LEARN: PMS vs PMDD

PMS vs PMDD

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are related conditions that occur before menstruation, but they differ in severity and impact:

PMS

• Affects up to 75% of menstruating women
• Characterized by mild to moderate physical and emotional symptoms
• Typically doesn't significantly disrupt daily life
• Symptoms may include bloating, tender breasts, mood swings, and fatigue

PMDD

• Affects 3-8% of menstruating women
• A more severe form of PMS, classified as a depressive disorder
• Causes significant disruption to daily life and relationships
• Symptoms include severe mood swings, depression, anxiety, and irritability

Key Differences

• Severity: PMDD symptoms are more intense and debilitating than PMS12.Emotional impact: PMDD has a more pronounced effect on mood and mental health.
• Diagnosis: PMDD is a recognized mental health condition in the DSM-5, while PMS is not.
• Duration: PMDD symptoms typically last longer, up to two weeks before menstruation2.

Managing PMS and PMDD Together

Managing these conditions together can be beneficial because:

• Overlapping symptoms: Many symptoms are similar, allowing for some shared management strategies.
• Holistic approach: Addressing both conditions promotes overall menstrual health.
• Continuity of care: It allows for better tracking and management of symptoms across the spectrum.

Lessons from Perimenopause Management

In my practice with midlife women and menopause I have noticed many patterns in perimenopause management and PMS/PMDD.  It is generalising to say it is a continuum, but there are definitely parallels.  Once again, a sweeping statement is that 'it's the same management'.  I don't think it is specifically, but the principles are.  This is why I manage all hormonal menstrual changes - because it is part of the journey and understand your own nuances.

Managing perimenopause alongside PMS and PMDD can provide valuable insights:

• Hormonal fluctuations: All three conditions involve hormonal changes, emphasizing the importance of hormone balance.
• Lifestyle factors: Similar lifestyle modifications (e.g., diet, exercise, stress management) can benefit all three conditions.
• Individualized treatment: Each woman's experience is unique, requiring personalized approaches.
• Long-term perspective: Understanding the continuum of reproductive health from menstruation to menopause aids in comprehensive care.  For example if you have had PMDD then you are more likely to experience perimenopause/menopause depression.  Therefore I would like to prepare you for this.

Treatment Approaches

• Lifestyle modifications: Exercise, healthy diet, stress reduction, and good sleep hygiene
• Medications: SSRIs for PMDD, hormonal birth control for both conditions or hormone replacement therapy.  Some individuals also benefit from higher dose progesterone, but for others this is a disaster.  Professor Studd, in the 1980's also reported a benefit in testosterone.
• Cognitive-behavioral therapy: Helpful for managing emotional symptoms in both PMS and PMDD
• Tracking symptoms: Essential for accurate diagnosis and treatment of both conditions

By managing PMS and PMDD together and incorporating lessons from perimenopause management, healthcare providers can offer more comprehensive, effective care throughout a woman's reproductive life.