PMS & PMDD: What is the difference and when is it time to seek help?

The menstrual cycle is divided into two halves, the follicular phase which encompasses the time from the first day of your period until ovulation, and the luteal phase which includes the time from ovulation to the start of your next period. In the follicular phase estrogen is the dominant hormone and in the luteal phase progesterone is dominant. Between the two phases ovulation occurs, at this point in the cycle estrogen, FSH and LH all spike. Those who experience PMS and PMDD may have a higher sensitivity to these hormonal fluctuations, or inflammatory reactions to these fluctuations, involving histamine and inflammatory cytokines. Regardless the cause of your premenstrual symptoms, it is important to be in tune with your body and know when to seek help.

What is PMS?

The American Academy of Family Physicians defines PMS as recurrent moderate psychological and physical symptoms that occur during the luteal phase of the menses and resolves during menstruation. By definition, these symptoms stop within the first 4 days of the period and do not present in the follicular phase. If the symptoms you are experiencing do present outside of the luteal phase but are worse during the luteal phase, you may be experiencing premenstrual exacerbation of another condition. Some of the most common PMS symptoms include irritability, fatigue, bloating, breast tenderness, body aches, anxiety, changes in appetite, headaches, and depression. The Royal College of Obstetricians and Gynecologists rates PMS as mild, moderate, or severe. Mild PMS may not interfere with personal/social and professional life but will cause significant discomfort. Moderate PMS starts interfering with personal, social and professional life but does not keep you from being able to function or interact. The being said, moderate PMS may cause you to function sub-optimally, especially in the work and school settings. PMS is considered severe when it consistently interferes with your ability to participate in your regular routines and may cause withdrawal from social and professional activities. When PMS is severe, the luteal phase can be a very isolating time. Those who struggle with severe PMS may find themselves “cleaning up their messes” once they re-enter their follicular phase. This may be catching up on work you couldn’t complete, reconnecting with friends and colleagues that you distanced yourself from, apologizing to your friends or family, or literally cleaning up a mess that you didn’t have the energy for in your luteal phase. While these rankings of PMS severity can be helpful for tracking progress in PMS treatment, they do not define who requires treatment. The most important thing is how your PMS makes you feel. If there are any points in your cycle where you feel disconnected from your body or feel that your body is working against you instead of for you, then it is time to seek support.

What is PMDD?

PMDD is like PMS’s lesser-known evil twin. PMDD stands for premenstrual dysphoric disorder, and it is characterised by affective or somatic symptoms that cause a severe dysfunction in your life during your luteal phase. The severity of the mood and cognitive symptoms is the main thing that differentiates PMDD from PMS. In PMDD we may see fatigue become depression, irritability become anger, or anxiety become panic. With PMDD you may notice your personal and professional relationships being impacted significantly during your luteal phase due to your changes in mood. PMDD can also present with weepiness, increased sensitivity to rejection, or brain fog during the luteal phase. If you notice that in your luteal phase you have decreased interest in the things your usually love or very low energy and motivation, it may be worth looking into PMDD treatment. Those with PMDD will often meet the diagnostic criteria for conditions like Major Depressive Disorder or General Anxiety Disorder, but only in their luteal phase. Having some changes in emotional sensitivity in the luteal can be normal, and some women find that this is a great time to connect with their intuition, but if the changes are severely impacting your quality of life or ability to connect with others, then it is time to seek support.

What can we do?

Experiencing bloating, low mood, pain, anxiety, bouts of crying or any other debilitating symptoms in your luteal phase may be common, but it is definitely not normal. Unfortunately, societal norms have caused women to hesitate on seeking care for these concerns as they have widely been promoted as a “normal part of womanhood”. There is a lot that your ND can do support you on a healthy hormone journey and minimize symptoms, so you don’t feel like you’re missing out on life for half of your cycle. Nutrition and dietary support, organizing a supplement regime or luteal phase acupuncture are just a few examples of the way naturopathic medicine can decrease PMS and PMDD symptoms. Your ND is always on your side and is there to support you with whatever you may be feeling. We don’t want to see hormonal conditions keep you from achieving your goals and becoming your best self.