Most women get some premenstrual symptoms. PMDD is a severe form that can disrupt work and relationships. Learn the difference, how to track it and what treatment options exist.
The short answer
Premenstrual syndrome (PMS) is a group of physical and emotional symptoms in the week or two before a period that ease once bleeding starts. Premenstrual dysphoric disorder (PMDD) follows the same timing but the mood symptoms are severe enough to affect work, school or relationships. PMDD affects roughly 3 to 8 percent of people who menstruate and is very treatable.
Common PMS symptoms
- Bloating, breast tenderness and headaches
- Tiredness and changes in sleep
- Food cravings and appetite changes
- Irritability, low mood or anxiety
- Spots or acne flare-ups
What makes it PMDD
PMDD is diagnosed when at least five symptoms appear in the last week before most periods, improve within a few days of bleeding starting, and are minimal the week after. At least one must be a core mood symptom: marked mood swings, irritability or anger, depressed mood or hopelessness, or marked anxiety or tension. Others include low interest, trouble concentrating, fatigue, appetite changes, sleep changes, feeling overwhelmed and physical symptoms. The key test is impact: the symptoms cause real distress or get in the way of daily life.
The short version
Track it for two cycles
Diagnosis relies on daily ratings over at least two cycles, because memory blurs patterns. Each day, note your cycle day and rate mood, anxiety, irritability, energy, sleep and physical symptoms from 0 to 3. If symptoms are present all month and only get worse before your period, that may be premenstrual exacerbation of another condition, such as depression or anxiety, which is treated differently.
What helps
- Lifestyle first for mild PMS: regular exercise, steady sleep, regular meals, and less alcohol and caffeine in the second half of the cycle.
- Calcium: studies suggest about 1,200 mg a day from food and supplements may ease PMS symptoms.
- SSRIs: antidepressants such as sertraline or fluoxetine are a first-line treatment for PMDD and can be taken all month or only in the two weeks before a period.
- Hormonal options: some combined pills, particularly those with drospirenone taken continuously, can help.
- CBT: cognitive behavioural therapy helps many people manage symptoms.
When to get help now
If premenstrual symptoms include thoughts of self-harm or suicide, seek help right away. In Canada and the US you can call or text 988 at any time.
Frequently asked questions
What is the difference between PMS and PMDD?
Both happen before a period and ease after it starts. PMDD has severe mood symptoms that disrupt daily life, while PMS is milder.
How is PMDD diagnosed?
By daily symptom ratings over at least two cycles showing severe symptoms before periods that clear after bleeding starts.
Can birth control help PMDD?
Some combined pills, especially drospirenone pills taken continuously, can help. SSRIs are also a first-line treatment.
Does PMDD go away?
It continues while you have cycles but usually ends after menopause, and treatment can control symptoms in the meantime.
Try the free period & ovulation predictor tool
Your next periods, estimated ovulation and fertile window, with a calendar. It takes about a minute and your answers stay on your device.
