What’s the Difference Between PMS and PMDD – and How Can You Tell If You Have It?

Premenstrual Syndrome (PMS) is a common but often overlooked condition that causes physical and/or emotional symptoms in the days leading up to your period.
Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS. It primarily involves significant emotional symptoms and functional impairment in the weeks leading up to menstruation. Both conditions are related to the menstrual cycle, but they differ in terms of symptoms and severity.

Here you can learn about PMS and PMDD, how the diagnosis is made, and what you can do to relieve the symptoms.

Premenstrual dysphoria disorder is often overlooked, but it can have serious emotional consequences

What Is PMS?

PMS involves a wide range of physical and emotional symptoms that begin in the second half of the menstrual cycle (the luteal phase). The symptoms usually ease once menstruation starts or shortly afterward.

What Is PMDD?

Up to 1 in 20 women of reproductive age experience a more severe form of PMS known as Premenstrual Dysphoric Disorder (PMDD). PMDD is a depressive disorder that can lead to intense emotional symptoms and functional impairment in the weeks leading up to menstruation. The symptoms of PMDD are very intense.

Common Symptoms of PMS

Mood swings
Irritability
Lack of energy or fatigue
Concentration problems
Sleep problems
Bloating
Breast tenderness
Weight gain
Headaches

Common Symptoms of PMDD

Severe depression
Anxiety
Panic attacks
Suicidal thoughts
Extreme irritability
Angry outbursts
Emotional instability

PMDD – A Severe Form of PMS

PMDD stands for Premenstrual Dysphoric Disorder. Dysphoria refers to a state of deep sadness or emotional discomfort. The World Health Organization (WHO) officially recognizes PMDD as a medical diagnosis. PMDD is classified as an affective disorder, a type of mental health condition that affects a person’s mood and emotional state.

What sets PMDD apart from other affective disorders is that its symptoms are directly linked to the menstrual cycle. Unlike depression or anxiety disorders, PMDD always includes a symptom-free phase. Symptoms typically begin around six days before menstruation starts, peak about two days before, and then fade quickly once the period begins. For the rest of the cycle, most people feel well and function normally.

The exact cause of PMDD is not fully understood, but it appears to be linked to how the brain responds to the natural hormonal changes that occur during the menstrual cycle.

PMDD can be debilitating, as it brings severe emotional symptoms every month. These symptoms can make it difficult to manage daily activities. They often result in sick days and affect social relationships, which can impact quality of life.

How Is PMS or PMDD Diagnosed?

PMS can be diagnosed by your primary care physician or by a gynecologist with specific expertise in the condition. The doctor will typically ask about your medical history, lifestyle, the severity of your symptoms, and how they relate to your menstrual cycle. A gynecological exam may also be performed, and the doctor will work to rule out other possible conditions such as endometriosis, polycystic ovary syndrome (PCOS), thyroid disorders, or mental health conditions.

Once other possible causes have been ruled out, you will typically be asked to fill out a form where you record every day what symptoms you experience and how much they affect you. The form is called the Daily Record of Severity of Problems (DRSP). It includes 11 psychological and physical symptoms that you rate on a scale from one to six, typically over a period of two months.

If your responses show that you experience at least 5 out of the 11 symptoms including at least one affective (i.e., emotional) symptom, and your ability to function is significantly impaired, this may indicate PMDD. It is important to rule out whether your symptoms are caused by a flare-up of another underlying mental health condition that may require a different treatment.

“Almost all women experience cycle-related symptoms before their period. The difference between these normal symptoms and PMS is that with PMS, the symptoms interfere with your ability to function in daily life.

How Are PMS and PMDD Treated?

According to the Danish Society of Obstetrics and Gynecology, treatment for PMS (including PMDD) can be divided into four main categories:

Non-medical treatment, such as vitamin supplements (including calcium, magnesium, and vitamin B6), physical exercise, and cognitive behavioral therapy.
Hormonal treatment (birth control pills or estrogen and progesterone therapy)
Psychotropic medication
Surgical (removal of the ovaries – should only be considered in severe cases of PMS where other reversible treatment options have not been effective)

Danish Society of Obstetrics and Gynecology Guideline on Premenstrual Syndrome: Diagnosis, Evaluation, and Treatment

Hormone Patches

Hormone patches deliver a controlled dose of the sex hormone estrogen through the skin. This helps regulate hormonal fluctuations and relieve symptoms. Estrogen should always be combined with progestin (a form of the hormone progesterone) to prevent cellular changes in the lining of the uterus. The patch needs to be changed once or twice a week. Compared to systemic hormone treatments, such as oral tablets, hormone patches act more locally and may cause fewer side effects.

If you are experiencing symptoms and would like to explore whether hormone therapy is the right option for you – you are welcome to contact our clinic for further information.

The 4 Phases of the Menstrual Cycle

On average, an adult woman’s menstrual cycle lasts 28 days,
although anything between 23 and 35 days is considered completely normal.

Menstrual Phase
The menstrual phase lasts 3 to 7 days and begins on the first day of bleeding. During menstruation, the body sheds the uterine lining along with the unfertilized egg.

Follicular Phase
The follicular phase lasts about 10 to 14 days and includes the menstrual phase. During this time, the body produces more of the sex hormone estrogen to prepare for ovulation. It also releases follicle-stimulating hormone (FSH), which stimulates the growth of follicles in the ovaries. Follicles are small fluid-filled sacs inside the ovaries that contain the eggs.

Ovulation Phase
The ovulation phase lasts 24 to 48 hours. During this phase, the body releases a hormone called LH (luteinizing hormone), which stimulates the process of releasing a mature egg from the ovary. This is the time in your cycle when you can become pregnant.

Luteal Phase
lasts about 14 days and covers the time between ovulation and menstruation. During this phase, the body initially responds as if it were pregnant by producing more of the sex hormone progesterone. If you are not pregnant, progesterone levels drop, signaling the body to shed the uterine lining along with the unfertilized egg during menstruation.

Book an Appointment

If you suspect that you may have PMS or PMDD, you can schedule a consultation at our clinic with gynecologist Dr. Marie Foegh. During the consultation, you will talk about your symptoms and how they affect your daily life. Dr. Foegh will examine you and may take a blood sample if needed. She will also show you how to complete the symptom tracking form, and together you will schedule a follow-up to review your records, discuss treatment options, and create a plan for how she can best support you.

Book a Consultation

The Menopause-Clinic offers personalized support and treatment related to menopause. Consultations can take place either online or in person at the clinic, depending on what suits you best.