That time of the month versus THAT time of the month! PMS versus PMDD

Samah Ahmed

For most of us, that time of the month never fails to come without a warning in the form of PMS. The bloating, fatigue, and mood swings have almost become second nature, but what specifically is PMS? Why does it happen? And what is PMDD? We’re going to explore the fascinating details surrounding the subject of PMS vs. PMDD and how physicians can tell the difference! 

What are PMS and PMDD?

PMS or premenstrual syndrome is a group of physical, emotional, and/or mental symptoms that happen on average, five to seven days before a period. It is very common and occurs in up to 75% of women. PMDD or Premenstrual Dysphoric Disorder is a more severe version of PMS with similar symptoms including anger, irritability, anxiety, and depression. It’s important to remember that the two are not interchangeable and are separate conditions. In comparison to PMS, PMDD only affects 3 to 8 percent of women. It’s a chronic condition that can negatively impact one’s quality of life. Fortunately, treatment options are available for both!

What are the symptoms of PMS vs. PMDD?

PMS and PMDD have a lot of overlap in terms of their symptoms and are often difficult to distinguish. The most common symptoms are bloating and fatigue and irritability. Other symptoms include, but are not limited to:
  1. Mood swings
  2. Feelings of sadness, hopelessness 
  3. Crying Spells
  4. Changes in appetite 
  5. Difficulty with concentration
  6. Changes in sleep (either too much or struggling to sleep)
  7. Breast soreness and/or swelling
  8. Headaches 

PMS can vary in terms of severity from one individual to another. If severe enough, PMS can have a negative impact on one’s work, school, or interpersonal relationships.

Why do PMS and PMDD happen?

The body is very sensitive to hormone levels (i.e. estrogen and progesterone) which are known to fluctuate throughout a woman’s menstrual cycle. Aside from producing the physical symptoms commonly associated with this syndrome, studies have shown that these hormonal fluctuations can affect the chemical known as serotonin within the brain. As a result, this will affect a woman’s mood. 


How do you tell the two apart?

Physicians use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Criteria in order to help diagnose and differentiate a patient’s symptoms as being either PMS or PMDD. 

To make a diagnosis of PMS, a patient has:

  1. One to four symptoms in varying aspects, whether it be physical, emotional, or mental
  2. Five or more symptoms that are physical or behavioural in nature
The current system provides PMDD criteria, which requires:
  1. Documentation of physical and behavioural symptoms (in the form of diary entries) being present for most of the preceding year
  2. Five or more symptoms are present in the week preceding a woman’s menses and resolve a few days after menstruation begins.
Another interesting point to note is that the two conditions (especially PMDD) can often be 


How is it managed?

Conservative options are usually the first set of treatments for PMS and PMDD as they are known to have the least to no side effects profile. These include things like exercise, relaxation techniques as well as supplementation of vitamins and minerals. 

If conservative treatments are not enough to help relieve PMS or PMDD, the next step would be to use medications. Selective Serotonin Reuptake Inhibitors or SSRIs are a highly effective treatment for PMS and PMDD. This is a class of drugs often used to treat conditions such as depression, anxiety, PTSD, and more of which PMS and PMDD are included. They have side effects especially when first starting the medication with the most common being in achieving an orgasm. It’s important that one speaks to their doctor about any side effects they may experience with the medication they have been prescribed.


In Conclusion

PMS and PMDD are both common hormonal disorders for many women all over the globe. They encompass related symptoms but with some crucial differences that lead to a change in the severity, prognosis, and treatment options. Both are still prevalent due to a high number of cases that go unreported. The media coverage PMS receives is far greater than PMDD although both present similar symptoms, like irritability, mood swings, and depression. PMDD definitely presents itself in a more intense manner than PMS which is why early detection and appropriate treatment is necessary. 



  1. Yonkers, K., & Casper, R. (2021). Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder. Retrieved 21 December 2021, from!
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  3. PMS vs. PMDD: What’s the Difference and Which is Worse?. (2021). Retrieved 21 December 2021, from


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