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7 Signs Your PMS Is Actually PMDD—Which is Way Worse

Health experts explain the difference between PMS and premenstrual dysphoric disorder, and how to recognize the telltale signs.

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The difference between PMS and PMDD

Many women can successfully cope living with premenstrual syndrome (PMS). You find ways to soothe your cramps, satisfy food cravings, and process feelings that may feel more intense than usual, if those are an issue for you. But for premenstrual dysphoric disorder (PMDD), the usual rules don’t apply, says Prudence Hall, MD, ob-gyn and founder of The Hall Center in Santa Monica, California.

“Severity is the difference,” says Dr. Hall. “The emotional component to PMDD can include one or more severe symptoms, such as extreme depression, or anger.” Though it may not occur every cycle, PMDD usually hits about seven to 14 days before your period, and the intensity increases as you get closer.

How do you know if your PMS is actually PMDD? “Start by keeping a diary of your symptoms—along with the severity and duration—through a couple of cycles,” says Constance A. Young, MD, an ob-gyn at Columbia University Medical Center in New York City. Watch for these telltale signs—diagnosis will usually include a combination of these symptoms, she says.

In general, your doctor might consider a diagnosis of PMDD if you have extreme anger or mood swings and at least five symptoms in the week before your menstrual cycle (for most months), and they tend to get better after your period starts.

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Bloating, muscle weakness, or weight gain seems out of control

When you have breast tenderness or swelling, joint or muscle pain, weight gain, appetite changes or specific food cravings, headache, severe bloating, severe cramping, or fatigue several cycles out of the year and it’s enough to interfere with work, school, or social activities, that’s an indicator of PMDD, says Sarah Noble, DO, a psychiatrist with Einstein Healthcare Network in Philadelphia.

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Exhaustion or fatigue is common

A woman’s estrogen levels drop in the second half of her cycle, while progesterone levels rise dramatically during this time, says Dr. Hall. The result is feeling lethargic no matter how well you’ve slept.

“When the adrenal glands—the ones responsible for regulating and releasing hormones during your cycle—stay stressed over time, they become stop creating healthy and balanced amounts of hormones, and the result is feeling exhausted, depressed, and even having a low sex drive,” she says.

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Mood swings are extreme and unpredictable

The mood-related symptoms are one of the more distinguishing factors, says Dr. Noble. These can include intense anger and depression—and you’re at higher risk if you have a history of traumatic events or anxiety disorder, according to Dr. Eliza Bruscato, ob-gyn at Winnie Palmer Hospital for Women & Babies in Orlando. “These symptoms usually arise in your mid-twenties, but they should resolve themselves when you reach menopause,” she says.

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Relationships are severely impacted

You’ll notice an uptick in conflicts with colleagues, family, or significant others, and a general feeling of being very on edge. The intensity of these interactions are what matters—snapping at someone or being a little cranky is one thing, says Michael E. Platt, MD, a physician in Palm Desert, California, and author of Adrenaline Dominance, but women living with PMDD can be can feel like they’re almost impossible to live with.

“I have had a number of patients who have had their marriages ended because of this condition,” he says.

Be on the lookout for emails sent in anger or frustration, or having a shorter fuse than normal with your friends or children in a way that feels harmful.

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Anxious, out of control, and overwhelmed

If you’re dealing with anxiety, panic attacks, an inability to focus, or you’re feeling overwhelmed and out of control that’s heightened during a certain part of the month, take note. These changes might disrupt your everyday life in serious ways, coloring everything from how you experience your morning commute to preparing dinner. The distinction for people with PMDD is that these feelings make daily tasks and situations that you usually handle with aplomb suddenly feel unmanageable, stressful, scary, or upsetting.

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Pre-existing migraines or irritable bowel syndrome, or other chronic issues

Some conditions can put you at higher risk of PMDD. Along with migraines and irritable bowel syndrome, chronic fatigue syndrome, anxiety disorder, depression, or post-traumatic stress disorder, your chances of experiencing PMDD can also increase, according to Dr. Noble.

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Sleep is disrupted

A common PMDD symptoms is insomnia, most likely triggered by the disturbance in your system relating to how stressed and anxious you feel during the day and the imbalance of hormones that can keep you up at night. Because of those low estrogen levels that fall before your period, you start to feel more stressed. But more stress means higher levels of cortisol, the stress hormone. “Cortisol rises to its highest levels in the middle of the night which interrupts our sleep,” says Dr. Hall.

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PMDD treatment

Luckily, there are effective solutions for PMDD, including both prescription and herbal medications.

“Your doctor may prescribe Xanax or Valium if you suffer from anxiety during the time frame when you experience PMDD,” says Kristen N. Burris, an acupuncturist in Eagle, Indiana. “Others prefer prescribing the time-tested drug Prozac or a newer drug for more intense mood disorders,” she adds. However, she notes, it’s important to keep an eye on side effects like increased weight gain or decreased libido.

For women who would like to try alternative remedies, Svetlana Kogan, MD, an internist in Naples, Florida, recommends specific herbs, ones that she has been recommending to patients with PMDD for the past twenty years. “Try taking brahmi guduchi, shatavari, and ashwagandha taken twice a day with food and in powdered form, mixed with organic ghee or smeared on bread or a cracker,” she says.

Vitamins B6, magnesium (400mg), omega 3, and calcium (500mg) proved effective for Judi Goldstone, MD, a hormone replacement therapy doctor in Torrance, California, who has experienced the disorder firsthand and tried a number of different ways to treat it.

“Ten years ago when I started getting worse and worse PMS I couldn’t find any doctor to treat me holistically. At that time, my ob-gyn wanted to put me on birth control pills and antidepressants,” she says. “I’d also recommend consuming more high-protein foods or complex carbs like green vegetables, sweet potatoes, or beans, and applying primrose oil in the evening.”

Helaina Hovitz is an editor, journalist, and author of After 9/11.

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