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In most cases, PMS peaks between 25-35 years of age. PMDD or premenstrual dysphoric disorder is a severe form of PMS affecting approximately... PMS or PMDD?

by Kimberly Allen, RN

Premenstrual syndrome, more commonly known as PMS, is a wide ranging group of symptoms that women experience during their menstrual cycle.  Approximately 3 out of 4nwomen experience PMS during menstruation.  In most cases, PMS peaks between 25-35 years of age.  PMDD or premenstrual dysphoric disorder is a severe form of PMS affecting approximately 8% of women.
Though Drs do not know exactly what causes PMS or PMDD, they do know that it occurs on a regular cycle coinciding with a woman’s menstrual cycle and that there are several contributing factors.  The first thing they looked at was the cyclic nature of PMS.  It develops along with the fluctuations of hormones during menstruation and it is not present during pregnancy or after menopause.  There are also fluctuations in the serotonin levels during menstruation which can alter a persons mood as well as cause sleep problems, fatigue  and food cravings.  Drs also believe that there are environmental factors that can also contribute to PMS and/or PMDD, including stress.  Increased stress can affect everyone in different ways including triggering PMS or PMDD.  Diet is another factor that can contribute to PMS and PMDD.  Poor nutrition as well as eating salty foods have been linked to symptoms of PMS.  Drinking alot of caffeinated beverages as well as alcohol is known to cause disturbances in mood and energy levels.  Many women with PMDD also either already suffer from or have a history of anxiety disorder, a major depression or seasonal affective disorder.
The symptoms of PMS can vary significantly from woman to woman and categorized into 2 types – emotional and behavioral symptoms and physical symptoms.  The emotional symptoms include anxiety, tension, mood swings with irritability and anger, depression and social withdrawal as well as crying spells.  Some women also experience food cravings and changes in appetite, insomnia and difficulty concentrating.  The physical symptoms that you may experience include increased acne, bloating and weight gain, pain in your joints and/or muscles, headache and fatigue as well as breast tenderness.  Some women also experience varying degrees of abdominal discomfort.  Not all women will experience all these symptoms, most will experience only a few.  However, many women experience symptoms that are severe enough to interfere with their activities of daily living.
Women with PMDD experience the same symptoms as PMS, however they are much more intense and are usually debilitating to the point where the woman has significant difficulty  with her activities of daily living.  Some women with PMDD experience depression so severe that they have suicidal thoughts.  For a woman to be diagnosed with PMDD she must have at least 5 of the symptoms of PMS and at least one of them has to be an emotional/behavioral symptom.
There are no tests or physical exams that can diagnose PMS or PMDD, diagnosis is made through a complete medical history.  Most Drs will have you keep a daily diary that details your moods and physical symptoms as well as your eating and sleeping patterns over a period of at least 2 menstrual cycles.  The Dr will also usually request a psychiatric exam to rule out any other disorders.
There is no one treatment that will effectively relieve every woman’s symptoms, however, there are several things your Dr may suggest.  One of the first things your Dr will look at is your diet and do you get regular exercise.  Regular exercise and eating a healthy diet avoiding salt and sugar as well as caffeine and alcohol can significantly reduce the symptoms of PMS.  Over the counter NSAID’s can relieve the mild to moderate aches and pains associated with PMS, however in cases of severe PMS your Dr may prescribe other medications like birth control pills to stop ovulation.  In cases of PMDD in addition to diet and exercise your Dr may also recommend antidepressants for either part of the month or the whole month.  The type of treatment and medication will depend on the severity of your symptoms.
In you or someone you know is experiencing symptoms severe enough to interfere with the activities of daily living encourage them to seek medical attention, help is available to help control your symptoms.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at