Categories: The Latest in Health

PMS vs PMDD, PME and PMAD: Combatting The Worst of PMS Symptoms

PMS symptoms are the worst but PMDD could be even worse. Menstrual related mood disorders are becoming more and more common but do you know all of them and the key differences?

It’s normal to feel different in the lead up to your period. 30-80 percent of women experience symptoms of premenstrual syndrome (PMS,) causing bloated feelings, mood swings, food cravings and brain fog. While this makes their lives more difficult, the majority of women cope and live a normal life. 

But in extreme circumstances, these symptoms become so severe that they impact their quality of life and ability to do normal things. This isn’t normal and If you are experiencing this, you might be suffering from premenstrual dysphoric disorder (PDD). Rather than suffering in silence, you may benefit from medical advice.

Maternal Mental Health Week is this month. Whether you’re a teenager preparing for her menstrual cycle, a pregnant woman, or a clueless boyfriend trying to better understand; it’s important you’re aware of symptoms and the treatments available.

Most women have heard of it… but what actually is PMS?

Premenstrual syndrome” (PMS) is a broad term describing the physical, emotional and psychological symptoms occurring a week before a woman’s period. The cause is attributed to hormone levels and imbalances  – such as the rising and falling of estrogen and progesterone – which cause changes in the brain.

As many as 150 different symptoms have been assigned to PMS. But common and recurring experiences include:

  • Psychological changes and emotional symptoms, such as anxiety, sadness, extreme moodiness, depression, and persistent irritability.
  • Physical symptoms, like breast tenderness, headaches, and abdominal bloating.
  • Behavioural symptoms, including poor concentration, forgetfulness, decreased interest in usual activities and fatigue.

PMS occurs during the luteal phase of ovulation and menstruation; which is approximately 14 days from your cycle (between five and seven days before your period.) According to research, symptoms can be intense in your twenties. It then eases in your thirties; before worsening again in your forties as you approach your menopause.

Most women with PMS don’t need to see a doctor to cope, as the symptoms are temporary and manageable.

What about PMDD?

At first glance, PMS and PMDD look similar. But premenstrual dysphoric disorder is a much more severe form – it’s a serious medical condition that requires attention from a medical professional. It’s also less common: around 75 percent of women experience the former, while around 8% have PMDD.

Like before, it arises in the lead up to a period, during the luteal phase of the menstrual cycle – affecting women of childbearing age –  but it causes extreme mood disturbances and irritability that the individual can’t control. PMDD symptoms are behavioural/emotional thoughts and tendencies that lead to social impairment; preventing a woman from living an ordinary life. 

In a recent study, it was discovered those with untreated PMDD experience a loss of three quality-adjusted life years as a result of premenstrual pains. So if you’re suffering, speak out.

The major differences

A woman with PMDD will suffer seemingly similar symptoms to those with PMS: bloating, tender breasts, headaches, changes in mood, and fatigue. But their experiences are more intense and serious. For example:

  • If you have PMS, you might suffer from depression. But with PMDD, your sadness will be so uncontrollable and intense you might feel hopeless and have suicidal ideations.
  • Those with PMS have mild and temporary anxiety whereas people with PMDD are constantly on edge.
  • PMS sufferers feel disrupted and detached from their usual routine. But PMDD sufferers stop caring about the things they were once passionate about.

These intense experiences negatively impact a woman’s everyday life, for example: as they experience hopelessness, they are excessively self-critical; because they are on edge, PMDD sufferers are at greater risk of panic attacks and relationship conflict; in addition, they are unable to sleep and constantly feel tired.

Overall, PMS sufferers might experience temporary discomfort, but those with PMDD face serious symptoms preventing them from living their daily lives.

Links to Mood Disorders

There is a strong connection between premenstrual symptoms and mental disorders. According to Tatnai Burnett M.D. those with depression, anxiety or mental health issues are much more susceptible to PMDD. When someone suffers from it, the hormones and changes in the brain that arise before a period could make the pre-existing disorders worse. 

Learn strategies to cope with depression and anxiety

For a PMDD diagnosis, the symptoms must only last persist during the lead up to a period. If your symptoms last for longer, you may be experiencing PME.

What is PME?

Rather than causing new symptoms, premenstrual exacerbation (PME)  occurs when hormone changes during menstruation worsen the experience of a pre-existing disorder – like depressive disorder or generalized anxiety disorder.

Like PMDD, the worse-than-usual symptoms usually subside a few days after the period, but it does leave behind the original disorder.

Unfortunately, PME is lagging behind the research of PMDD and is not yet diagnosed or treated clinically.  But if your family has a history of depression or mental health conditions and you’re experiencing extreme symptoms, it’s worth investigating whether you have a  pre-existing disorder.

What are the causes?

We now have a better understanding of the different symptoms a woman might experience leading up to her period. But what causes them? According to Mind, two key factors influence your experiences:

Firstly, how sensitive you are to hormone changes, common symptoms arise when someone has increased sensitivity to bodily changes that arise during a menstrual cycle. Secondly, genetics: how sensitive you are and how radically your hormones change may is caused by your genetic variation.

Beyond uncontrollable causes, certain lifestyle habits influence the frequency of premenstrual discomfort. For example, the reason symptoms are worst in your twenties is that this age group lives more recklessly than older generations.

Life choices making your cycle less comfortable include:

Whether you’re going to experience premenstrual symptoms comes down to uncontrollable biology. But its intensity and frequency is influenced by your lifestyle.

Does PMS get worse with pregnancy?

Mood changes during the perinatal period are usually referred to as PMAD – perinatal or postpartum mood and anxiety disorder. The perinatal period refers to the period of pregnancy but also the first year after birth. As women’s period will typically return about six to eight weeks after giving birth, if symptoms do occur postpartum (post-birth), the individual could be suffering the effects of their period returning in a new way (and their body getting used to that cycle again).

Perinatal Mental Health Course

If symptoms don’t seem to occur once a month (or during/prior to ovulation), mothers could be experiencing one or more of the following PMADs, the least serious and most common one being postnatal depression – also known as the ‘baby blues’ when new mothers experience feelings of sadness in the first few days of maternity.

  • Postnatal depression
  • Perinatal or postpartum anxiety disorder
  • Perinatal or postpartum psychosis
  • Perinatal or postpartum obsessive-compulsive disorder (OCD)

Strategies for coping

If you think you’re experiencing PMS, PMDD or PME, there are a number of things you can do to cope.

First, seek the help of medical experts. After a diagnostic process, they might provide you with medication. FSSRI anti – depressants are an effective way to resolve hormonal imbalances, while birth control pills stop ovulation and reduce PMDD risk. Beyond these, doctors may prescribe you nutritional supplements or hormone suppressants which are proven to reduce the risks of PMDD in certain circumstances.

But these medications cause radical hormone changes. They don’t work for everyone and have been known to make symptoms worse. For others, it can take months before their hormones regulate. So seek advice and weigh up the benefits/cons before using them. Before turning to medication, we recommend making some lifestyle changes:

1. Maintain a healthy diet: food rich in whole grains, protein, fruits and vegetables.

2. Avoid the PMS and PMDD triggers outlined above: like alcohol, caffeine, chocolate and salt.

3. Undergo low impact exercise, even when you don’t feel like it. Walking, swimming and cycling can ease PMS.

4. Try herbal remedies. Research indicates Chasteberry reduces irritability, mood swings, breast tenderness and cramps.

These are just a few of the easy and simple things you can incorporate into your daily life. But if you know you’re susceptible to symptoms, it’s worth consulting an expert to determine the best course of action. 

Final Thoughts

It’s normal to feel discomfort in the lead up to your period. Mood swings, cramps, and brain fog are the result of hormone changes and imbalances.

Most women suffer from PMS and are able to live normally with the symptoms. Others, however, experience more serious side effects, like PMDD or PME, which impinge on their ability to live a normal life.

if you’re looking to lessen the severity of your premenstrual symptoms; we recommend following the lifestyle tips outlined above. Alternatively, if you’re finding your symptoms insufferable, we recommend considering the help and medication of a healthcare professional. 

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This post was last modified on 17 May 2021

Nola Garavaglia-McGann

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