Could Extreme PMS Symptoms Be Premenstrual Dysphoric Disorder?

What Is PMDD?

PMDD "is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation," according to MedlinePlus, In other words, PMDD wreaks the same emotional havoc of PMS but at a worse level. The disorder strikes females the week before their period and subsides when their period starts, just like PMS.

PMDD has been added as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Additionally, the International Classification of Diseases 11th Revision (ICD-11) added PMDD to its list of diagnoses, according to a January 2019 World Psychiatry article.

While about 75% of women have at least mild premenstrual symptoms, 3% to 9% have symptoms severe enough to quality for PMDD, according to 2021 research published in theJournal of Affective Disorders Reports. No one knows exactly what causes either PMS or PMDD, but figuring out whether you have PMDD can help you ease its effects.

Your Symptoms Are Primarily Emotional

PMS includes a whole host of physical symptoms, like breast tenderness or bloating, along with emotional symptoms like mood swings. A mood-related symptom, along with four other severe PMS symptoms, should be included in order for a person to get a diagnosis of PMDD per researchers of a March 2022 Endocrines article.

"When it crosses over to where the symptoms are mostly emotional and are really interfering with your life, that could be PMDD," Patricia J. Sulak, MD, a professor of obstetrics and gynecology at the Texas A&M Health Science Center College of Medicine and the director of the adolescent sex education program at Scott & White Clinic and Memorial Hospital, in Temple, TX, told Health.

You Experience Debilitating Depression

If you're a little down the week before your period but feel fine the rest of the month, chances are you could be experiencing PMS. But if your pre-period depression really interferes with your work and your relationships, PMDD is likely to blame. If your symptoms are month-long, however, you may have depression or another underlying illness.

"Some women will say they're really, really impossible the week before their period, but when you start probing into their energy, appetite, and sleep conditions, they tell you they never really get back to their old self," M. Beatriz Currier, MD, the medical director of the Cancer Patient Support Center and chief of psychosocial oncology at Miami Cancer Institute/Baptist Health South Florida, told Health. "That could mean patients have a baseline depression that gets worse during their premenstrual time."

You're Extremely Irritable, Anxious, and Weepy

Even if you don't have depression, you could still be a have PMDD if you are irritable, anxious, and cry easily.

The Office on Women's Health (OWH) noted that people dealing with PMDD might experience "lasting irritability or anger that may affect other people" as well as feeling very sad or very tense. It may also be hard to determine if your level of irritability is normal or not.

If your annoyance level rises to the point where you're lashing out at your family or co-workers, you may have moved beyond PMS. And while you may be weepier than usual before your period, you shouldn't be concerned unless you experience regular weepiness without reason.

You Feel Overwhelmed and Out of Control

Feeling uncontrollably overwhelmed, particularly about routine tasks, is often a symptom of PMDD. "My patients tell me they're easily discombobulated when they need to get the kids off to school," said Dr. Currier. "They feel overwhelmed with their typical day-to-day schedule."

Sometimes symptoms of PMDD can make people feel like their actions are uncontrollable too. "I've even had a couple of patients tell me in tears that the week before their period was when they were most apt to scream at—or even think about hurting—their children," said Dr. Sulak. "They get to the point where they feel completely out of control."

You Have Problems Concentrating

Memory or concentration lapses—such as misplacing your keys or blanking on a name—are no cause for alarm right before your period. However, if you have a "subjective sense of difficulty in concentrating," as described by the National Library of Medicine, PMDD may be the culprit.

"It's really common for women with PMDD to say, 'I just can't get through my work,'" said Dr. Currier. "They'll tell you they're just not productive during this time."

Your Symptoms Extend Beyond Your Period

Typically, PMS symptoms become a problem the week before you get your period and abruptly subside on day two, said Dr. Currier.

But if the symptoms aren't necessarily in sync with your period, generalized anxiety disorder or depression may be to blame. "If the bad stuff is going on all month long," said Dr. Sulak, "there's [likely] something other than PMS going on."

Ultimately, if you have any concerns about your menstrual cycle, it's always a great idea to see your healthcare provider for assistance.