Self-Diagnosis: Is It PMS or PMDD?
What causes severe PMS? What's the point in diagnosing?
“I think I have Premenstrual Dysphoric Disorder,” I wrote in my journal after Googling my symptoms.
Back in late 2020, I had a feeling my PMS was a little different than your typical monthly moodiness. Even as a teen & into my twenties, mood swings had been the norm for me. It’s one of the big reasons I went on hormonal birth control for several years. PMS used to be several days of feeling emotionally out of control or shutting down and bed rotting. I would be sensitive as a sunburn and then withdraw completely from my loved ones.
While most women commiserate about this emotional rollercoaster, PMS significantly impacted my quality of life (one of the telltale signs of PMDD). All of my progress towards goals were put on pause for several days each month. My moods created tension in the house as my partner basically walked on eggshells around me. I could barely function for days on end, and wouldn’t find relief until my period began (another sign of PMDD). PMS was stealing my life.
What’s the point in a diagnosis?
For months I had been wondering: Do I have bipolar? Cyclical depression? Why do I feel great for two weeks & then suddenly become a shell of a person prior to my period?
I spoke with my doctor in fall of 2020 & basically told him “I think I have PMDD”. I was immediately prescribed an antidepressant and sent on my merry way. Turns out SSRI’s wasn’t the right treatment option for me. Nevertheless, I was informally diagnosed by simply self-reporting my symptoms to my practitioner.
A diagnosis is helpful because it points you to treatment options, such as:
If your symptoms are particularly debilitating — seeking a formal diagnosis with a psychiatrist, gynecologist and general practitioner might be the best option. This could provide you with adjustments at school or work, if needed. Basically, if having a doctor confirm PMDD makes you feel seen, heard & validated — this can be extremely helpful in the road to recovery. Even if severe PMS has become your “normal”, you deserve to have a higher quality of life. Period.
Can I self-diagnose PMDD?
You most definitely can! You’ll want to track your symptoms for at least 2-3 months. And if you’ve already been doing that, then you’re ahead of the game! Make sure your notes are detailed and taken on a consistent basis — you want to avoid recall bias with this type of diagnosis. Below you’ll find a breakdown of Premenstrual Syndrome, Premenstrual Dysphoric Disorder and PMS/PMDD. MY GENERAL RULE OF THUMB IS THIS:
A healthy cycle will experience a mild shift in mood, energy & physical symptoms like bloating and breast tenderness for 1-2 days prior to your period. This is the body’s natural reaction to hormones dropping prior to menstruation.
Any symptoms that are moderate to severe (& impact your ability to function) for 3-18 days prior to your period… is a problem. If you’re even wondering whether your symptoms are normal or not — they probably aren’t. The women who don’t have PMS (& yes, they’re out there!), aren’t wondering whether they have PMS or PMDD. The only reason you’re still reading this article is because you want validation that your premenstrual experience sucks. Deep down you know it shouldn’t, but it’s hard to know because the media portrays PMS as a rather miserable time.
PMS may be common, but it’s not normal.
What causes PMDD?
There are theories that PMDD is due to issues in the brain (HPA-axis, allopregnanolone, GABA or serotonin). Many times when seeking a PMDD diagnosis, your gynecologist &/or practitioner will want to rule out low iron or hypothyroidism with some blood tests. I would hate for you to jump to hormonal birth control / SSRI’s and bandaid a deeper issue going on.
If you’re only experiencing symptoms of anxiety & depression during the luteal phase (anytime from ovulation to your period), then the issue could be progesterone. BUTTTT when I treated my hormone imbalance, I STILL struggled with difficult PMS. This is the case with most of my clients. You could focus on balancing your estrogen & progesterone levels and STILL feel moody before your period, like I did.
So what gives? Perhaps estrogen & progesterone creates more of an energetic, somatic or spiritual experience than we give it credit for. Take a look at the graphs below to see what you think.
Premenstrual Syndrome:
A moderate symptom experience that impacts about 80% of women. These symptoms of hormone imbalance are typically downplayed or even joked about. You notice the onset of symptoms a week or so before your period, and are particularly intense 1-2 days before your period. PMS includes symptoms of irritability, mood swings, trouble sleeping or sleeping too much, trouble concentrating, and/or depression. As well as headaches, breast tenderness, weight gain, acne and/or body aches.
Premenstrual Dysphoric Disorder:
A DSM-V Diagnosis that has one or more of the following:
irritability, anger or increased interpersonal conflicts
depressed mood, feeling hopeless or self-deprecating thoughts
anxiety, tension and/or feeling on-edge
mood swings, feeling suddenly sad or tearful, increased sensitivity to rejection
AND one or more of the following must ALSO be present:
decreased interest in usual activities (work, school, friends, hobbies)
difficulty focusing or concentrating
lethargic, fatigued or lack of energy
change in appetite, overeating or specific food cravings
insomnia or sleeping too much
a sense of being overwhelmed or out of control
physical symptoms like breast tenderness, joint or muscle pain, bloating or weight gain
PMS/PMDD (somewhere in-between):
A category of women who resonate with a PMDD diagnosis BUT:
your symptoms interfere with your life yet you still manage to “get by” & survive each month
something stops you from taking action with investing the time to get a formal diagnosis
your rationalize PMS as mainly due to stress or just patterns of anxiety & depression that you’ve endured for most of your life
somewhere deep down you wonder if PMS is revealing unhealed trauma wounds & providing you an opportunity to courageously process tough emotions
Remember, PMS doesn’t CAUSE emotions but it will exacerbate what is already there.
Many of the women I work with also struggle with ADHD-like symptoms or have a history of anxiety and depression. They tend to be perfectionistic or are a Highly Sensitive Person. The hardest part about PMS for them is the fact that they are ambitious go-getters who feel shame and guilt when their potential is derailed every month. PMS bruises their self-confidence, pauses momentum and impacts the quality of their relationships.
If this resonates, I have a variety of resources + courses where you can learn more.
Thanks for reading!
Mary Nordahl