PMDD: When PMS Interferes With Life and Living

PMDD, or Premenstrual Dysphoric Disorder, is the most severe form of PMS (Premenstrual Syndrome.) It is believed to affect 3-8% of reproductive-aged women, and while its symptoms are identical to PMS, its impact on women’s lives is much greater. PMDD is defined by the degree to which it interferes with social life, family and home life, and work and school. Women with PMDD find that their premenstrual symptoms are truly debilitating for anywhere from a couple of days to a couple of weeks before their period.


While PMDD is a distinct diagnosis compared to PMS, misconceptions about the difference between the two abound. There are really three characteristics that set them apart: the degree to which they interfere with a woman’s ability to enjoy life and to meet her responsibilities; the medications approved by the Food and Drug Administration to treat PMDD; and the prominence in PMDD of mental and emotional symptoms.


One source of confusion is that PMS itself can be quite severe and can interfere with a woman’s life. The American College of Obstetricians and Gynecologists’ definition of PMS clearly states that PMS causes “identifiable dysfunction in economic or social performance.” In spite of this, the misunderstanding continues that PMS is a mild annoyance and only PMDD causes real problems. What is undeniable is that every woman with PMDD experiences a major disruption to her life as a result of her symptoms, whereas only 25% of women experience PMS to such a degree that it significantly interferes with their life.


Also, while both PMS and PMDD have physical, mental and emotional symptoms, in PMDD the mental and emotional symptoms are usually much more prominent. Severe premenstrual depression, moodiness, irritability, social withdrawal, anxiety and difficulty concentrating are the hallmarks of PMDD. Women with PMDD can have typical mild to severe premenstrual physical symptoms also: cramps, aches and pains, breast tenderness, headaches, bloating, and the like.


Oftentimes, women who don’t know of the existence of severe PMS and PMDD mistakenly believe that premenstrual symptoms can’t ever be more than a mild annoyance, so the mismatch of their expectations and their actual symptoms results in confusion. This may be compounded by the expectations of friends, family, co-workers, spouses, and significant others, some of whom may not believe PMS even exists, let alone the truly debilitating specter of PMDD. They may have the idea (and may say it out loud!) that you should just “Snap out of it” or that premenstrual suffering and misery is a sign of weakness.


Of course, nothing could be further from the truth. PMS and PMDD result from an imbalance of female hormones and of mood chemistry, and there are both natural health approaches and pharmaceuticals that can help ameliorate the symptoms.


Another source of PMDD confusion can occur when it’s cyclical nature isn’t recognized. Women may think they are experiencing severe depression or another mood disturbance that comes and goes for no apparent reason. Closer attention to the timing of the symptoms of PMDD will nearly always reveal that the symptoms clearly come on between ovulation – usually the 15th day of the menstrual cycle – and the onset of the period, and disappear shortly after the onset of the period.


If you think you might have PMDD, or even severe PMS, please consult with your health-care professional. Don’t believe anyone who tells you to “Just snap out of it,” and don’t think you have to “Just live with it.”


Added to Women's Health, Symptom Definition on Tue 02/28/2012