PMS-depression VS PMDD

Premenstrual Syndrome (PMS) is characterized by a number of significant mental, physical, and behavioural changes that recur in the luteal (second half/post ovulation) phase of a women’s cycle, and that cease soon after menstruation starts.

If these changes are severe enough to disrupt quality of life and affect one’s normal activities of daily living, then a diagnosis of premenstrual dysphoric disorder (PMDD) is considered. PMDD is a particularly severe form of premenstrual syndrome with an emphasis on the affective (psycho-emotional) symptoms. There are specific diagnostic criteria used to determine if it’s PMS or PMDD. This quiz is a helpful tool, but please don’t use it as a diagnostic tool. (1) PMDD Quiz: Do you Have Premenstrual Dysphoric Disorder?

“Because PMDD differs from PMS in severity but not type of symptoms, there is considerable debate as to whether PMDD is a subset of PMS or constitutes a distinct entity”. (2)

This is an interesting point because it suggests that two women can have the same PMS symptoms, yet the degree to which they are affected by them is different. For this reason, it is difficult to differentiate between PMS and PMDD.

The following symptoms are part of the DSM-IV Criteria for Premenstrual Dysphoric Disorder. (2) If you think that you may be suffering from PMDD, I encourage you to seek diagnosis and treatment from a healthcare provider and/or a mental health professional.

  1. Markedly depressed mood; hopelessness; self- deprecating thoughts
  2. Marked anxiety, tension, feeling ‘‘keyed up’’ or ‘‘on edge’’
  3. Marked affective lability (feeling suddenly sad or tearful; increased sensitivity to rejection)
  4. Persistent and marked anger, irritability, or increased interpersonal conflicts
  5. Decreased interest in usual activities
  6. Difficulty concentrating
  7. Lethargy, easy fatiguability, or marked lack of energy
  8. Marked change in appetite, overeating or specific food cravings
  9. Hypersomnia or insomnia
  10. Sense of being overwhelmed or out of control
  11. Physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain, bloating, weight gain

I want to emphasize that these symptoms (or the severity of these symptoms) are not in your head! There is a reason that you feel this way.

Overview of PMS-depression symptoms (3)

  • Depression
  • Angry feelings for no reason
  • Feelings that are easily upset
  • Poor concentration or memory
  • Feelings of low self-worth
  • Violent feelings

From my experience and training, I would add tearfulness, appetite changes, fatigue, insomnia, apathy (lack of interest), feelings of hopelessness, and low libido to that list.

“Some 150 symptoms have been ascribed to PMS—most commonly feelings of anxiousness (premenstrual tension was the first name given to this syndrome), irritability, and anger or moods vacillating unpredictably among the three. Some women feel predominantly sad or self-deprecating, others simply fatigued and lethargic. Physical changes include bloating, breast tenderness, food cravings, headache, and gastric upset. No particular assortment of symptoms is diagnostic; it is the regular recurrence of symptoms on a monthly basis, just before the menstrual period, that matters” (4).​

Pain points of PMS-D

Does this sound like you?

  • My mood is all over the place. One second I’m sad, the next I’m angry.
  • If my partner just looks at me, I’m irritated.
  • I feel tense and on edge for no reason.
  • Why am I so tired? I had a good night’s sleep, I think.
  • I just looked at a snail and cried. It was so tiny and vulnerable.
  • Why don’t I want to do anything except veg, watch Netflix, and eat peanut butter out of the jar?
  • I feel like my hunger is never satisfied (she says as she scarfs down her 5th “healthy” post-workout brownie. She didn’t even work out).
  • I’m sick of looking so bloated that people ask me if I’m pregnant!
  • I can go on, but I think you get the point.

Most of the pain points (or problems you are experiencing because of PMS-D) are similar to the ones I discussed in my post about PMS-A. There is certainly overlap between all of the PMS types, but what makes this problem bad enough that you’re here trying to solve it? The answer is different for everyone. Here are a few common themes.

1. Frustration. This is a major one because depression limits you from enjoying your life or taking part in your typical activities of daily living due to lack of interest (that is what apathy is). What are you unable to do, enjoy, experience because of PMS-D?

It can be incredibly frustrating to feel this way for 1-2 weeks every month. When you consider a women’s lifetime menstruating, that isa lot of time not feeling your best. If you do the math, right now, how much of your life is spent experiencing PMS-D? Do you experience symptoms of PMS-D for days or weeks? Did it start with your first menses? How many more periods are ahead of you, if we say that menopause usually occurs between 45 and 55 years of age? For some women, this could be half of their reproductive years.

2. Decreased self identity/feeling lost. When faced with a complex and frustrating condition like PMS-depression, it is common to feel lost. You don’t feel like yourself. And what’s worse is that you feel bad for feeling bad, and suddenly you’re caught in a self perpetuating thought cycle of self deprecation. When does it end?

3. Lack of understanding. Given the cyclical nature of PMS symptoms, we often brush them off as normal, or wait for things to get better. And they usually do, for awhile. But when you’re feeling your worst, you probably catch yourself asking “is this normal”? Let me be clear that PMS symptoms are common, but they are not “normal”. Given the complexity of this syndrome, I advise you to seek diagnosis and treatment from a healthcare provider.Trying to understand, treat, and manage this syndrome on your own often leads to suboptimal outcomes. And it can seem overwhelming. But with the appropriate guidance and care, you can become more capable of maintaining your own health. One of the significant benefits of treating PMS naturally is that it serves as a motivator to make lifestyle changes that have a positive cascade effect on overall health.

Benefits of solving these problems

We often make changes only when the consequences of not doing so becomes too painful. Women are tough! But please don’t wear this as a badge of honour. I know you’re tough. Other women know it too. That resilience and mental toughness does not mean that you have to tolerate feeling less than. Even if you could tolerate feeling overwhelmed, sad, angry, irritated, bloated, tearful, tired, lethargic, etc. why would you? These feelings (yes, bloated is a feeling too) feed into a self perpetuating thought cycle that leads to more negative emotions. No thank you! I wanna feel awesome every day, or at the very least, remove the obstacles to feeling awesome every day.

Even when presented with options or solutions, one may catch yourself saying that you don’t want to put in the work for potentially little to no return. Why follow a plan for no reason? Let’s talk about those reasons, or better stated, the benefits of solving these problems.

Let’s use our pain points from earlier as a thought experiment. Imagine your life without these symptoms. What does that look like to you? How does that change your daily activities, social interactions, work-life balance, self-identity? My mood is all over the place. One second I’m sad, the next I’m angry.

Your mood is stable. Sure you still feel sad and angry sometimes, but those mood swings don’t confuse your loved ones anymore. Heck, you’re less confused too! Bonus: you’ll probably notice that all your friends and family who are usually “busy” at this time of the month are suddenly free and excited to hang out! If my partner just looks at me, I’m irritated.

Improved relationship with your partner. Even if it’s just PMS induced, how many arguments could have been avoided if your mood was less volatile? How many times have you apologized to your partner for “starting a fight” due to raging hormones? I think it goes without saying that it’s probably better for your relationship if PMS-induced arguments were minimized. I feel tense and on edge for no reason.

Feelings of unexplained tension are decreased or gone. There are plenty of real things to be stressed and anxious about. No need to add nothing to the list, am I right? I’m being cheeky, but really, I don’t want to waste my energy feeling edgy for no reason. I need to save said energy for more resourceful and productive activities, like baking more “workout” brownies. Did I say baking, I meant work. Yes, more energy for work purposes of course. Why am I so tired? I had a good night’s sleep, I think.

Sustained energy levels throughout the day. And I’m not talking about espresso energy. No jitters or crashes please. Ain’t nobody got time to stand in line at Starbucks 4 times a day. This is true energy, a clear head, a rested body, harnessed from good ol’ balanced hormones. ‘Nuff said.

Point being, by knowing what solving your problems will allow you to do, you can imagine what’s on the other side of seeking treatment. ​

Alternatively, we can think about the risks of not solving this problem. Here is another thought experiment to help you visualize this. Think about the number of days you spend every single month not feeling like the best version of yourself. Remember that math we did? Even if it’s just 5 days a month that you experience these symptoms, how many days over your lifetime is that? If you do not solve this problem now, how many more days do you risk feeling sad, hopeless, lost, and [insert your symptoms here]. Then, make a list of all the things you usually pass up when you experience PMS-D symptoms. Look at both of these metrics. How many opportunities are you potentially missing out on, both personally and professionally? ​

How can naturopathic medicine help you solve these problems? Or more specifically, what does a private naturopathic consult contain that will help you?

Hormones are susceptible to many influences. To ensure that we get to the root of the problem, we must identify and address the principle causes of your hormonal disruption.

No cause has been established as the clear dominant cause of PMS, and no cause explains every case. It is likely multifactorial… But influences may include:

  • Hormonal imbalance, specifically a low progesterone level during the luteal phase of the cycle
  • Abnormal neurotransmitter response to ovarian signalling
  • Abnormal HPA (hypothalamic-pituitary-adrenal) hormone secretion
  • Nutritional deficiency including magnesium, certain B vitamins
  • Carbohydrate intolerance
  • Environmental factors, including stress

Based on this list, I can tell you that PMS-depression (just like PMS-A) is highly influenced by diet, sleep, blood sugar, inflammation, hormones, fatigue, mental states, stress, and exercise. As your doctor, I need to identify the factors that are most likely driving your symptoms and address them to achieve reliable and sustainable improvements. A thorough history will help me identify and address those factors. What works for one person may not work for another. We are truly individuals with our own unique physiology, stressors, and psychological makeup. There is no clear dominant cause of PMS, but it is likely multi-factorial. That means that this is going to take time.

From your initial 90-minute online (private and secure via ZOOM) Naturopathic consult you will:

  • Have a new framework for understanding and treating your PMS symptoms
  • Receive clear explanations of the principle causes of hormonal disruption to ensure you get to the underlying cause of the problem
  • Learn about the most appropriate lifestyle changes for PMS problems and how to implement them
  • Receive recommendations for acute treatment options, as well as a clear long term management plan
  • Have access to handouts, resources, ZOOM recordings, and my private online dispensary

Please refer here for more specific information about the initial and follow-up appointments.

This might be obvious, but at the risk of sounding repetitive, I want to re-iterate that the content I write and the care that I provide is based on four principles: listen, validate, inform, involve.

Listen, Validate, Inform, Involve

Listen. The foundation of naturopathic diagnosis is an extensive patient history – aka, your story. Each one of you has a unique story to tell. By assessing the physical, environmental, lifestyle, attitudinal, and emotional aspects of your life, I am in the best position to provide individualized and wholistic care for your health concerns and overall well-being.

Validate. Your symptoms are real, and it is not all in your head. I can’t emphasize this enough.

Inform. Your health status is likely a product of your environment and your reaction to environmental stimuli. For this reason, lifestyle and behavioural interventions are often key components of treatment strategies. Understanding the factors that affect your health provides a new perspective and awareness.

Involve. You are an active participant in your health. My patients are involved in their treatment program and learn to make effective, educated, self-care decisions that can prevent future health problems. Optimal wellness and improved quality of life is within your capacity.

Naturopathic medicine is perfect for those who are

  • Seeking complimentary and/or alternative treatment options to manage the symptoms of PMS
  • Committed to a minimum 3 month timeline
  • Motivated and ready to make long term changes

FYI (if you are ready to book): The best evaluation and determination of PMS is a symptom diary relating symptoms to the menstrual cycle. Here is an example of one. Please use it as a template to track your PMS symptoms leading up to your initial appointment.

Source: Romm, A. Botanical Medicine for Women’s Health (2009, Churchill Livingstone)

Finally, I want to discuss objections: time, money, and the uncertainty of success

This is an investment of both your time and money – two things we all hold dear. There is no getting around the time required to address hormonal problems. A three-month minimum time commitment is what I recommend, since our bodies need time to adapt and respond to the changes you are implementing. This leads to the next objection: the uncertainty of success. My mission is to provide patients with the information and tools that they need to take care of their own health. The health industry is full of many ways to change your body, your nutrition and your psychological well being. I believe in treating all patients as individuals. Not a one size fits all. I hope you appreciate this approach. Having said all that, consistency is everything. If you consistently work at improving the factors that influence your hormones (which I will teach you), then you will see improvements.

In terms of money, the value of this service is likely going to be based on your results, which depends on your level of commitment and consistency over the next 3 months. That makes this hard to determine right now. Values are extremely personal. If you are thinking of investing in this, then you likely value the perceived benefits to your health or you value avoiding the pain and inconvenience of symptoms associated with your problem. Some people are positively motivated, while others are negatively motivated. There is no right or wrong motivator. In either case, if money is a serious objection, then perhaps you are not in the right head space to make the commitment right now. That is okay. I wish you health and success no matter what you decide to do.

For everyone else, this is the start to a new hormonal symphony. Book now.


Cover Photo by Volkan Olmez on Unsplash

(1) Remedy Health Media & PsyCom

(2) Romm, A. Botanical Medicine for Women’s Health (2009, Churchill Livingstone)

(3) Premenstrual Syndrome Clinical Presentation: History, Physical Examination via @medscape

(4) Hudson, T. Women’s Encyclopedia of Natural Medicine (2008, McGraw-Hill)