How To Tell The Difference Between PMS & PMDD

For many women, the second half of our cycle can feel like a real struggle. Whether we’re dealing with physical symptoms or mental-emotional symptoms, the one to two weeks leading up to our periods can be truly difficult to deal with.

In many cases, the symptoms of PMS can feel so intense that they actually interfere with our ability to function normally. In these instances, we have to wonder if what we’re dealing with is actually PMDD (premenstrual dysphoric disorder) rather than PMS.

This begs the question; how do we tell the difference between PMS and PMDD? And if it is PMDD, what does this mean long-term?

Understanding PMS

PMS (premenstrual syndrome) is a collection of symptoms that occur in the luteal phase of our cycle. We’ll be reviewing the phases of our menstrual cycle more in more detail in our next blog, but the luteal phase begins with ovulation and ends with the first day of our period. During the luteal phase, our hormones estrogen and progesterone both reach their peak, and then subsequently decline, leading to the beginning of our periods. This fluctuation in our hormones can be marked by the physical and emotional symptoms that we know and often refer to as PMS.

There have been as many as 150 symptoms assigned to PMS! However, the ones we most commonly see include mood changes, irritability, bloating, digestive changes, headaches, breast swelling and tenderness, weight gain and water retention, fatigue, appetite changes and sleep changes.

Now don’t get us wrong, even if you are experiencing PMS and not PMDD, it’s still highly unpleasant, and there’s still a lot Naturopathic Medicine can offer to help alleviate these symptoms!

The key differentiator between PMS and PMDD though is that with PMS you are still able to function normally in your day to day life. Let’s break it down even further.

Understanding PMDD

So what constitutes as PMDD? While PMDD also occurs during the luteal phase and can be marked by similar symptoms to PMS, here is the exact diagnostic criteria used to differentiate between PMS and PMDD, and provide someone with a PMDD diagnosis.

criteria a: timing of symptoms

In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses.

criteria b: core symptoms

One or more of the following symptoms must be present:

Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
Marked irritability or anger or increased interpersonal conflicts
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, and/or feelings of being keyed up or on edge

criteria c: additional symptoms

One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms from criterion B above:

Decreased interest in usual activities
Subjective difficulty in concentration
Lethargy, easy fatigability, or marked lack of energy
Marked change in appetite; overeating or specific food cravings
Hypersomnia or insomnia
A sense of being overwhelmed or out of control
Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain

criteria d: severity

The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others.

criteria e: rule out other mental health conditions

Symptoms can’t just be an exacerbation of another mental health disorder such as major depressive disorder, panic disorder, persistent depressive disorder, or personality disorder.

criteria f: confirm pmdd

Criteria A needs to be confirmed by daily ratings during 2 symptomatic cycles.

criteria g: rule out other medical explanations

This includes ruling out other medical conditions such as hypothyroidism, or medical explanations such as medication changes.

What To Do With A PMDD Diagnosis

If your symptoms the one to two weeks before your period have become so intense, a PMDD diagnosis can feel like a lifeline, something to hold on to when you don’t feel like yourself and don’t understand why.

While a diagnosis of PMDD can be incredibly helpful as it allows someone to put a name to the chaos they experiencing each month, it can also be difficult because it doesn’t provide us with an explanation as to why this experience is happening.

With Naturopathic Medicine, our next step is to try to better understand why this is happening and treat accordingly.

Unfortunately, this is where conventional treatment options can sometimes fall short for those with PMDD. While SSRIs or oral contraceptives can be exceptionally helpful and provide relief to many individuals with PMDD, it doesn’t get to the root cause of why PMDD is present in the first place.

In order to start to change PMDD long term, we need to look at the way that these hormonal shifts are impacting our body and how our body in turn is responding to them.

Hormones, PMS, and PMDD

Our hormones are functional. What this means is that they are always changing in relation to our environment both internal and external. Our hormonal climate can even be thought of as a reflection of the internal functioning of our body. In women hormonal shifts can actually give us insight into how all of the other systems in our body are working and where we might need some extra support.

When we look at our body from a functional perspective and start to identify your individual factors that are contributing to your experience of PMDD that is when we can find a true diagnosis for your symptoms and thus start to correct these imbalances.

The same goes for PMS! Even if you don’t meet the diagnostic criteria for PMDD it doesn’t mean there aren’t functional imbalances present in the body that are impacting your enjoyment of your life.

A Final Word

If you’re struggling with PMS or PMDD, please know there is so much Naturopathic Medicine can offer to help you feel better! If you would like to learn more about how Naturopathic Medicine can help support PMS or PMDD, you can book a complimentary consult with me here.

Also stay tuned for our next blog going over the underlying causes of PMDD, so you can start to better understand the big contributors that play into this diagnosis, and hopefully start to gain control over your cycles again!