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Learn the difference between PMS and PMDD, explore symptoms, causes, and therapeutic treatment options to support your mental health

Around the same time every month, you or someone you know and love may experience one or more of the following symptoms: tearfulness, unexplained anger, sadness, irritation, or depression, a feeling of being out of control, mood swings, insomnia, or anxiousness. Maybe that equates to crying, screaming, sliding down the wall. Maybe crashing out. But it happens every month and always seems to come out of nowhere. Why is this? And why is it so common?

As a therapist, I work with people who get periods and experience these symptoms each month and deal with things like period-related depression or anxiety as the status quo. While I cannot offer direct medical advice, and encourage clients and anyone reading this to consult with their medical provider (gynecologist, primary care physician, etc.), I can offer some insight into mental health treatment for PMS (Premenstrual Syndrome) and PMDD (Premenstrual Dysphoric Disorder). For the purpose of this blog, I will refer to folks who get periods as such, women, or womxn.

Periods 101

Learning how to manage the aforementioned symptoms better starts with understanding. If you get a period each month, one of the most important things to understand is the phases of your cycle. They are: menstrual, follicular, ovulatory, and luteal. In the most simplest terms, your menstrual phase is when your uterine lining sheds and you get your period (also called your menstrual cycle). You may feel more tired and have lower energy. The following week brings your follicular phase. That’s when your body is preparing an egg for release. This phase of your cycle can lead to more motivation and socialization and clearer thinking.

Next up is ovulation, where the ovary releases an egg. This can lead to energized, confident feelings. If the egg is not fertilized during the ovulatory phase of your cycle (meaning, if you don’t get pregnant), your cycle resets. This is known as your luteal phase. You may initially feel calm but then PMS or PMDD symptoms may ramp up.

What happens to my mental health during the week before and of my period?

In the luteal phase, one’s perception shifts. It is difficult to determine what is true from what is not. Increased depression and anxiety exacerbate this - causing a distortion in reality. You may notice an uptick in intrusive thoughts, causing you to rethink everything and ruminate more than usual.

During your menstrual cycle, memory diminishes. You’re more prone to forget, experience clumsiness and exhaustion. Research also shows that mood changes during both the luteal and menstrual phases impact cognition (Le, Thomas & Gurvich, 2021) and that working memory (the mental system that temporarily holds a limited amount of information and actively manipulates it to perform cognitive tasks) deficits are implicated during the luteal phase, particularly within women with PMDD. Imagine that - for two weeks out of the month, your ability to problem solve, follow instructions, and make decisions may be impacted. No wonder it is hard to focus on washing the dishes or completing an important work task!

What is the difference between PMS and PMDD?

Many womxn experience PMS (Premenstrual Syndrome) every month, but for some, symptoms are far more intense, leading to PMDD (Premenstrual Dysphoric Disorder). Understanding the difference between PMS and PMDD can support you in finding relief.

What is PMS?

While I am not a huge proponent of diagnosing folks, I find diagnoses valuable to help alleviate suffering and operationalizing symptoms for management. PMS diagnosis requires at least one physical symptom and at least one psychological symptom in 5 days prior to menses. Physical symptoms include: breast tenderness, headaches, muscle or joint pain, and bloating. Psychological symptoms include: anhedonia (disinterest in activities you typically enjoy), depressed mood, angry outbursts, irritability, anxiety, confusion, and social withdrawal).

PMS can also have an additional physical impact on physical and mental health conditions such as allergies, migraines, chronic headaches, anemia, asthma, IBS, diabetes, anxiety, depression, and even gingivitis.

Many women ask how to know if it’s PMDD or PMS - one clear difference is the severity of emotional symptoms such as depression and anxiety.

What is PMDD?

PMDD symptoms occur during the final week of the luteal phase (as opposed to the five days before menses with PMS) and are minimal/absent in the week post menses. A PMDD diagnosis requires one or more of the following: marked lability (mood swings), marked depressed mood, or marked anxiety PLUS at least one of the following symptoms to equal five total symptoms: anhedonia, reduced concentration, lethargy, appetite change, hypersomnia/insomnia, sense of being out of control, and physical symptoms.

**(Not so) fun fact: Trauma history can increase likelihood of PMDD.

Lastly, we have Premenstrual Exacerbation (PME). PME doesn’t cause new symptoms to occur. and is not necessarily its own condition. Rather, it is the worsening or exacerbation of already occurring mental and physical health conditions due to your period. So if you already have depression, bipolar disorder, or anxiety for example, your period can cause the symptoms you experience to worsen or be harder to manage.

How do I know if I have PMDD or PMS?

It can be challenging to differentiate between PMS, PMDD, and PME and determine a plan for treatment. So, the first step a treatment provider (psychotherapist, counselor, or prescriber) would take is to conduct a full psychiatric history and check your symptoms. Providers may also use screening tools such as the PMDD Symptom Tracker, The McMaster Premenstrual Symptoms Screening Tool, and the Premenstrual Symptoms Screening Tool. There is also an adolescent version of the Premenstrual Symptoms Screening Tool. Each of the screening tools ask the client for data from their two most recent cycles and symptoms such as anxiety, irritability, depressed mood, lack of interest, difficulty sleeping, and changes in sleep patterns or appetite.

For clients who want to utilize technology, there are apps such as Me v. PMDD and Belle. These apps can help digitally track symptoms similar to provider-led screening tools.

The *Premenstrual Symptoms Screening Tool*

What are my options for treatment for PMS and PMDD?

There are myriad treatments for PMS and PMDD including medication and therapy. Prescribers may recommend SSRIs, SNRIs, or oral contraceptives. As a psychotherapist with a certification in women’s mental health, I am able to provide therapy for PMS and PMDD. I’ll share a bit about my approach in the next section.

Can therapy help with PMS and PMDD?

Therapy can absolutely help with PMS and PMDD. My approach as a therapist who works with clients who struggle with PMS and PMDD is to begin with collecting as much data as possible. As previously noted, memory diminishes in the menstrual cycle. I encourage clients to take active notes about their symptoms and needs during other phases of their cycle to support their needs during menstruation.

The week leading up to one’s period can be an opportunity to reflect on their body. Pains and inconvenient symptoms can be allies in investigating what’s happening physically, mentally, and emotionally. What is your body saying to you during your late luteal phase? Did it say the same thing last month, or the month before that?

I also work with clients to identify tracking methods for self care before and during their periods. How is sleep, mood, food consumption, movement, and technology usage? How often are boundaries ignored, or relied on too rigidly? Who is there to support their needs at this time?

PMS and PMDD are far too common to still be taboo or misunderstood. If you deal with either disorder and live in DC, Maryland, or Virginia, please know support is available to you. Book a complimentary consultation with me to find some relief from PMS or PMDD.

Sources

Le, J., Thomas, N., & Gurvich, C. (2020). Cognition, The Menstrual Cycle, and Premenstrual Disorders: A Review. Brain Sciences, 10(4), 198. https://doi.org/10.3390/brainsci10040198