Premenstrual Dysphoric Disorder (PMDD) and the Difference from Premenstrual Syndrome (PMS)

While premenstrual syndrome (PMS) is well-known to many, premenstrual dysphoric disorder (PMDD) often remains unfamiliar. In the upcoming article, we delve into the details of PMDD and highlight its distinctions from premenstrual syndrome.

What is Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder can be regarded as a subtype of Premenstrual Syndrome.

It is recognized as the most severe manifestation of PMS, impacting an estimated 3-8% of women in their childbearing years [3]. Like PMS, individuals with PMDD encounter physical and psychological discomfort, although the psychological symptoms are more pronounced in PMDD [1]. 

Symptoms typically commence during the latter half of the menstrual cycle, mirroring the pattern of PMS, but persist during the initial days of the menstrual period. Amid the array of symptoms associated with PMS, PMDD is characterized by the presence of at least one of the following prominent psychological indications:

  • Feeling of sadness and hopelessness.
  • Intense anxiety and tension.
  • Severe mood swings.
  • Marked irritability and anger.

Similarly to PMS, the exact cause of PMDS is still unclear. It is believed that depression and anxiety often underlie PMDS. Consequently, the hormonal changes triggered by menstruation might worsen the already present symptoms [2]. 

In essence, categorizing the symptoms of PMDS can be challenging; diagnostic criteria can be found in the DSM-V, a psychological classification system [4].

PMDS is considered present when symptoms, such as affect lability, anger, irritability, tension, or sleep disturbance, have been experienced in most preceding cycles and subside with the start of the menstrual period.

Furthermore, akin to PMS, maintaining a cycle diary can be highly beneficial in determining whether the symptoms correlate with the menstrual cycle and how the fluctuations in symptoms occur. Accordingly, personalized therapy approaches can be collaboratively developed with a medical professional.

What are the treatment options for PMDS?

PMDS treatment should address the underlying mental health concerns and follow a similar approach to treating PMS. Psychotherapeutic techniques, notably cognitive behavioral therapy, have demonstrated effectiveness. In some cases, under the guidance of a healthcare professional, medication can also yield positive results [2],[3].

Similarly to PMS, adopting the use of contraceptive pills throughout the extended cycle can help mitigate hormonal fluctuations, leading to a reduction in symptoms. For pronounced PMDS symptoms, incorporating antidepressants alongside can contribute to symptom improvement. This approach empowers those affected to regain control, even during the premenstrual phase, markedly enhancing their quality of life. This treatment can also diminish symptoms like fatigue, food cravings, and sleep disruptions. The encouraging news is that symptoms respond promptly to suitable therapy [2],[3].

In a Nutshell

Premenstrual Dysphoric Disorder represents the heightened intensity of Premenstrual Syndrome. Alongside physical discomfort, PMDS notably features psychological issues like depression and anxiety. Despite ongoing research, the precise cause remains elusive. Given the diagnostic challenges, maintaining a symptom diary proves valuable for connecting complaints to potential PMDS symptoms. The spectrum of therapeutic approaches is diverse and contingent on individual symptoms, underlying conditions, and personal distress.

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  1. Gätje R, Eberle C, Scholz C, Lübke M, Solbach C. Kurzlehrbuch Gynäkologie und Geburtshilfe. Deutschland; 2015.
  2. Tatnai Burnett. What’s the difference between premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS)? How is PMDD treated? [Updated 2021 March 11]. Accessed November 27, 2022
  3. Rohde A. PMS und PMDS – Behandlungsmöglichkeiten in der Frauenarztpraxis, wenn die psychischen Symptome im Vordergrund stehen. Accessed November 27, 2022.
  4. Dorsch V. Die prämenstruelle Syndrome PMS und PMDS – Prämenstruelle dysphorische Störung – Mythos oder behandlungsbedürftige Störung? Published 2018.,des%20letzten%20Jahres%20bestanden%20haben. Accessed November 27, 2022.

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Katharina Klobusch
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