-
Written by Rosalie Mountain
Do you get mood swings, breast tenderness, sleep changes, food cravings, or other physical or emotional symptoms about a week before your period? If you do, you’re not alone. Up to 75% of women experience some form of physical symptoms or mood changes before menstruation, thanks to changing hormone levels throughout the menstrual cycle. But what happens when these symptoms become severe and interfere with your daily life? For some, this could indicate PMS, however in rare cases even a more serious condition called PMDD. Knowing the difference between PMDD vs PMS can make it easier to prepare for a conversation with your physician.
- Having physical and mental changes during the menstrual cycle is an expected and normal experience; they should be mild, and this is NOT considered PMS.
- PMS and PMDD are both caused by brain reaction to hormonal fluctuations that occur during the menstrual cycle.
- Premenstrual dysphoric disorder (PMDD) is a severe form of PMS affecting only around 2% of women.
- PMDD symptoms include suicidal thoughts, severe depression, anxiety, mood swings, and physical discomfort.
- PMDD treatment can include serotonin reuptake inhibitors, and birth control, and recommendations on diet and lifestyle changes, stress management, and supplements.
What are PMS and PMDD?
Whether you’ve just started your period or have had it for years, you’ve probably experienced some physical symptoms and mood changes before it began. While you may have heard of PMS, most likely not in the way we will describe you, PMDD may be completely unfamiliar. The question is, “What are PMDD vs PMS symptoms, and how do you know if you experience any of them?”
As your hormones fluctuate, it causes a range of emotional and physical symptoms, however unless they are mild and don’t prevent you from following your routine, it’s NOT considered PMS. With PMS or premenstrual syndrome, it’s common to experience mood swings, bloating, irritability, fatigue, and appetite changes. The key difference from normal experience is that PMS symptoms interfere with your daily routine. You may feel compelled to avoid your usual activities, skip exercise classes, or prefer staying home instead of meeting friends.
To be diagnosed with PMS, symptoms should occur for at least five days before your period and resolve within four days after it begins. Importantly, experiencing these symptoms once is not sufficient for diagnosis. You need to demonstrate to your doctor that this pattern is common by keeping a symptom diary for at least 2–3 menstrual cycles.
So, what is premenstrual dysphoric disorder? PMDD, or premenstrual dysphoric disorder, is a severe form of PMS with intense symptoms like severe anxiety, depression, mood swings, fatigue, irritability, and anger. Only around 2% of women are diagnosed with PMDD, making it incredibly rare. The difference between PMDD and PMS is the severity of the symptoms and the presence of suicidal thoughts. But how does premenstrual dysphoric disorder compare to premenstrual syndrome? Let’s explore more below.
Symptom comparison: PMDD vs. PMS
Please keep in mind that if you experience mild symptoms related to the menstrual cycle, this is normal and is NOT considered PMS. As we mentioned above, the main difference between PMS and PMDD is the severity of the symptoms, but that’s not the only way they differ.
Telling PMS symptoms vs PMDD symptoms apart can sometimes be challenging, so knowing what other factors to look for can be helpful. Both conditions can cause fatigue, breast tenderness, irritability, bloating, mood swings, appetite changes, and headaches, but the mental and emotional symptoms are more pronounced with PMDD. You can use the chart below as a quick glance guide.
What is PMDD vs PMS symptoms: At a glance
PMS | PMDD | |
Symptom severity | Moderate to severe | Severe |
Symptom focus | Emotional and physical | Emotional, mental and social |
Rate of experience | 30-40% of women | ~2% of women |
Suicidal thoughts | No | Yes |
Root causes and triggers
When discussing premenstrual dysphoric disorder vs PMS, it’s important to understand the causes and triggers of these conditions. There are several different theories about why PMDD happens, but proving any of them is difficult. One idea, based on cognitive and social learning theory, is that the start of menstruation can feel very stressful for people who are prone to PMDD. This stress may lead to negative and intense thoughts that make premenstrual symptoms worse. To cope, some might develop unhealthy habits, like missing school or work, or overeating, in hopes of finding quick relief. Unfortunately, these behaviors only provide temporary comfort and can make symptoms come back again and again before each period.
At the same time, current research shows that normal hormonal changes during the menstrual cycle can cause chemical shifts in the brain. For those who are especially sensitive, these changes may trigger the symptoms of PMDD.
As we’ve mentioned above, having a poor diet, not getting enough exercise or sleep, and inadequate stress management can make luteal phase symptoms worse. No matter what conclusion you’ve reached when comparing PMDD symptoms vs PMS, implementing healthy lifestyle choices and managing stress can make a difference.
Impact on daily life and relationships
Where you see the biggest difference between PMS vs PMDD symptoms is how they can impact your life and relationships. With PMS, you can feel irritable and short-tempered, but the mood swings are typically controlled.
PMDD, on the other hand, often causes uncontrollable anger, where you lash out at family and friends, which leads to a lot of conflicts. You may also feel severe depression and anxiety, decreased interest in activities, extreme and sudden mood changes, trouble concentrating, insomnia, and feeling out of control. PMDD can have a huge impact on your daily life and the way you interact with those around you.
Diagnosis: How to tell the difference
Diagnosing PMDD is straightforward; what you really need is to document your daily feelings and their severity for at least two consecutive months. If you suspect you are experiencing more than typical PMS symptoms, it’s important to schedule an appointment with your doctor. Your doctor may run tests to rule out other conditions or health issues and might suggest a psychiatric evaluation to ensure no other mood disorders are involved.
To receive a PMDD diagnosis, you must have at least five symptoms, one being mood-related, that significantly impact your social or occupational functioning, occurring around a week before menstruation. The symptoms must all be connected to your menstrual cycle and improve once you begin your period.
Treatment options for PMS and PMDD
When it comes to PMS, treatment involves lifestyle modifications like eating a balanced diet, exercising, getting enough sleep, and stress management. You can also use over-the-counter pain medication like ibuprofen to treat cramps, headaches or muscle aches. Hormonal birth control and SSRIs (selective serotonin reuptake inhibitors) may also be used if symptoms are persistent.
For PMDD, medications such as SSRIs and other antidepressants are the first-line treatments, followed by certain types of hormonal birth control. While lifestyle changes, stress management, and supplements play a role in overall wellbeing, their effectiveness as standalone treatments is limited.
When to consult a healthcare provider
If you experience thoughts of harming yourself or others or if your symptoms impact your daily life, you should consult with your healthcare provider. Both PMS and PMDD can be treated, and symptoms can be managed.
Understanding how your hormones impact your mind and body can help you better understand why you feel the way you do. Hormona is proud to offer the award-winning Hormona app, the revolutionary hormone tracker that provides tools and insights so you can take control of your hormone health.
FAQ
Is PMDD linked to autism?
It remains unclear, as one study published in 2008 showed that autistic women more often had PMDD, but the latest study published in 2021 did not confirm these results.
What happens if PMDD is left untreated?
Untreated PMDD can significantly impact your quality of life, possibly leading to severe anxiety and depression and interfering with relationships.
At what age does PMDD start?
Although PMDD can affect a woman at any time during her reproductive years, it starts most commonly in 20s.
What does a PMDD episode look like?
PMDD typically does not occur in isolated episodes; rather, it is a condition in which mood and social life are significantly affected after ovulation. During the second half of your menstrual cycle, when you are diagnosed with PMDD, you may experience rapid mood shifts, intense feelings of hopelessness, excessive worry, anger outbursts, panic attacks, or even suicidal thoughts. Additionally, symptoms can include extreme fatigue, insomnia, migraines, and muscle aches. In some cases, women may also experience psychosis.
What foods should you avoid during PMDD?
During PMDD, you should avoid alcohol and other foods that can worsen symptoms, like excess sugar, fried or processed food, caffeine, and salt.
-
Dr Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the myriad of sleep.
- Steiner M. (2000). Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. Journal of psychiatry & neuroscience : JPN, 25(5), 459–468.
- Reilly, T. J., Patel, S., Unachukwu, I. C., Knox, C., Wilson, C. A., Craig, M. C., Schmalenberger, K. M., Eisenlohr-Moul, T. A., & Cullen, A. E. (2024). The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. Journal of Affective Disorders, 349, 534-540. https://doi.org/10.1016/j.jad.2024.01.066
- Htay, T., Hategan, A. (2025). Premenstrual Dysphoric Disorder. Medscape. Available online: https://emedicine.medscape.com/article/293257-overview#a4
- Premenstrual syndrome. (2006). Institute for Quality and Efficiency in Health Care (IQWiG); Available online: https://www.ncbi.nlm.nih.gov/books/NBK279264/
- Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. (2023). StatPearls Publishing; Available online: https://www.ncbi.nlm.nih.gov/books/NBK532307/
- Treating premenstrual dysphoric disorder. (2022). Harvard Health Publishing. https://www.health.harvard.edu/womens-health/treating-premenstrual-dysphoric-disorder
- Groenman, A. P., Torenvliet, C., Radhoe, T. A., Agelink van Rentergem, J. A., & Geurts, H. M. (2022). Menstruation and menopause in autistic adults: Periods of importance?. Autism : the international journal of research and practice, 26(6), 1563–1572. https://doi.org/10.1177/1362361321105972
- Obaydi, H., & Puri, B. K. (2008). Prevalence of premenstrual syndrome in autism: a prospective observer-rated study. The Journal of international medical research, 36(2), 268–272. https://doi.org/10.1177/147323000803600208
- Steiner M. (2000). Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. Journal of psychiatry & neuroscience : JPN, 25(5), 459–468.
- Reilly, T. J., Patel, S., Unachukwu, I. C., Knox, C., Wilson, C. A., Craig, M. C., Schmalenberger, K. M., Eisenlohr-Moul, T. A., & Cullen, A. E. (2024). The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. Journal of Affective Disorders, 349, 534-540. https://doi.org/10.1016/j.jad.2024.01.066
- Htay, T., Hategan, A. (2025). Premenstrual Dysphoric Disorder. Medscape. Available online: https://emedicine.medscape.com/article/293257-overview#a4
- Premenstrual syndrome. (2006). Institute for Quality and Efficiency in Health Care (IQWiG); Available online: https://www.ncbi.nlm.nih.gov/books/NBK279264/
- Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. (2023). StatPearls Publishing; Available online: https://www.ncbi.nlm.nih.gov/books/NBK532307/
- Treating premenstrual dysphoric disorder. (2022). Harvard Health Publishing. https://www.health.harvard.edu/womens-health/treating-premenstrual-dysphoric-disorder
- Groenman, A. P., Torenvliet, C., Radhoe, T. A., Agelink van Rentergem, J. A., & Geurts, H. M. (2022). Menstruation and menopause in autistic adults: Periods of importance?. Autism : the international journal of research and practice, 26(6), 1563–1572. https://doi.org/10.1177/1362361321105972
- Obaydi, H., & Puri, B. K. (2008). Prevalence of premenstrual syndrome in autism: a prospective observer-rated study. The Journal of international medical research, 36(2), 268–272. https://doi.org/10.1177/147323000803600208