You normally get achy and crampy during the time leading up to your period. You tend to feel restless and anxious, you have minor mood swings that come and go and your breasts get tender. You suffer PMS. Premenstrual Syndrome affects close to 90% of women and is totally normal.

 You suddenly start to notice changes. Your mood swings start happening much earlier in your cycle, you feel an unrelenting depression that can even lead to suicidal thoughts or attempts. You find yourself losing control of the mood swings and the aching even feel worse. You decide to start charting your symptoms and find that they happen half the month- from around the time you would be ovulating to right after your period starts. The rest of the time you’re normal. You research it and find Premenstrual Dysphoric Disorder or PMDD.

What is PMS?

Premenstrual Syndrome or PMS is that crampy, achy, and irritable mood you feel before starting your period. It usually starts one week prior and causes bloating, minor mood swings, crying and tender breasts. It’s caused by hormones and changes that happen immediately before you start. It can be irritating but with Tylenol or Midol, you can get through it with minimal interference. PMDD has similar symptoms but they are more severe and many times will interfere with jobs and relationships.

What is PMDD?

Premenstrual Dysphoric Disorder or PMDD is a mood disorder that occurs between ovulation and the beginning of the period. It typically clears up between the time a woman is on her period and starts to ovulate. It’s similar to a mix of Bipolar and PMS but more severe than PMS. PMDD is labeled as a mental health disorder, a mood disorder.

The exact cause of PMDD is not known. It may be tied to being more sensitive to the normal hormonal reactions that happen during ovulation and menstrual cycle periods. People with certain disorders (PMS, ADHD to name a couple) are found to potentially be more prone to developing PMDD. The disorder is incurable but treatable. It gets worse as time goes on, but symptoms leave during pregnancy and after menopause.

There are many similarities between PMDD and PMS, so what should you look out for if you believe your PMS symptoms are going above normal and you may be developing PMDD?

Symptoms

The main symptoms to look out for are

1. Depression

2. Anxiety

3. Sudden mood changes

4. Irritability

5. Losing interest in everyday activities

6. Low energy

7. Food cravings

8. Insomnia

9. Breast tenderness/bloating/other PMS symptoms, normally magnified

The doctor will go through your medical and family history. You will be asked about your symptoms and tested for other conditions that could mimic the symptoms of PMDD and if the condition comes back, you will be treated. 

The women most likely to get PMDD are in their 30s and older, a lot of women at risk as getting closer to Menopause. Conditions like ADHD can also put women at an increased risk of developing more severe PMS symptoms and mood disorders.

Treatment options for PMDD

There are several treatment options for PMDD. Antidepressants such as SSRIs can help the depressive episodes while sometimes mood stabilizers will be prescribed.

Birth control is another option to help since PMDD is tied to the hormonal changes that come with ovulation and menstruation.

Some diet and lifestyle changes can help on top of the medications. Eating a healthy diet and exercising can help with moods and taking pain relief or PMS medication can help relieve some of the PMS symptoms like bloating and cramping (make sure it’s safe, some pain relievers can have interactions with some SSRIs).

PMDD and Pregnancy

Since the timing of PMDD typically extends from ovulation through your period, pregnancy is one time of your life you won’t have to deal with it. While you’re in the early postpartum stage before you start your period, it also won’t come back. Once you start ovulation and your menstrual cycle, it will return.

PMDD is not known to have an effect on fertility but some medications taken to treat PMDD may not be safe to take while pregnant. Since symptoms stop when there is no period nor ovulation, it should be safe to talk to your doctor about going off the medication while you’re pregnant. With all disorders, always talk to your doctor before going off a medication. Many SSRIs lead to withdrawal symptoms if they aren’t tapered off correctly and some can be replaced with pregnancy-safe medications.

PMDD and PPD

According to one study, there was found to be a correlation between PMS and Postpartum Depression. The prevalence was higher in women with PMS, but the rate was around 34% for PMDD. Despite the hormonal reactions involved in both PMS/PMDD and PPD, there have only been a few studies to determine if PMDD is, in fact, a risk factor despite the speculation that there is.  

PMDD doesn’t have to mean a life sentence. The symptoms normally go away with age and by the time you hit menopause, it will disappear. It shouldn’t affect your ability to get pregnant and you should find that pregnancy gives you relief. If you do think you have it, talk to your doctor. It is a mental health (mood) disorder related to depression or Bipolar and it’s a hormonal disorder related to PMS so there are treatments. Like all medical conditions, you may not find the “magic” treatment on the first try, but with a doctor’s help, you should be able to find relief.