Why Am I Sad Before My Period? A Complete Guide on PMS and PMDD

Duly Care
May 25
7 min read

For many women, the days leading up to their period can bring a host of uncomfortable physical and emotional symptoms. While these symptoms are commonly grouped under the term "PMS" or Premenstrual Syndrome, a significant number of women experience a more severe condition known as PMDD or Premenstrual Dysphoric Disorder. Although these conditions are frequently discussed in relation to menstruation, there’s still a lot of confusion surrounding them - particularly when it comes to how to manage and treat these symptoms.

In this comprehensive guide, we’ll explore the differences between PMS and PMDD, dive into the symptoms that distinguish the two, and offer practical advice on how to treat them.

Key Takeaways

Premenstrual Syndrome (PMS) is a set of mild to moderate physical and emotional symptoms that occur in the days leading up to menstruation or period, often influenced by hormonal changes.
Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS characterized by intense emotional and physical symptoms, such as extreme mood swings, depression, and anxiety, that significantly disrupt daily life.
PMS symptoms usually occur 5-7 days before menstruation, while PMDD symptoms can last much longer and are more intense.
Treatment for PMS may include lifestyle changes, while PMDD may require more intensive medical intervention.

What is PMS?

Premenstrual Syndrome (PMS) refers to a collection of physical, emotional, and behavioural symptoms that many women experience in the days leading up to their menstrual period. These symptoms are linked to the luteal phase of the menstrual cycle, which occurs after ovulation and before menstruation. During this phase, levels of hormones such as progesterone and estrogen fluctuate significantly, which can influence mood, energy levels, and physical well-being.

For most women, PMS symptoms are mild to moderate and manageable. Common signs include bloating, irritability, fatigue, and tender breasts. These symptoms typically resolve once menstruation begins, marking the end of the luteal phase and the start of the next cycle.

Understanding that PMS is connected to natural hormonal changes during the luteal phase can help normalise the experience and empower women to manage their symptoms effectively.

While PMS is common, it is important to recognise that not every woman will experience all of these symptoms, and their severity can vary widely from one person to another.

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a severe and debilitating form of Premenstrual Syndrome (PMS) that significantly impacts emotional and physical well-being.

Like PMS, PMDD is closely associated with the luteal phase of the menstrual cycle, which occurs after ovulation and before menstruation. The hormonal fluctuations during this phase, particularly the changes in estrogen and progesterone levels, are believed to play a key role in triggering PMDD symptoms.

PMDD typically begins a week or two before the onset of menstruation, coinciding with the luteal phase, and its symptoms often subside within the first few days of the menstrual period. However, the intensity of PMDD symptoms sets it apart from PMS.

Women with PMDD may experience severe mood swings, depression, extreme anxiety, and physical discomfort that interfere with daily functioning, affecting relationships, work, and overall quality of life. If symptoms consistently disrupt daily life or last beyond the expected timeframe, consulting a doctor is crucial for proper diagnosis and management.

Key Differences Between PMS and PMDD

The primary difference between PMS and PMDD lies in the severity and impact of symptoms. While PMS can cause mild to moderate discomfort, PMDD is a debilitating condition that can seriously affect a woman’s emotional and physical well-being. If you experience extreme mood swings, depression, or anxiety that interfere with your daily life, it could be a sign that you may have PMDD.

PMS Symptoms

Bloating and water retention: Feeling swollen or heavier due to fluid retention.
Tender breasts: Mild soreness or sensitivity in the breasts.
Acne flare-ups: Skin breakouts caused by hormonal changes.
Fatigue: Low energy levels or feelings of tiredness.
Mood swings (mild): Temporary emotional ups and downs.
Irritability: A tendency to feel easily annoyed or frustrated.
Headaches: Mild to moderate head pain often linked to hormonal shifts.

Although PMS symptoms can be bothersome, they are usually predictable and tend to subside with the onset of menstruation.

PMDD Symptoms

Severe mood swings: Episodes of extreme irritability, anger, or sadness that may feel uncontrollable.
Depression and feelings of hopelessness: A deep sense of despair or worthlessness, sometimes accompanied by thoughts of self-harm.
Extreme anxiety: Heightened feelings of worry or tension that can feel overwhelming.
Fatigue and sleep disturbances: Severe tiredness or insomnia that affects daily life.
Joint or muscle pain: Discomfort in the body that can exacerbate emotional distress.
Food cravings or changes in appetite: Intense desires for certain foods or a noticeable lack of appetite.
Severe bloating and abdominal discomfort: Significant swelling or pain in the stomach area.

The symptoms of PMDD are not only more intense than PMS but also have a profound impact on emotional health and daily functioning. Women with PMDD often find it challenging to manage their routines or maintain relationships due to the condition’s severe emotional and physical toll.

Aspect	PMS (Premenstrual Syndrome)	PMDD (Premenstrual Dysphoric Disorder)
Severity	Mild to moderate discomfort	Severe and often disabling
Mood changes	Mild mood swings and irritability	Intense mood swings, rage, or sadness that may feel out of control
Emotional impact	Some emotional ups and downs, which are usually manageable	Can cause depression, hopelessness, and anxiety that disrupt daily life
Physical symptoms	Bloating, breast tenderness, acne, mild headaches, fatigue	Severe bloating, joint/muscle pain, extreme fatigue, and sleep problems
Effect on daily life	Usually does not interfere with daily activities	Often disrupts work, relationships, and daily responsibilities
Predictability	Symptoms are often predictable and ease with periods	Symptoms are intense, recurring, and may worsen over time without treatment
Appetite changes	Occasional cravings	Intense cravings or complete loss of appetite
Sleep issues	Occasional tiredness	Severe fatigue or insomnia that affects functioning
Mental health risks	Typically does not lead to mental health crises	May involve thoughts of self-harm or suicidal ideation

What Causes PMS and PMDD?

Both PMS and PMDD are influenced by hormonal fluctuations during the menstrual cycle. The hormone progesterone rises after ovulation and can cause various physical symptoms, while the drop in estrogen just before menstruation can trigger mood-related symptoms.

However, research suggests that the way women respond to these hormonal changes can vary significantly. In women with PMDD, the body’s response to hormonal shifts is more extreme, which is why the symptoms of PMDD are far more severe than those of PMS.

Genetics, stress, and other underlying conditions (like thyroid imbalances or depression) can also contribute to the development of these conditions. Women with a family history of depression or other mood disorders may be more likely to experience PMDD.

How Do I Know If I Have PMDD?

It can be difficult to distinguish between PMS and PMDD without professional guidance. If your symptoms are mild and manageable, they are likely indicative of PMS. However, if you find that your symptoms are more severe, especially emotional symptoms like extreme mood swings, depression, or anxiety, and they disrupt your work, relationships, or overall quality of life, it is crucial to consult a doctor. A doctor will assess your symptoms and may recommend keeping a symptom diary to track your cycles and any patterns in your mood and physical health.

A doctor can help differentiate between PMS and PMDD and recommend appropriate treatments, such as lifestyle adjustments, counselling, or medications like antidepressants or hormonal therapy. Addressing PMDD early can help improve your quality of life, ensuring that you get the support you need to manage this condition effectively.

How to Treat PMS?

Managing PMS often involves simple lifestyle changes, over-the-counter medications, or natural remedies. Here are a few ways to reduce PMS symptoms:

Exercise: Regular physical activity can help reduce bloating and improve mood.
Diet: Eating a balanced diet rich in fruits, vegetables, and whole grains can help balance hormones and reduce PMS symptoms. Avoid excessive sugar, caffeine, and alcohol.
Supplements: Certain supplements, like calcium and magnesium, may help alleviate mood swings and muscle cramps.
Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help alleviate pain and cramps associated with PMS. Additionally, the usage of hot water bags will help bring the pain down.
Stress Reduction: Mindfulness, yoga, and relaxation techniques can help manage stress and mood swings.

How to Treat PMDD?

Because PMDD is more severe, treatment often requires a combination of medical intervention and lifestyle changes:

Antidepressants (SSRIs/SNRIs): Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed to help manage the mood-related symptoms of PMDD.
Hormonal Therapy: Birth control pills, patches, or hormone therapy may help stabilise hormone levels and reduce symptoms.
Diet and Supplements: Just like PMS, a healthy diet can be beneficial for PMDD. Additionally, supplements like vitamin B6, calcium, and magnesium can provide relief for some women.
Lifestyle Adjustments: Reducing stress through yoga, meditation, and regular exercise can help alleviate symptoms. Maintaining a regular sleep schedule is also essential for mood stabilisation.

Conclusion

Managing PMS and PMDD requires a combination of self-care, lifestyle adjustments, and, in some cases, medical intervention. While PMS is a common and manageable condition, PMDD is a serious disorder that requires a more comprehensive treatment approach. Understanding the symptoms, causes, and treatments for both conditions can help you take control of your health and well-being by knowing when to seek help.

Frequently Asked Questions

At what age does PMDD start?
PMDD typically begins in a woman’s 20s to 30s, but it can develop at any age. It often starts after the first few years of menstruation.
How can I treat PMS naturally?
Natural remedies for PMS include exercise, stress reduction techniques like yoga or meditation, dietary changes, and supplements such as calcium and magnesium.
Is there a cure for PMDD?
While there is no cure for PMDD, it can be managed with medication, hormonal therapy, lifestyle changes, and natural remedies.
How do I know if I have PMDD?
If you experience severe mood swings, depression, and anxiety before your period, and these symptoms significantly affect your daily life, it may be time to consult a doctor.

Important

This blog, including its text, images, and infographics, is for educational purposes only and not a substitute for professional medical advice. For personalized advice, always consult a doctor.

References

American Family Physician. Premenstrual Syndrome and Premenstrual Dysphoric Disorder. 2016. https://www.aafp.org/pubs/afp/issues/2016/0801/p236.html
Mayo Clinic. Premenstrual Dysphoric Disorder: Different from PMS. Accessed on 29 December 2024. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
The American College of Obstetricians and Gynecologists. Premenstrual Syndrome (PMS). Accessed on 29 December, 2024. https://www.acog.org/womens-health/faqs/premenstrual-syndrome
Statpearls. Premenstrual Syndrome. 2023. https://www.ncbi.nlm.nih.gov/books/NBK560698/