Q: I recently heard about a condition called premenstrual dysphoric disorder (PMDD). How does this differ from premenstrual syndrome (PMS)?
A: The difference between PMS and PMDD is a matter of definition. Think of them as two different areas on a spectrum.
menstrual cycle. Symptoms usually start in the last week before the onset of a period. They diminish over the first few days of menstrual flow. Symptoms are minimal or absent after a woman's period.
Premenstrual syndrome (PMS) is a popular term rather than an official diagnosis. A woman usually has mood changes (feeling depressed, tearful, emotional, anxious or irritable). She can have low energy or poor concentration. Physical symptoms include breast tenderness, headache, joint pain or bloating.
Up to 80 percent of women may notice symptoms with their menstrual cycle. The intensity varies.
Premenstrual dysphoric disorder (PMDD) is a diagnosis with specific criteria. It is on the severe end of the spectrum.
In PMDD, symptoms cause marked distress or impair functioning. A woman has significant depression or anxiety during most cycles. She has multiple physical symptoms. It affects roughly 3 percent and 5 percent of women.
The distinctions between PMS and PMDD are mostly in intensity of the symptoms. There is no clear dividing line between the two categories.
There are many effective treatments to try. Approaches include lifestyle changes, hormonal adjustments, psychotherapy and medicines.
By the way, the word dysphoria means feeling bad or uncomfortable. No matter the label, if you feel bad or uncomfortable, it will probably be helpful to talk to your doctor about getting relief.
(Michael Craig Miller, M.D., is an Assistant Professor of Psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center, Boston, Mass. He is a Senior Medical Editor at Harvard Health Publications.)
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