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pms or pmdd? 7 signs your symptoms might be more serious

pmdd is like pms' unruly cousin, and for many people who menstruate, it's debilitating.

by angelica bottaro

published apr 26, 2024

5 minute read

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5 minute read

join the conversation

pmdd affects three to eight per cent of people who menstruate. getty images

if you have a menstrual cycle, there’s a good chance you’ve been caught in the fire of good old pms, otherwise known as premenstrual syndrome. maybe you go from happy to furious at the drop of a hat, or your normal anxiety becomes heavily amplified, making you feel as though you may just be losing your mind. you’re also craving chocolate like it’s nobody’s business, and that toilet paper commercial made you cry again.

these irritatingly unavoidable symptoms of pms come around once a month to show you just how powerful hormones truly are. but what if it’s not actually pms? for many, the typical symptoms warning you that aunt flo is coming to town aren’t typical at all.

in fact, research shows that as many as 90 per cent of females of menstruating age have premenstrual dysphoric disorder (pmdd); they just don’t know it because it’s been diagnosed as something else entirely, or they’re unaware that it’s not simple pms.

what is pmdd?

premenstrual dysphoric disorder (pmdd) is an extension of pms. the symptoms associated with pmdd are similar to those experienced during pms. however, they are intensified to the point of being disabling.

in pms, you may be more emotional or quick to irritability, but in pmdd, these mood swings can resemble that of other mental health conditions and lead to damaging results when it comes to a person’s daily life, work, and personal relationships.

like pms, pmdd symptoms start to roll in around seven to ten days before the first day of your cycle, in the luteal phase. once you start menstruating, those symptoms begin to subside, and by the time your period is over, you’re back to normal and wondering what just happened.

it isn’t easy to determine if the extreme nature of symptoms is something other than pms because many females have been living with pmdd since their first menses, making all those debilitating symptoms seem normal.

that said, here are seven ways to tell between pms and pmdd that could prompt a visit your healthcare provider for answers—and a possible solution.

1. depression rears its ugly head

pms can surely cause feelings of sadness, but when you have pmdd, it’s not simple sadness that gets you. depression, in all senses of the word, can develop around that time of the month in people with pmdd. you may feel utterly hopeless, feel extreme sadness, and even go through suicidal thoughts or ideations. in fact, roughly 34 per cent of people with pmdd attempt suicide at some point in their lives.

these symptoms are not typical in pms, and if every month you go through dark periods of depression and wonder why, you may have pmdd.

2. anxiety amplified

you could have regular levels of anxiety all the time or none at all. but when pms occurs, you typically get a little more on edge and feel those anxious effects. that said, if you have pmdd, you will feel significantly more anxiety. in some cases, you could even start to have full-blown panic attacks, when outside of the period pmdd hits, you rarely, if ever, experience them at all.

if anxiety is only slightly on your radar, but you experience the most severe forms of the condition at the same time every month, pmdd may be to blame.

3. hulking out

pms makes you irritable, but pmdd causes you to feel rage so hot that you could feel like you’re dangerously close to transforming into the hulk. the anger in pmdd is usually over more minor, less significant annoyances like someone getting your order wrong at starbucks or your spouse leaving their socks on the floor beside the laundry basket—again.

if you experience feelings of anger so strong that they cause issues with those around you, and it only happens during the luteal phase of your cycle, pmdd could be driving it.

4. routines go out the window

because of the high levels of depression, anxiety, and irritability, your routine may be disrupted during the pmdd phase. you detach from your typical day-to-day because those severe mental changes force you to. it isn’t just calling in sick one day because you just can’t deal with work. it’s more like you couldn’t care less about your job. the lack of routine also applies to your hobbies and social engagements.

if, at the same time every month, you find yourself apathetic toward everything in your life, it’s likely that your pms isn’t pms at all.

5. highs and lows are too much to bear

the highs and lows of pms aren’t a picnic in the park, but when pmdd causes them, it’s like trying to have a picnic in the middle of a wildfire. you’ll be happy, crying, angry, and feel generally out of control of your emotions and life.

starting ww-level fights with people for minor grievances? crying at something that would never make you shed a tear? feeling as though your mind is spinning and you can’t quite keep up with all the emotions it wants you to feel? you may have pmdd.

6. you’ve been diagnosed with another mental health disorder

because of how extreme pmdd symptoms are, many people may mistake them for an entirely different mood-affecting disorder: bipolar disorder, which is marked by mood changes that cycle between extreme highs and lows.

because pmdd comes around every month, people with the menstrual-related disorder can be cycling between these highs and lows regularly throughout each month. however, the two are not the same.

pmdd only occurs within the luteal phase of your cycle, whereas bipolar disorder does not have any set schedule in relation to menstruation.

7. severe fatigue sets in

it’s normal to feel tired before you start your period. increased sleepiness or fatigue is typical in pms. if you have pmdd, though, severe tiredness hits you like a ton of bricks, making even the simplest of tasks difficult to accomplish.

studies show that pmdd affects sleep so severely that you could even develop temporary insomnia, finding it difficult to fall asleep, stay asleep, or achieve enough restorative sleep throughout the night. because of how intensely pmdd affects sleep, the following day will be filled with the after-effects of a long sleepless night, such as poor concentration, decreased alertness, poor work performance, and daytime sleepiness.

what you can do about it

if you relate to the telltale signs of pmdd and your entire life is beginning to make some sense, it’s essential that you see your healthcare provider for further testing. you don’t have to accept the effects of pmdd. treatments are available to help combat the severity of the menstrual condition. some treatments include:

antidepressants
birth control pills
nutritional supplements, including vitamin b6, magnesium, and l-tryptophan
herbal remedies, such as chasteberry
lifestyle changes, such as reducing caffeine intake, getting regular exercise, and avoiding alcohol and smoking
implementing mood-regulating therapies, including mindfulness, meditation, and yoga
avoiding stressful triggers during the time of the month

living with pmdd isn’t easy, and for three to eight per cent of menstruating people that have it, it can be downright debilitating. for those who have it but have yet to be correctly diagnosed, the nightmare experience is that much harder to cope with. there is hope, however, and you can find it by speaking to your healthcare provider about possible testing, treatments, and coping strategies.

angelica bottaro

angelica bottaro is the lead editor at healthing.ca, and has been content writing for over a decade, specializing in all things health. her goal as a health journalist is to bring awareness and information to people that they can use as an additional tool toward their own optimal health.

pms or pmdd? 7 signs your symptoms might be more serious