Writer:
If you’ve been getting your period for a while, you probably already know about premenstrual syndrome, or PMS. Around 3 out of 4 people who menstruate will feel a little crampy, a little on-edge, and maybe cry a little more easily the week before their period — the key here being “a little.”
But if your cramps are so bad you can’t walk, or if your mood swings turn into full-on rage spirals, it might be more than just garden-variety PMS. Premenstrual dysphoric disorder, or PMDD, is a constellation of physical and emotional symptoms that occur during the luteal phase of your cycle (after you ovulate, right before your period). A clinician can offer a diagnosis and help you minimize the impact it has on your life.
So, how do you know if you might have it?
PMS vs. PMDD
“We all can have mood swings before the start of our periods,” says clinical psychologist Stephanie Samar, PsyD, “but in the case of PMDD we’re talking about feeling like a different person.”
To better understand the difference between the two, have a look at the table below and see what resonates.
PMS | PMDD |
“I have a harder time focusing and getting my work done.” | “I can’t get out of bed even though I know I have to and feel too out of it to even brush my teeth or get dressed.” |
“I’m short with people and more easily annoyed.” | “I find myself picking fights and lashing out at people. I know it’s irrational, but I can’t stop myself.” |
“I get more teary-eyed than usual at certain songs, shows, sad thoughts, or memories.” | “Nothing is ‘wrong,’ but I feel worthless, suicidal, and I can’t stop crying.” |
“I have to sit out during gym class or practice because I have cramps.” | “My cramps are so bad that it hurts to walk or even stand up.” |
How to track your symptoms
To be diagnosed with PMDD, symptoms should occur in a consistent pattern for a minimum of two full menstrual cycles.
So, time to start tracking your cycle! Do all your big fights tend to happen around the same time each month? Is there a cadence to your sugar and salt cravings? The easiest way to track these sorts of things is with an app. Here are some good ones that won’t sell your data:
Habit trackers, bullet journals, and physical calendars are another great option, if you’re into that sort of thing.
Who to talk to about PMDD
If you feel like you may have PMDD, here are some people to talk to for guidance and support:
Gynecologist: Make an appointment with your OB-GYN. Tell them you’ve been tracking your symptoms over the past two menstrual cycles and you think you may have PMDD.
Primary Care Physician (PCP): If you don’t have or haven’t yet been to a gynecologist, go to your PCP. Tell them you think you have PMDD, and ask for an OB-GYN referral, then make an appointment. Remember that you have the right to find a different OB-GYN if the one you see makes you feel uncomfortable or not heard.
Parents or family: Just letting them know that what you’re struggling with every month has a name can help them support you more. If it’s too awkward to bring up in person, sending them links to resources like these might be easier.
Friends or partners: While telling your loved ones about your PMDD doesn’t excuse hurtful behavior, it can help explain it. Talk about what sorts of things can trigger your rage spirals, and work together to be sensitive to each other’s feelings.
Things that can help PMDD
Meds: Your doctor may recommend going on the birth control pill, as it’s known to regulate and balance those hormonal shifts. If you take antidepressants, they may consider increasing your dosage around that time of the month.
Exercise: Working up a sweat is known to help calm the PMDD aggression. If it hurts too much to go for a run, try some gentle yoga or stretching.
Avoiding alcohol: Alcohol can often make PMDD symptoms worse, so be mindful of that when choosing whether or not to drink.
Planning ahead: Save dates, parties, and other high-pressure social situations for a time of the month when you’re less conflict-prone. If you’re having a conflict with a loved one and you know it’s your PMDD flaring up, let them know that you can talk it out once you’re feeling more regulated.
Exploring a PMDD diagnosis can help you better prepare for the difficulties you face each month before your period. While it’s still no fun to endure, PMDD can be managed with the right treatment and awareness of your symptoms.
