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PMS AND PMDD: What's The Difference?

"PMS" --the acronym for "premenstrual syndrome"-- has become a household term and the brunt of many jokes, but according to a survey conducted by Yankelovich Partners, Inc. on behalf of the Society for Women's Health Research, women have a very low awareness of its much more severe form, premenstrual dysphoric disorder or PMDD.  Among 500 women surveyed, 8 out of 10 did not know that severe premenstrual problems have been officially classified as PMDD, nor did they know that such problems can be diagnosed and treated.  Even more disturbing is that the one in 4 respondents who described their premenstrual symptoms as strong or severe were among those unaware of PMDD.

While nearly all women surveyed reported experiencing premenstrual symptoms in the last 12 months, nearly half (45 percent) have never discussed PMS with their doctors.  Even among women with strong or severe symptoms, more than one out of four (27 percent) had never talked with their doctors about PMS, despite the fact that most in this group reported that the symptoms interfere with their daily activities.

When asked about their reluctance to seek medical treatment even if they thought they had PMDD, nine of every 10 respondents who would not seek treatment said that they could cope with their problems on their own, and about one of every four felt their doctors would not take their complaints seriously if they did bring it up.

Like PMS, PMDD occurs the week to 10 days before, and disappears a few days after, the onset of menstruation.  PMDD is characterized by severe monthly mood swings and physical symptoms that interfere with everyday life, especially a woman's relationships with her family and friends.  PMDD symptoms go far beyond what are considered manageable or "normal" premenstrual symptoms. 

PMDD is a combination of symptoms that may include irritability; very depressed mood; feeling out of control or overwhelmed; marked anxiety; sleep disturbances; difficulty concentrating; fatigue; angry outbursts; sudden mood shifts; muscle or joint aches and pains; breast tenderness; weight gain and bloating.  The diagnostic criteria emphasize symptoms of depressed mood, anxiety, mood swings or irritability.  The condition affects up to one in 20 American women who have regular menstrual periods.

What is the difference between PMS and PMDD?

The physical symptom list is identical for PMS and PMDD; while the emotional symptoms are similar, they are significantly more serious with PMDD than with PMS.  In PMDD, the criteria focus on the mood rather than the physical symptoms.  With PMS, sadness or mild depression is not uncommon.   With PMDD, however, significant depression and hopelessness may occur; in extreme cases, women may feel like killing themselves or others.  Attributing suicidal or homicidal feelings to "it's just PMS" is inappropriate; these feelings must be taken as seriously as they are in anyone else and should promptly be brought to the attention of mental health professionals.

Women who have a history of depression are at increased risk for PMDD.  Similarly, women who have had PMDD are at increased risk for depression after menopause.

In simplest terms, the difference between PMS and PMDD can be likened to the difference between a mild headache and a migraine or the difference between having a cold and having the flu.

For more information about depression or other mental health issues, click here.

Created: 10/10/2003  -  Donnica Moore, M.D.

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