Table of ContentsView AllTable of ContentsDifferencesAverage PMS ExperienceMisdiagnosed ConditionsProvidersTreatmentLiving With PMDD and Bad PMSWhen Do They Go Away?
Table of ContentsView All
View All
Table of Contents
Differences
Average PMS Experience
Misdiagnosed Conditions
Providers
Treatment
Living With PMDD and Bad PMS
When Do They Go Away?
Premenstrualdysphoricdisorder (PMDD) and premenstrual syndrome (PMS) are two conditions linked to the menstrual cycle. Both cause many of the same symptoms, such as fatigue, mood changes, and bloating. However, PMDD causes a more severe emotional response that can disrupt your daily life and affect how you relate to others.
Knowing whether your symptoms occur from PMDD, PMS, or another health concern is key to getting the right treatment and feeling better. There are no formal tests to diagnose PMS or PMDD. Instead, you may have to track symptoms daily for at least twomenstrual cyclesto determine the cause of your problems.
PMDD vs. PMS: What’s Different?
Premenstrualdysphoricdisorderandpremenstrual syndromeare easily confused because they share many physical and emotional symptoms. If you have symptoms that fluctuate with your menstrual cycle, you may wonder if you have PMDD or PMS. Here is how these conditions compare.
Severity of Mental Health Effects
The severity of mental health effects differs between PMDD and PMS. PMDD is a hormone-basedmood disorderthat occurs when your brain has a negative reaction to the monthly rise and fall ofestrogenandprogesteronelevels.
The mental health effects of PMDD can interfere with your normal work, social, or home activities. These mental health effects can be so severe that people with PMDD have an increased risk ofsuicideand suicidal behavior.
A diagnosis of PMDD involves at least five symptoms that start in the final week before the start of your menstrual period and improve within a few days of the onset of bleeding. These criteria include the following:
One or more of the following symptoms:
Plus, one or more of the following symptoms to reach a total of five symptoms combined with four symptoms from the first list:
While these symptoms can also occur in PMS, they tend to happen at a much less intense level. For example, PMS can trigger feelings of mood changes and feelings ofdepression. However, the depression that occurs in PMDD can be so pronounced that you may have thoughts of self-harm or suicide.
The mental health effects of PMS can include:
Timing Before Period and Symptom Duration
While symptoms differ for everyone, a menstrual cycle consists of two phases based on an average 28-day cycle, as follows:
Symptoms usually occur in the following patterns:
PMS:
PMDD:
Frequency
Research indicates that almost 90% of people who menstruate have symptoms of discomfort before their period. About 20% to 40% of people experiencing discomfort have symptoms that meet the criteria for premenstrual syndrome (PMS). While PMDD is considered a more severe form of PMS, PMDD only affects about 2% to 8% of people who menstruate.
Similarities/Overlaps in PMS and PMDD SymptomsMany symptoms overlap between PMS and PMDD. Generally, the same symptoms tend to occur in PMDD but are more severe, including:AnxietyBloatingBreast tendernessChanges in eating habitsChanges in sleepDepressionFatigueIrritability
Similarities/Overlaps in PMS and PMDD Symptoms
Many symptoms overlap between PMS and PMDD. Generally, the same symptoms tend to occur in PMDD but are more severe, including:AnxietyBloatingBreast tendernessChanges in eating habitsChanges in sleepDepressionFatigueIrritability
Many symptoms overlap between PMS and PMDD. Generally, the same symptoms tend to occur in PMDD but are more severe, including:
Comparing the Average PMS Experience
PMS involves a combination of physical and emotional symptoms that are not well understood due to misinformation. Here is what the average PMS experience involves:
A condition that affects many but not all people who menstruate: While mild to acute premenstrual symptoms affect the majority of people who menstruate, only up to 40% of them have symptoms that qualify as PMS. While PMS is a natural reaction, it is not a necessary part of the menstrual cycle.
Monthly symptoms that can increase stress: PMS can affect your ability to maintain normal sleeping and eating patterns. The effect can cause physical effects that can add to your feelings of stress and how you interact with others.
Relief of symptoms with conservative treatments: The symptoms that occur with PMS can typically be resolved with conservative treatments that involve living a healthy lifestyle. Mild PMS symptoms do not usually interfere with your ability to participate in everyday activities. Prescription medications can relieve severe symptoms that do not respond to lifestyle modifications.
PMDD and PMS have a range of symptoms that overlap with several other physical and mental health conditions, including:
Lab testing may identify other conditions that share symptoms with PMDD and PMS. Tracking your symptoms can indicate whether they only occur in days before your period or whether they affect you all the time.
While PMS and PMDD align with your menstrual cycle, other conditions are more likely to cause symptoms all the time, regardless of your menstrual cycle.However, some other conditions have symptoms that worsen before the menstrual period, such as depression and irritable bowel syndrome.
Suicidal Ideation and Hotline/ResourcesResearch indicates that 34% of people with PMDD have attemptedsuicide.If you or someone you know is at risk of self-harm due to PMDD or any reason:Call or text988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor 24/7.Call911to reach emergency services in your area.Text741741to reach the Crisis Text Line to reach trained counselors 24/7.
Suicidal Ideation and Hotline/Resources
Research indicates that 34% of people with PMDD have attemptedsuicide.If you or someone you know is at risk of self-harm due to PMDD or any reason:Call or text988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor 24/7.Call911to reach emergency services in your area.Text741741to reach the Crisis Text Line to reach trained counselors 24/7.
Research indicates that 34% of people with PMDD have attemptedsuicide.If you or someone you know is at risk of self-harm due to PMDD or any reason:
Which Provider Has Insights?
You should consult with a healthcare provider if you have symptoms of depression, anxiety,suicidal ideation, mood swings, anger/rage, or irritability that fluctuate across your menstrual cycle or premenstrual symptoms that severely disrupt your life and interfere with your ability to maintain relationships.
Several types of providers can offer insights into your symptoms of PMS and PMDD. Ideally, you will work with a multidisciplinary team of medical providers. If possible, seek out providers who are well-informed and experienced in diagnosing and treating premenstrual disorders.
The type of provider you contact may ultimately depend on which types of symptoms are most severe, your preferences, and the type of providers to which you have access in your health insurance system. The following providers can typically address a wide range of PMS/PMDD symptoms:
Consider bringing a partner, trusted family member, or friend to your appointment. They can help you take notes and pose questions that you may not think to ask.
Treatment Differences and Similarities
PMS and PMDD do not have standard treatment regimens. Numerous symptoms can occur with PMDD, and over 150 symptoms have been linked with PMS. No one has all the identified symptoms.
In some cases, one symptom is most prominent. Therefore, treatment must be individualized to each person’s symptoms, preferences, and needs. Since so many symptoms overlap, some treatments may be helpful for both disorders.
For Emotional and Psychological Effects
Conservative Treatments
Conservative treatments are the first tried for PMS. These treatments can improve symptoms without the side effects inherent in drug treatments. These treatments include:
A combination of conservative treatments and prescription drugs is often advised for treating PMDD. The most common prescribed drugs include:
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIsare considered the first-line treatment for PMDD and severe PMS mood symptoms.These drugs tend to work effectively at low doses and act quickly. These antidepressants are typically prescribed with either continuous daily dosing all month or intermittently for the 14-day luteal phase before your period begins.
The following SSRIs are Food and Drug Administration (FDA)-approved in the United States for the treatment of PMDD:
Antianxiety Drugs
Antianxiety drugs (anxiolytics)can be effective in treating severe premenstrual anxiety that does not improve with SSRIs or other treatments.These drugs include:
Hormone Therapies: Oral Contraceptives
Oral contraceptives(birth control pills) that contain combinations of estrogen (typicallyestradiol) andprogestin(the synthetic form of progesterone) are used to interrupt the hormonal cycle that triggers PMS symptoms in some people.
In the United States, two combination birth control pills that contain the progestin drospirenone are approved for the treatment of PMDD:
Hormonal Interventions: Leuprolide
For severe premenstrual symptoms that do not respond to any other treatments, therapies that includegonadotropin-releasing hormone (GnRH) agonists, such as Eligard (leuprolide), which suppress ovarian function, can be effective.
Surgical Intervention
When all other options fail to improve severe PMDD symptoms,hysterectomy(removal of the uterus) andbilateral salpingo-oophorectomy(removal of the uterus, fallopian tubes, and ovaries) with hormone add-back therapy can be considered when therapies are ineffective or the side effects and/or costs of treatments are unbearable.
For Physical Symptoms
The same treatments can be used to address physical symptoms such as bloating, breast tenderness, headaches, and muscle aches in PMS and PMDD. These treatments include over-the-counter (OTC)nonsteroidal anti-inflammatory drugs (NSAIDs)such as Advil and Motrin (ibuprofen), Aleve (naproxen), orBayer (aspirin).
Vitamins, minerals, and herbal remedies have not proven to be effective in treating the symptoms of PMS and PMDD.
Living with PMDD and bad PMS can feel overwhelming. Intense emotional symptoms interfere with your ability to live a normal life. The cyclical nature of symptoms can leave you feeling hopeless and out of control. You can help combat these symptoms with lifestyle strategies that support your mental and physical well-being so you can take charge of your physical and mental health.
When you are dealing with episodes of PMDD or bad PMS:
Living with PMDD involves maintaining a routine of self-care and healthy lifestyle habits throughout the entire month. Research indicates that you can often reduce premenstrual symptoms with the following lifestyle strategies:
When Do PMDD and PMS Go Away?
Symptoms of PMDD and PMS can start anytime between puberty and menopause. For most people who menstruate, these symptoms begin in the mid-20s and remain a problem during the late 20s to early 40s. PMDD and PMS symptoms may get worse with age or during periods of stress.
Research indicates that both PMS and PMDD may begin as early as the teen years, although people may not seek treatment until later. Studies show that 2% to 6% of people who menstruate between the ages of 14 and 16 meet the criteria for PMDD. PMS, PMDD, and other menstrual problems go away atmenopause(the end of menstrual periods).
Summary
PMS and PMDD are two ailments that come and go with the hormonal changes that occur during the menstrual cycle. They trigger a combination of physical and emotional effects that occur in the days just before your period and then resolve until the next month.
PMS and PMDD differ in the severity with which the symptoms occur. The symptoms of PMS can cause physical discomfort, mood swings, and depression. These symptoms become much more intense and sometimes dangerous in PMDD.
If you are having symptoms of PMS, try to make lifestyle changes that can help reduce symptoms so you feel normal. If symptoms persist or become severe, contact a healthcare provider for a diagnosis and ways to help you feel better every day of the month.
18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UCLA Health.Is your severe PMS actually premenstrual dysphoric disorder (PMDD)?International Association for Premenstrual Disorders (IAPD).What is PMDD?Office on Women’s Health (OASH).Premenstrual syndrome (PMS).University of California San Francisco (UCSF) Center for Reproductive Health.Normal menstrual cycle.Mount Sinai.Premenstrual syndrome.Gao M, Zhang H, Gao Z, et al.Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder: a study protocol for systematic review and meta-analysis.Medicine (Baltimore). 2022;101(1):e28528. doi:10.1097/MD.0000000000028528UpToDate.Patient education: premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (beyond the basics).National Association for Premenstrual Syndrome.What is PMS?Yi SJ, Kim M, Park I.Investigating influencing factors on premenstrual syndrome (PMS) among female college students.BMC Women’s Health.2023;23(592). doi:10.1186/s12905-023-02752-yOffice on Women’s Health (OASH).Premenstrual dysphoric disorder (PMDD).Eisenlohr-Moul T, Divine M, Schmalenberger K, et al.Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder.BMC Psychiatry. 2022;22(1):199. doi:10.1186/s12888-022-03851-0International Association for Premenstrual Disorders (IAPD).Finding a provider.DailyMed.Yaz-drospirenone and ethinyl estradiol kit.DailyMed.Beyaz-drospirenone/ethinyl estradiol/levomefolate calcium.Green LJ, O’Brien PMS, Panay N, Craig M on Behalf of the Royal College of Obstetricians and Gynaecologists.Management of premenstrual syndrome.BJOG2017 ;124:e73–e105. doi:10.1111/1471-0528.14260MedlinePlus.Premenstrual dysphoric disorder.Harvard Health Publishing Harvard Medical School.Treating premenstrual dysphoric disorder.MGH Center for Women’s Mental Health.PMDD/PMS: When PMS symptoms interfere with functioning and quality of life.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.UCLA Health.Is your severe PMS actually premenstrual dysphoric disorder (PMDD)?International Association for Premenstrual Disorders (IAPD).What is PMDD?Office on Women’s Health (OASH).Premenstrual syndrome (PMS).University of California San Francisco (UCSF) Center for Reproductive Health.Normal menstrual cycle.Mount Sinai.Premenstrual syndrome.Gao M, Zhang H, Gao Z, et al.Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder: a study protocol for systematic review and meta-analysis.Medicine (Baltimore). 2022;101(1):e28528. doi:10.1097/MD.0000000000028528UpToDate.Patient education: premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (beyond the basics).National Association for Premenstrual Syndrome.What is PMS?Yi SJ, Kim M, Park I.Investigating influencing factors on premenstrual syndrome (PMS) among female college students.BMC Women’s Health.2023;23(592). doi:10.1186/s12905-023-02752-yOffice on Women’s Health (OASH).Premenstrual dysphoric disorder (PMDD).Eisenlohr-Moul T, Divine M, Schmalenberger K, et al.Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder.BMC Psychiatry. 2022;22(1):199. doi:10.1186/s12888-022-03851-0International Association for Premenstrual Disorders (IAPD).Finding a provider.DailyMed.Yaz-drospirenone and ethinyl estradiol kit.DailyMed.Beyaz-drospirenone/ethinyl estradiol/levomefolate calcium.Green LJ, O’Brien PMS, Panay N, Craig M on Behalf of the Royal College of Obstetricians and Gynaecologists.Management of premenstrual syndrome.BJOG2017 ;124:e73–e105. doi:10.1111/1471-0528.14260MedlinePlus.Premenstrual dysphoric disorder.Harvard Health Publishing Harvard Medical School.Treating premenstrual dysphoric disorder.MGH Center for Women’s Mental Health.PMDD/PMS: When PMS symptoms interfere with functioning and quality of life.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
UCLA Health.Is your severe PMS actually premenstrual dysphoric disorder (PMDD)?International Association for Premenstrual Disorders (IAPD).What is PMDD?Office on Women’s Health (OASH).Premenstrual syndrome (PMS).University of California San Francisco (UCSF) Center for Reproductive Health.Normal menstrual cycle.Mount Sinai.Premenstrual syndrome.Gao M, Zhang H, Gao Z, et al.Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder: a study protocol for systematic review and meta-analysis.Medicine (Baltimore). 2022;101(1):e28528. doi:10.1097/MD.0000000000028528UpToDate.Patient education: premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (beyond the basics).National Association for Premenstrual Syndrome.What is PMS?Yi SJ, Kim M, Park I.Investigating influencing factors on premenstrual syndrome (PMS) among female college students.BMC Women’s Health.2023;23(592). doi:10.1186/s12905-023-02752-yOffice on Women’s Health (OASH).Premenstrual dysphoric disorder (PMDD).Eisenlohr-Moul T, Divine M, Schmalenberger K, et al.Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder.BMC Psychiatry. 2022;22(1):199. doi:10.1186/s12888-022-03851-0International Association for Premenstrual Disorders (IAPD).Finding a provider.DailyMed.Yaz-drospirenone and ethinyl estradiol kit.DailyMed.Beyaz-drospirenone/ethinyl estradiol/levomefolate calcium.Green LJ, O’Brien PMS, Panay N, Craig M on Behalf of the Royal College of Obstetricians and Gynaecologists.Management of premenstrual syndrome.BJOG2017 ;124:e73–e105. doi:10.1111/1471-0528.14260MedlinePlus.Premenstrual dysphoric disorder.Harvard Health Publishing Harvard Medical School.Treating premenstrual dysphoric disorder.MGH Center for Women’s Mental Health.PMDD/PMS: When PMS symptoms interfere with functioning and quality of life.
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International Association for Premenstrual Disorders (IAPD).What is PMDD?
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University of California San Francisco (UCSF) Center for Reproductive Health.Normal menstrual cycle.
Mount Sinai.Premenstrual syndrome.
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UpToDate.Patient education: premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (beyond the basics).
National Association for Premenstrual Syndrome.What is PMS?
Yi SJ, Kim M, Park I.Investigating influencing factors on premenstrual syndrome (PMS) among female college students.BMC Women’s Health.2023;23(592). doi:10.1186/s12905-023-02752-y
Office on Women’s Health (OASH).Premenstrual dysphoric disorder (PMDD).
Eisenlohr-Moul T, Divine M, Schmalenberger K, et al.Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder.BMC Psychiatry. 2022;22(1):199. doi:10.1186/s12888-022-03851-0
International Association for Premenstrual Disorders (IAPD).Finding a provider.
DailyMed.Yaz-drospirenone and ethinyl estradiol kit.
DailyMed.Beyaz-drospirenone/ethinyl estradiol/levomefolate calcium.
Green LJ, O’Brien PMS, Panay N, Craig M on Behalf of the Royal College of Obstetricians and Gynaecologists.Management of premenstrual syndrome.BJOG2017 ;124:e73–e105. doi:10.1111/1471-0528.14260
MedlinePlus.Premenstrual dysphoric disorder.
Harvard Health Publishing Harvard Medical School.Treating premenstrual dysphoric disorder.
MGH Center for Women’s Mental Health.PMDD/PMS: When PMS symptoms interfere with functioning and quality of life.
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