What's the difference between PMS and PMDD?
"Severity is the difference," says Dr. Hall. "The emotional component to PMDD can include one or more severe symptoms, such as extreme depression, or anger." Though it may not occur every cycle, PMDD usually hits about seven to 14 days before your period, and the intensity increases as you get closer.
How do you know if your PMS is actually PMDD? "Start by keeping a diary of your symptoms—along with the severity and duration—through a couple of cycles," says Constance A. Young, MD, an ob/gyn at Columbia University Medical Center. Watch for these telltale signs—diagnosis will usually include a combination of these symptoms, she says.
The bloating, muscle weakness, or weight gain seems out of control
You feel exhausted or drained of energy
"When the adrenal glands—the ones responsible for regulating and releasing hormones during your cycle—stay stressed over time, they become stop creating healthy and balanced amounts of hormones, and the result is feeling exhausted, depressed, and even having a low sex drive," she says.
Your mood swings are extreme and unpredictable
These can include intense anger and and depression—and you're at higher risk if you have a history of traumatic events or anxiety disorder, according to Dr. Eliza Bruscato, ob-gyn at Winnie Palmer Hospital for Women & Babies.
"These symptoms usually arise in your mid-twenties, but they should resolve themselves when you reach menopause," she says.
Relationships are severely impacted
"I have had a number of patients who have had their marriages ended because of this condition," he says.
Be on the lookout for emails sent in anger or frustration, or having a shorter fuse than normal with your friends or children in a way that feels harmful.
You feel anxious, out of control, and overwhelmed
You already struggle with migraines or irritable bowel syndrome, or other chronic issues
Your sleep is disrupted
Because of those low estrogen levels that fall before your period, you start to feel more stressed, as we've already covered. But more stress means higher levels of cortisol, the stress hormone.
"Cortisol rises to its highest levels in the middle of the night which interrupts our sleep," says Dr. Hall.
"Your doctor may prescribe Xanax or Valium if you suffer from anxiety during the time frame when you experience PMDD," says acupuncturist Kristen N. Burris. "Others prefer prescribing the time-tested drug Prozac or a newer drug for more intense mood disorders," says Pristiq. However, she notes, it's important to keep an eye on side effects like increased weight gain or decreased libido.
For women who would rather take natural supplements instead of prescription medication, Svetlana Kogan, MD, recommends specific herbs, ones that she has been recommending to patients with PMDD for the past twenty years. "Try taking brahmi guduchi, shatavari, and ashwagandha taken twice a day with food and in powdered form, mixed with organic ghee or smeared on bread or a cracker," she says.
Vitamins B6, magnesium (400mg), omega 3, and calcium (500mg) proved effective for Judi Goldstone, MD, who has experienced the disorder firsthand and tried a number of different ways to treat it.
"Ten years ago when I started getting worse and worse PMS I couldn't find any doctor to treat me holistically. At that time, my ob-gyn wanted to put me on birth control pills and antidepressants," she says. "I'd also recommend consuming more high-protein foods or complex carbs like green vegetables, sweet potatoes, or beans, and applying primrose oil in the evening."