that didn’t feel “right” or “normal” during my luteal phase. I also wrote down questions I had about PMDD.

According to the NIH, there are a few criteria for diagnosis: (the following is straight from that article)

A - There should be at least 5 of the following 11 symptoms present, and at least 1 of the first 4.

Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, feelings of being “keyed up” or “on edge”
Marked affective lability (tendency to experience strong and variable emotions)
Persistent and marked anger or irritability or increased interpersonal conflicts
Decreased interest in usual activities (eg, work, school, friends, and hobbies)
Subjective sense of difficulty in concentrating
Lethargy, easy fatigability, or marked lack of energy
Marked change in appetite, overeating, or specific food cravings
Hypersomnia or insomnia
A subjective sense of being overwhelmed or out of control
Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.

B - Symptoms are severe enough to interfere significantly with social, occupational, sexual, or scholastic functioning.

C - Symptoms are related to the menstrual cycle and must not merely represent an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder (persistent depressive disorder), or a personality disorder (although the symptoms may be present on top of these disorders).

D - Criteria A, B, and C are confirmed by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles. The diagnosis may be made provisionally before this confirmation.

Because PMDD is serious and chronic (won’t just go away on its own) what are the treatment options that may help relieve or decrease how bad you’re experiencing symptoms?

chances in diet (increase protein and carbs while decreasing sugar, salt, caffeine and alcohol)
regular exercise
stress management
supplements (such as B6, calcium and magnesium)
anti-inflammatory medicines
SSRIs (selective serotonin reuptake inhibitors)

I have always had a noticeable difference in my period and PMS symptoms depending on what my diet was during that cycle. If I was eating a lot of sugar, salt, etc. my physical symptoms were worse.

An SSRI has dramatically helped me with the psychological aspects of PMDD.

Mild exercise has always had a positive impact on my mental and physical health.

Everyone is different and you know yourself best. If something feels off or wrong listen to your gut and get it checked out.

For those with PMDD, what was it that made you question whether it was more than just bad PMS?