The 101 on PMS and PMDD

What is PMS?

PMS = premenstrual syndrome. This involves a group of physical and behavioral symptoms that occur in a cyclic pattern in the second half of the menstrual cycle.

What is PMDD?

PMDD = premenstrual dysphoric disorder. This is a more severe form of PMS. With PMDD, symptoms interrupt activities of daily life. Examples of such symptoms may include anger, depression, and irritability.

Are PMS and PMDD common?

Yes! PMS affects up to 75% of women and PMDD affects about 3-8% of women.

What is the cause?

It is not fully clear! The changing hormone levels (i.e. estrogen and progesterone) during the cycle can impact tissues in the body and chemicals in the brain. It is interesting because hormone levels are similar in those who have these conditions and in those who don’t. It is likely that those who develop PMS or PMDD are very sensitive to the changes in hormone levels.

What are the most common symptoms?

There is a wide range of symptoms! One often hears about fatigue, bloating, irritability, depression, and anxiety.

What are mimics of PMS and PMDD?

Many conditions have similar symptoms to both PMS and PMDD so it is very important to make the correct diagnosis in order to treat appropriately. Many psychiatric disorders (i.e. depression, anxiety, bipolar) can have similar mood symptoms. Other medical disorders such as migraines, chronic fatigue syndrome, irritable bowel syndrome, and pelvic and bladder pain may get worse before or during menses so it is important to pay attention to all other medical conditions as well.

How can we make a diagnosis of PMS and PMDD?

Unfortunately, there is no easy one test that can diagnose this! Providers look at symptoms and time frame of symptoms: the symptoms must be both physical and behavioral and usually occur about 5 to 7 days before one’s period. They occur in the second half of the menstrual cycle and should not be present on days 4 through 12 in the cycle.

Specifically, there is no blood test to make the diagnosis but a blood test could exclude other medical conditions contributing to symptoms such as anemia and hypothyroidism, which both cause some similar symptoms to PMS and PMDD.

How can we treat PMS and PMDD?

At first, one can try regular exercise (to lower stress, tension, etc) and relaxation techniques (i.e. meditation) or even vitamin or mineral supplementation (Vit B6 might have a small benefit). There are many medications that can be employed for treatment. For example, selective serotonin reuptake inhibitors (SSRIs) and birth control pills are common treatments. For example, the birth control pill called Yaz is approved for PMDD.

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