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2 clues that your bad PMS is really PMDD

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UPDATED May 3, 2022 (originally published September 30, 2019)—Do bothersome symptoms (such as mood changes, difficulty sleeping and pain) appear on the days leading up to your period?

If so, they could be due to premenstrual syndrome (PMS), a cluster of symptoms that occur as a result of plunging estrogen and progesterone.

Or they could be due to premenstrual dysphoric disorder (PMDD), a medical condition that impacts approximately 8% of those with menstrual cycles and is believed to be due to an extra sensitivity to fluctuating hormones.

So, how can you tell if your pre-period symptoms are due to PMS or PMDD?

There are two big clues to look for: the intensity of your symptoms and the length of time your symptoms persist.

Here’s how it breaks down:

If you have premenstrual symptoms (such as sadness, irritability, aches, lousy sleep, tiredness) that are annoying, but do not interfere with everyday life and pop up primarily during the six days before your period, this is PMS. You could have mild, moderate or even severe symptoms of PMS. But, if you’re still pretty much going on with your life, you do not have suicidal thoughts or actions, and your pain/insomnia/mood issues are manageable, this is still PMS. Another clue: PMS symptoms can vary from cycle to cycle, and you may have PMS symptoms one cycle, but not the next.

If you have premenstrual symptoms that are intense (such as, but not limited to, depression, suicidal thoughts or thoughts of self-harm, uncontrollable anger, unbearable pain, insomnia and/or debilitating fatigue), these symptoms do interfere with everyday life and they impact you anywhere from the day after ovulation through the day before your period, then you likely have PMDD. Another clue: In those with PMDD, symptoms tend to crop up regularly every cycle.

While symptoms of PMS and PMDD can be lessened with stress-reducing techniques (such as yoga and meditation), exercise, a nutritious diet and good sleep, those with PMDD typically also require the support of a healthcare team. You may want to try prescription medicine, cognitive behavioral therapy, holistic treatments, nutritional supplements and/or other remedies. But, whatever you choose, it’s important to get health support to help manage this condition.

It’s equally important to get peer support from others challenged by PMDD. Please visit the following groups if you or a loved one has PMDD:

International Association for Premenstrual Disorders
Vicious Cycle

If you suspect someone has PMDD, but that person is unaware, please bring it up to that person and discuss it. Your talk could change their life.

Have a lousy menstrual week, too?

While research is currently ongoing to uncover if a subvariant of PMDD includes depression and anxiety during the first few days of your period, there may be an alternative explanation: low iron. Your level of iron dips as you shed menstrual blood. And research shows that a drop in iron that isn’t enough to officially make you anemic can still impact your mood, energy and more.1 For example, it can lead to sadness, anxiety, trouble sleeping, cravings and fogginess.

These effects from low iron are even greater in those with heavy periods since you’re shedding even more of this mineral.2

The reason that iron is so vital is that it helps create serotonin in the brain as well as deliver energizing oxygen throughout the cells in your body.

If you suspect a dip in iron during menstruation could be behind your symptoms after your period starts, ask your doctor if you can take iron supplements. The recommended daily dosage is 15 mg. for women ages 14 to 18 and 18 mg. for women ages 19 to 50.3 Or include more iron-rich foods in your meals, such as beans, tofu and lean protein. (Note: Avoid iron if you have an iron-metabolizing disorder, such as hemochromatosis.)

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Learn how the hormones in your menstrual cycle impact you every day in my book, 28 Days: What Your Cycle Reveals About Your Moods, Health & Potential

(1) Paul Vaucher, et al., “Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial”, Canadian Medical Association Journal, (2012): 1247-1254
(2) Pirkko Peuranpää, et al., “Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding,” Acta Obstetricia et Gynecologica Scandinavica, 93 (2014): 654-660


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