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Period got you down? When your symptoms are more than just PMS

Most women experience premenstrual symptoms (PMS). Estimates are that 75% of women experience some physical and emotional changes around their periods. These symptoms usually don't impact functioning much and are considered mild. So you might be asking yourself why you seem to get such big changes around your period. Let's talk about something that even healthcare providers are still learning about: premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation (PME).

First, some period basics

Before talking about premenstrual symptoms, it's helpful to know the terminology used. Premenstrual symptoms occur in what is called the Luteal Phase of your cycle. The luteal phase occurs after you ovulate but before you menstruate. A normal luteal phase is anywhere from 11-17 days in length. Premenstrual symptoms usually occur in the last week of your luteal phase, meaning the week before your period.

So how is PMDD different than PMS?

On first glance, PMS and PMDD seem very similar but there are important differences that distinguish them from each other. PMDD is much more severe than PMS is. Symptoms of PMDD interact with life and daily functioning. PMDD is also rarer- it's estimated that around 5-8% of childbearing women suffer from PMDD.

Mental health providers and OBGYNs follow a set of criteria to diagnose PMDD. The criteria includes the following:

  • Symptoms have had to occur during most menstrual cycles in the past year and you experienced at least 5 of the below symptoms of PMDD

  • Significant depression, hopelessness, or self depreciating thoughts

  • Significant anxiety, feeling tense, or keyed up

  • Significant mood swings

  • Decreased interest in your usual activities

  • Troubles concentrating

  • Lethargy, feeling extremely tired

  • Big change in appetite- eating much more or less

  • Sleeping too much or not being able to sleep well

  • Feeling overwhelmed and out of control

  • Physical symptoms such as breast tenderness, cramping, headaches, joint pain, weight gain, or bloating.

  • The symptoms need to occur during the luteal phase of your menstrual cycle and get better within a few days of starting your period. No symptoms occur during the week after your period.

Some of the PMDD symptoms sound similar to PMS but remember, the big difference is the severity and the impact it has on your functioning. The other thing to note is that these symptoms are absent during the week after your period.

Wait, I definitely notice those symptoms worsen during my period but I also have some of those things during my entire cycle. What does that mean?

This is where the research lags behind. When women have a history of mood disorders or anxiety disorders, those can worsen premenstrually. We call that premenstrual exacerbation (PME). Sadly, this isn't an official diagnosis yet or something we have targeted treatments for.

The difference in PMDD and PME is that PME causes a severe worsening of symptoms you already experience during the luteal phase. PMDD causes an onset of new symptoms in the luteal phase which completely go away after your period.

The most common premenstrual disorder I see in my practice is premenstrual exacerbation (PME).

What causes the premenstrual disorders?

We aren't sure of the exact cause of things like PMDD or PME. It might be an abnormal reaction to the normal fluctuations of hormones that occurs throughout your cycle. The hormonal changes may lead to a serotonin deficiency which could lead to mood changes.

There are some risk factors identified for PMDD, these include:

  • Family history of PMS and PMDD

  • A history of postpartum depression

  • A history of trauma

  • A history of major depressive disorder

What does PMDD look like in the long term?

Unfortunately, PMDD is a chronic illness. Symptoms do seem to improve when ovulation is suppressed like during pregnancy or menopause. The symptoms seem to stay the same from cycle to cycle and research indicates symptoms may peak during your 30's.

What can I do about it?

Great question! First, seek out support from a provider who is knowledgable about premenstrual disorders. This could include your psychiatric provider, OBGYN, or primary care provider. Below are some options that seem to help manage the symptoms of PMDD but be sure to talk to your provider before trying them out.

Lifestyle changes

  • Regular exercise

  • Changes to diet such as increasing protein and decreasing things such as caffeine, sugar, salt, and alcohol

  • Sleep (need help with this? Check out our previous blog on getting good sleep)

  • Mood charting


There are some supplements that could be helpful for PMDD. Remember, supplements are not regulated by the FDA and you should always check with your provider before starting any new supplement.

  • Calcium: 1200mg of calcium daily has some evidence in helping with premenstrual symptoms

  • Vitamin B6: 50-100mg daily. Results support that daily B6 up to 100mg could help support premenstrual symptoms

  • Magnesium: 200-460mg daily

  • Vitamin E: 400 IU daily


There are some medications that have evidence to help in PMDD. Talk to you provider about these options

  • Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are considered the first line treatment for PMDD. There are a few different ways to consider using SSRIs throughout your cycle so talk with your provider about what is best for you

  • Birth Control Pills: Some oral contraceptives seem to help with PMDD. Birth control pills that only contain progesterone (the mini pill) are not likely to help.

So what next?

It can feel overwhelming to think about managing premenstrual disorders. You aren't alone- Northern Oak Wellness specializes in the treatment of women and is here to help with your journey. Contact us today for a consult


Clayton, Jnl of Psych Prac. 2008;14:13-21. Winer & Rapkin, Jnl Reproductive Med. 2006;51(4): 339-347.

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Wittchen HU, Becker E, Lieb R, et al. Psychol Med. 2002;32:119-132.

2Block. Am J Psychiat. 1997;154:1741.

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