What is PMS?
Premenstrual syndrome (PMS) refers to physical and emotional symptoms that occur in the one to two weeks before a woman’s period. Up to 80% of women report having some symptoms prior to menstruation. The cause of PMS is unknown but the underlying mechanism is believed to involve changes in hormone levels though this isn’t completely confirmed.
What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of PMS affecting 1.8–5.8% of menstruating women. The main difference between PMS and PMDD is that PMDD disables women to live a normal life. PMDD can cause severe emotional, professional, and personal harm to those who have it. Sufferers of PMDD report damaging and impulsive behaviors that may include suddenly leaving a job or a relationship. Others report sudden and increased thoughts about suicide and self-harm. PMDD can feel like a “half-life”. where there is “two weeks of hell and two weeks of cleaning up”. As women today have an estimated 450 periods during their lifetime, PMDD is a long term diagnosis since the disorder affects women from their early teens up until menopause, excluding the period during pregnancy and breastfeeding. PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013. DSM-V (V stand for the fifth edition of the DSM) are published by The American Psychiatric Association (APA) and categorizes mental disorders and its criterias so that proffessionals can be on the same page.
What is PME?
Premenstrual Exacerbation (PME) means that you have a underlying mental illness such as depression, dysthymia, anxiety or eating disorder that is worsens during the luteal phase, thus the time between ovulation and menstruation. Unlike PMDD you have symptoms all the time but worsens by the time PMS/PMDD sets in and therefore often are being mixed up with PMDD. In fact, 40% of everyone that seek help for PMDD actually are estimated to have PME. It’s therefore also important to separate the two disorders in order to get the right treatment and help.
1-3% of all menstruating women are estimated to have PME.
The best way to separate PMDS and PME is to journal your symptoms and mood every day to see whether the symptoms disappear completely at the onset of the period or becomes better but the symptoms still remains.
Symptoms of PMS and PMDD
Some of the physical symptoms
- Swollen or tender breasts
- Constipation or diarrhea
- Bloating or a gassy feeling
- Cramping
- Headache, migraine or backache
- Clumsiness
- Increased sensitivity to sounds, light and touch
- Acne
- Fluid retention
- Food cravings
- Hot flushes or sweats
- Increased appetite
Some of the emotional symptoms
- Irritability, angry outbursts or hostile behavior
- Feeling tired
- Sleep changes, including insomnia or excessive sleepiness
- Appetite changes or food cravings
- Trouble with concentration or memory
- Tension or anxiety
- Depression, feelings of sadness, or crying spells and may include suicidal thoughts
- Mood swings
- Less interest in sex
- Confusion
- Drop in self-esteem and confidence leading to social isolation
- Feelings of loneliness and paranoia
How am I diagnosed?
To be diagnosed with PMDD, the following criterias need to be accounted for according to DSM-V.
Timing of symptoms
A)
In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week postmenses
Symptoms
B)
One or more of the following symptoms must be present:
1) Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
2) Marked irritability or anger or increased interpersonal conflicts
3) Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
4) Marked anxiety, tension, and/or feelings of being keyed up or on edge
C)
One (or more) of the following symptoms must additionally be present to reach a total of 5 symptoms when combined with symptoms from criterion B above
1) Decreased interest in usual activities
2) Subjective difficulty in concentration
3) Lethargy, easy fatigability, or marked lack of energy
4) Marked change in appetite; overeating or specific food cravings
5) Hypersomnia or insomnia
6) A sense of being overwhelmed or out of control
7) Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain
Severity
D)
The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others.
E)
The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia) or a personality disorder (although it may co-occur with any of these disorders).
Confirmation of the disorder
F)
Criterion A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles (although a provisional diagnosis may be made prior to this confirmation)
G)
The symptoms are not attributable to the physiological effects of a substance (e.g., drug abuse, medication or other treatment) or another medical condition (e.g., hyperthyroidism).
