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Contributed Photo / Phyllis Miller, M.D.

Q: What is the difference between PMS and PMDD?

A: The two conditions have similar symptoms and are both related to women's menstrual cycle, but premenstrual dysphoric disorder (PMDD) symptoms are much more severe than PMS (premenstrual syndrome symptoms) and can last longer. PMDD symptoms typically begin up to 10 days before a woman begins her period. It's thought that PMDD may occur as serotonin levels fluctuate during the menstrual cycle, but more research is needed on PMDD. PMDD symptoms can include depression, irritability, extreme mood changes, hopelessness, anxiety and tension, to name a few.

While PMS and PMDD share symptoms, in women with PMDD, they are usually more serious and obvious. In many cases, the mood-related symptoms can be intense enough to disrupt work and cause difficulties in relationships. Of the two conditions, PMS is far more common, while PMDD occurs in about 5% of menstruating women.

Treatment for PMDD may be aimed at preventing symptoms or managing symptoms. Whichever treatment plan is decided upon, a patient will have to work with her physician to find the right way to manage the condition. Some treatment options include SSRI antidepressants, birth control pills, nutritional supplements and lifestyle changes. Finding the treatment that works best for you may take a while, but PMDD can be managed.

It is important to distinguish PMS and PMDD from an underlying depression that may be worsened premenstrually but is present throughout the cycle. PMS and PMDD resolve with the onset of menses.

— Phyllis Miller, M.D., Erlanger Women's Health

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