PMS vs PMDD

PMS vs PMDD  History of the two. 

Women experience changes in the levels of their hormones throughout their lives and unfortunately, it causes a whole host of problems for them. Researchers who are interested in women's mental health believe that hormones play a huge role in women's mood.   Before menopause women are almost twice as likely as men to be diagnosed with depression, but after that time it drops to about the same rate as that in men! This and other research is often cited as evidence of the connection between mental health and hormones in women. 


History of PMS

Dr. Katharina Dalton, a chiropodist in London, is responsible for putting Premenstrual Syndrome (PMS) on the map. She discovered that her crippling premenstrual migraines vanished during her pregnancy and this prompted her to make the connection between hormones and many other difficulties women had in their lives. So, she went to medical school.  

Dalton did studies that showed schoolgirls' grades declined by 10 percent before they menstruated followed by a 20 percent increase postmenstrually. Other studies she did found that half of the suicides committed by women in England in the 50’s and 60’s occurred during the 4 days before they menstruated as did half the crimes. Later she went on to reduce the sentence for a young girl who committed arson based on her PMS theory as well as one who committed murder. She was determined! Before Dr. Dalton’s theories, the symptoms women experienced before their periods were explained as hysteria or madness. We certainly owe her some gratitude. 

Whatever you think of these studies or ideas, if you are a woman reading this you don’t need them to know hormones have a dramatic impact on your mood, behavior, and capabilities. You have come to this page because of it. Katharina Dalton had to have extreme ideas to get PMS accepted into mainstream medicine.

Unfortunately, today medical professionals still may react with mixed emotions to you if you go seeking help for PMS or Pre menstrual Dysphoric Disorder(PMDD).

History of PMDD

The history of PMDD evolved from the history of PMS. It was determined in 1999 by a panel of experts that PMDD was a distinct diagnosis in a group of women that had severe mood dysregulation during the luteal phase of their period, so much so that it had distinguished itself from other disorders. 

An important feature of PMDD is that it cannot be diagnosed if you have depression or bipolar disorder. If you do then it is labeled Premenstrual Exacerbation (PME). An exacerbation of what you have already been diagnosed with. This does not in any way take away from the suffering that you may experience.  

PMDD faces controversy and some professionals don’t believe it exists. Others say women truly suffer and should be treated. THERE IS PLENTY OF EVIDENCE IT IS A REAL DISORDER. What both PMDD and PMS have in common, is that women who suffer from them are often met with skepticism and dismissed by medical professionals when presenting with their symptoms.  

The important thing to know is if you suffer, find a medical professional that takes you seriously, and will keep searching for treatment options until you find relief.

PMS vs PMDD: Different Professional Groups Weigh in

The APA or American Psychiatric Association is the group that sets up the definitions that separation PMS and PMDD. Keep in mind that different organizations serve women.

Other important groups combine PMS and PMDD into one category and have less strict criteria.

  • American College of Obstetricians and Gynecologists call it Premenstrual Syndrome and see it in 30 percent of women
  • World Health Organization calls it Premenstrual Tension Syndrome and sees it is up to 80 percent of women
  • International Society for Premenstrual Disorders (ISPD)----call it premenstrual disorders and essentially lumps it all together.

The ISPD’s stance is that all women who suffer should have access to treatment and care if they feel their life is impacted by symptoms.  

PMS vs PMDD symptoms

Regardless of whether you have PMS, PMDD, or Premenstrual Exacerbation(PME), it's important to take your concerns seriously and continue to seek help until someone takes you seriously and you get maximum relief.

What exactly is PMS and what is the difference in PMS vs PMDD?

The premenstrual syndrome(PMS) refers to the various symptoms that occur between the weeks of ovulation and the menstrual cycle. We refer to this as the luteal phase. This period is 1-2 weeks before menstruation most often a few days before it’s onset. Menstruation is a time that brings shifts in the mood for almost all women high estimates say up to 80 percent of women report symptoms of PMS.

Researchers have documented more than 150 different PMS symptoms in studies, ranging from physical to emotional to behavioral to cognitive. Food cravings are up there with the most commonly reported behavioral PMS symptoms, along with mood swings, irritability, anxiety and tension, and sad or depressed mood.

PMS symptoms vary dramatically in their severity and in the areas they manifest in. PMS manifests differently for each woman. Most women have mild symptoms. For all women with both PMS or PMDD, they resolve with the onset of menstruation.

PMS Symptoms can include things such as:

  • Anger
  • Anxiety
  • Depression
  • Sensitivity
  • Overwhelm 
  • More emotional
  •  Bloating
  • Tenderness
  • Headaches
  • Muscle
  •  Joint pain
  •  Fatigue
  •  Sleepiness
  • Food cravings

Symptoms of PMDD are much more severe and much less common. Low estimates say 3 percent of women suffer from it and high estimates say 8 percent of women can be diagnosed with it. PMDD is the only premenstrual disorder that is diagnosable.  

PMDD criteria

Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD) according to the DSM 5

Timing of symptoms 

A)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 postmenses 

Symptoms
B) One or more of the following symptoms must be present:

1) Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)2)

2) Marked irritability or anger or increased interpersonal conflicts

3) Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

4) Marked anxiety, tension, and/or feelings of being keyed up or on edge

C) 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

1) Decreased interest in usual activities

2) Subjective difficulty in concentration

3) Lethargy, easy fatigability, or marked lack of energy

4) Marked change in appetite; overeating or specific food cravings

5) Hypersomnia or insomnia

6) A sense of being overwhelmed or out of control

7) Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain 

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

 E) Consider Other Psychiatric Disorders The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia) or a personality disorder (although it may co-occur with any of these disorders). 

Confirmation of the disorder
F) Criterion A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles (although a provisional diagnosis may be made prior to this confirmation)

Exclude other Medical Explanations

G) The symptoms are not attributable to the physiological effects of a substance (e.g., drug abuse, medication or other treatment) or another medical condition (e.g., hyperthyroidism). 


 In reading the criteria you can see many more symptoms are required and that a woman would be much more disabled by PMDD than by PMS.

One of the reasons that the diagnosis of PMDD is so rare, is that PMDD cannot be diagnosed if a woman has a diagnosis of Depression or Bipolar Disorder. If that is the case, then the woman is diagnosed as having Pre Menstrual Exacerbation (PME).

Some other key things to remember about PMS VS PMDD are:

  • PMDD will often require meds
  • PMDD will likely require therapy
  • PMDD is more severe
  • PMDD has more symptoms
  • PMDD must include mood symptoms
  • PMDD interferes in your life more
  • PMDD is considered a diagnosis PMS is not

Both PMS and PMDD can be impairing. Both PMS and PMDD appear to be caused by a sensitivity to fluctuating hormones in a women's body. 



PMS vs PMDD treatment

You can learn more about PMDD treatment at this link. It may often require the same treatment as PMS and perhaps MUCH More.

PMS treatment usually includes

  1. Keep a daily diary or log for at least 3 months where you record the symptoms you are suffering from and details about the severity and the level of impairment they are posing for you. 
  2. Changes in your lifestyle often result in alleviation of symptoms. Simple changes such as decreases in alcohol, salt, sugar, and caffeine.
  3. Increasing sleep and exercise
  4. Nutritional supplements such as B6, calcium, and magnesium may be prescribed by your doctor as well as NSAIDs. 
  5. Doctors may prescribe birth control pills to reduce symptoms, or other drugs depending on your symptoms.
  6.  Also depending on the severity of your anxiety or mood symptoms, outpatient therapy can help. 
  7. If those symptoms become more severe you may need more assistance. 

 

This is how PMS vs PMDD vs PME are currently conceptualized by medical professionals such as doctors and psychiatrists.  

I can tell you in my client's exacerbation of underlying challenges during menstruation is almost the norm. Many women struggle on an ongoing basis with the impact of their hormones on their health it is astounding. If only society fully grasped and understood the impact of hormones on mood or invested the research and time it took we would be functioning much better in our homes and workplaces.

 There is a some suggestion that PMS can be responsive to St Johns Wort. However it is associated with a reduction in dose of Oral contraceptives which can result in break through bleeding or failure.


PMS, PMDD, and Transwomen

As you can imagine, this group of women are even less understood, researched and embraced by the medical community. I have some websites here where you may find some more information if you are a transwoman who is looking for some information about hormonal cycles and about how those cycles might relate to PMS or PMDD. I am sorry I don't have more information. I will add it when it becomes available. 

https://theestablishment.co/yes-trans-women-can-get-period-symptoms-e43a43979e8c/index.html

http://www.onwednesdays.net/trans-girl-periods/

https://iapmd.org/transgender-pmdd

PMS vs PMDD references

Craig, M. C.,B.Sc M.B.B.S.PhD.F.R.C.O.G.F.R.C.Psych, Sadler, C.,B.M.B.S.D.R.C.O.G.D.C.H., & Panay, N.,B.Sc F.R.C.O.G.M.F.S.R.H. (2019). Diagnosis and management of premenstrual syndrome. Practitioner, 263(1824), 15-19. Retrieved from http://nclive.org/cgi-bin/nclsm?url=http://search.proquest.com/docview/2211915215?accountid=13217

Slater, L. (2004, December 26). The Prophet of PMS. Www.NYT.com. Retrieved from https://www.nytimes.com/2004/12/26/magazine/the-prophet-of-pms.html

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 

https://mghcme.org/Psychiatric Disorders in Women: Diagnostic and Treatment Considerations Across the Female Lifespan (February 2020) PMDD 

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