PMS vs PMDD—What’s the Difference & What Can You Do About It

If you are one of the 5% of menstruating women who experience PMDD, which stands for premenstrual dysphoric disorder, you know the havoc it can wreak on relationships, work, school, and self-esteem. PMDD is not just disruptive, it’s disabling—and it can take over your life one week each month. Many women describe PMDD as a true Jekyll-and-Hyde situation. Like PMS, PMDD occurs the week before your period, but it is far more serious than PMS. Women with PMS and PMDD both experience mood changes like irritability, anxiety, and low mood. But for women with PMDD, those changes are more extreme. Women with PMDD experience one (or more) of the following symptoms:

• Feelings of anger and anxiety that are so pronounced they negatively affect relationships with other people
• Feelings of extreme despair and hopelessness, sometimes accompanied by thoughts of suicide
• Panic attacks
• Feeling out of control emotionally
• Frequent uncontrollable crying
• A complete lack of interest in daily activities and relationships
• Intense mood swings
• Extreme fatigue and lethargy

For women with PMDD, these emotional changes are accompanied by many of the same physical symptoms that come along with PMS, like breast tenderness, changes in appetite, and trouble sleeping. In short, PMDD is a condition that causes a great deal of suffering—and significantly diminishes quality of life.PMDD is harder to treat than PMS (which can be resolved with lifestyle and nutrition changes), but this disruptive hormonal condition can be improved with lifestyle, nutrition, and targeted support. I also recommend that women with PMDD consult with a trusted healthcare provider.

What Causes PMDD?

Experts don’t know exactly why some women experience PMDD, or this more severe form of PMS, but it may involve several factors: (1) these women may be hypersensitive to the normal hormonal fluctuations that happen during the 28-day menstrual cycle, (2) women with PMDD may have more severe underlying hormone imbalances, (3) women with PMDD may experience more dramatic shifts in serotonin levels than women with PMS (or women without any premenstrual symptoms) during the menstrual cycle, and (4) women with PMDD may have other risk factors that predispose them to develop PMDD, including chronic stress, overweight or obesity, a history of trauma or abuse, and existing mental health conditions such as diagnosed depression or anxiety.

Hormones and neurotransmitters share some of the same receptor sites in the brain (in areas that help regulate mood), so experts suspect that women who are uniquely sensitive to hormone changes may have more mood issues throughout their cycle (and during other reproductive events, like postpartum or during perimenopause and menopause). Researchers also know that the gut-brain-microbiome axis plays a role in the development of some mood and mental health issues. That’s why paying attention to nutrition—like reducing or eliminating sugar and eating low-inflammatory foods—can help women manage the symptoms of PMDD. And because factors like unremitting stress, depression and anxiety, and a history of trauma are risk factors for PMDD, stress reduction techniques, like meditation and mindful exercise, can also help.

Manage the Symptoms of PMDD

PMDD is harder to treat than PMS, but you can improve your symptoms with some simple food and lifestyle interventions. Here’s what I recommend:

Incorporate high-protein and complex-carbohydrate foods into your daily diet. Some preliminary research suggests that PMDD symptoms may be less severe when eating a high-tryptophan diet. Tryptophan is a precursor to serotonin and can be found in many healthy high-protein and complex-carbohydrate foods, including wild caught salmon, pastured poultry, grass-fed beef, whole grains like brown rice and quinoa, and legumes like beans and chickpeas. Chickpeas are a great source of vitamin B, which helps with progesterone production. Progesterone helps balance and reduce estrogen dominance, which is the most common hormone imbalance in women who have premenstrual symptoms.

Avoid inflammatory foods. The luteal phase (the time between ovulation and your period) is associated with increased production of inflammatory molecules in the body. (Indeed, several inflammatory conditions, like gingivitis and inflammatory bowel syndrome, are known to get worse during the premenstrual phase.) Similarly, inflammation is thought to play a role in the development of PMDD. So avoiding inflammatory foods can help. I recommend eliminating gluten, dairy, and refined sugar and refined flour from your diet. It’s also important to skip factory-raised meat (which is high in inflammation-promoting omega-6 fats, whereas pastured meats are higher in inflammation-fighting omega-3s). I also advise saying no to coffee and artificial sweeteners, which can aggravate anxiety issues and fuel inflammation.

Balance blood sugar. Balanced blood sugar is essential for easing any hormone-related condition, and it may be especially valuable for PMDD. That’s because imbalanced blood sugar and unstable insulin levels (insulin helps control blood sugar in the body) further fuel inflammation. Blood sugar imbalances can also mess with cortisol production. Cortisol is one of the body’s stress hormones and stress management is a key component of easing PMDD.

Adopt a smart supplement strategy. Some key supplements can help manage the symptoms of PMDD and/or the help address some of the risk factors associated with PMDD:

Omega-3s —These healthy fats have shown promise in treating some types of depression, and some research shows that omega-3s may confer a protective effect against anxiety disorders. While studies that look specifically at omega-3s and PMDD are lacking, research does show that omega-3s may reduce some of the psychiatric symptoms of PMS including depression, nervousness, anxiety, and lack of concentration (it can also reduce some of the physical symptoms of PMS like bloating, headache, and breast tenderness.) Even if omega-3s don’t help PMDD sufferers as much as PMS sufferers, these supplements seem to have a positive overall influence on mood—and they certainly aren’t harmful to take. I recommend them as a good overall support for mood and hormone balance.

Magnesium and vitamin B6. As with omega-3s, research on magnesium and B6 for  PMDD is lacking, but these important micronutrients, when taken in combination, can help reduce the severity of PMS. Because women with PMS and PMDD share some similar underlying hormone imbalances, it may help to take magnesium and vitamin B6.

Calcium. Calcium supplements may ease PMDD symptoms, according to research. I recommend 1200 milligrams a day, but always consult a licensed healthcare provider before starting any higher-dose supplement.

Chasteberry. Also known as Vitex, this herbal remedy has been shown to help with the physical symptoms of PMDD, including breast tenderness, bloating, and cramps. Check with a trusted healthcare practitioner before starting.

L-tryptophan. This supplement has shown promise in reducing the symptoms of PMDD. As always, consult a licensed practitioner before starting a new supplement.

Prioritize stress reduction and support good mental health. Existing diagnoses of depression and anxiety are more common in women with PMDD, so it’s important to tend your mental health as well as your hormonal health. To this end, I encourage women to engage in unapologetic self-care, find and do activities that bring them joy, practice meditation or other mindfulness practices, and seek out extra support, such as finding a therapist, when needed.

Practice The Cycle Syncing® Method. To address PMDD, it’s essential to understand the distinct phases of your 28-day cycle and tailor your food and movement to each phase. For example, PMDD strikes during the luteal phase, when inflammation is more pronounced and may play a more activating role in PMDD. So it is critical to support your metabolism during the luteal phase with the right foods at the right times. That will help stabilize blood sugar and support healthy hormone balance. Likewise, it’s important during the luteal phase to hit the exercise sweet spot—not too much and/or not too intense—to decrease the cortisol output that can exacerbate symptoms.

To put these strategies into place, you first need to know which phase of your cycle you’re at any given moment during the month—and to understand what type of self care matters the most during each phase. And that is precisely what practicing The Cycle Syncing® Method is all about. The Cycle Syncing® Membership teaches you to engage in the type of phase-based self care that helps ease symptoms of PMDD (and other period problems). The Cycle Syncing® Membership makes phase-based self care simple, manageable, and makes caring for your hormones second nature.

Always remember that once you have the right information about how your body really works, you can start making health choices that finally start to work for you! You can do this—the science of your body is on your side!