Research Shows That Your Intense PMS Might Not Be PMS After All

Nobody enjoys having their period, but it's important to draw the line between normal and abnormal menstrual symptoms. Here's how to tell if you might have 'PMDD.'

By Mark Travers, Ph.D. | February 15, 2024

In a world where conversations about women's health are gaining momentum, the spectrum of premenstrual experiences still remains shrouded in secrecy. While statistics show 90% of women grapple with common premenstrual symptoms, up to 8% endure a hidden struggle with premenstrual dysphoric disorder. Often, these women unknowingly suffer beyond what is deemed normal.

As our society strives for gender equality, the openness around women's health is expanding. Yet, topics like gynecological health and menstruation continue to be veiled in societal taboo. Because of this, the silent battles fought by women facing severe menstrual challenges persist, unnoticed and unspoken.

Unraveling the science that shrouds menstruation is crucial, especially when it comes to identifying abnormalities. In this context, psychological research unveils pathways to distinguish between normal and abnormal menstrual experiences–offering a beacon of hope for identification and effective treatment.

The Difference Between PMS and PMDD

Both before and during menstruation, it is common to experience a few unpleasant symptoms, physically and psychologically. However, research outlines that there is a clear line between healthy and normal menstrual symptoms, premenstrual syndrome and premenstrual dysphoric disorder.

The authors explain that a vast majority of women will experience at least one psychological or physical symptom before the onset of menstruation. These include mood swings, bloating, acne and changes in appetite and sex drive. However, most women do not report that these symptoms affect their daily functioning.

When dysfunction becomes apparent, there is indication of a premenstrual disorder. Between 20% and 40% of women globally experience premenstrual syndrome, which is comprised of experiencing at least one of the following emotional and somatic symptoms:

• Emotional symptoms of premenstrual syndrome. Angry outbursts, anxiety, confusion, depression, irritability, social withdrawal.
• Somatic symptoms of premenstrual syndrome. Abdominal bloating, breast tenderness, headache, joint/muscle pain, swelling of extremities, weight gain.

However, premenstrual dysphoric disorder transcends these symptoms, leaving women in a far more severe state of distress and impairment. It manifests as an extreme form of PMS, disrupting not only emotional and physical well-being, but also interfering significantly with daily functioning and interpersonal relationships.

According to the authors, women with premenstrual dysphoric disorder will experience at least five of the following symptoms in an extreme manner in the week before menstruation, subsiding thereafter:

• Marked changes in emotions (e.g. mood swings; feeling tearful or sad; increased sensitivity)
• Marked irritability or anger, or increased interpersonal conflicts
• Marked depressed mood, hopelessness or self-deprecating thoughts
• Marked anxiety, tension or feelings of being on edge
• Decreased interest in usual activities
• Subjective difficulty concentrating
• Lethargy, fatigue or lack of energy
• Marked change in appetite, overeating or food cravings
• Insomnia or hypersomnia
• A sense of overwhelm or feeling out of control
• Physical symptoms (e.g. breast tenderness, swelling, pain, bloating, weight gain)

How To Tell If You Have PMDD

Diagnosing premenstrual dysphoric disorder poses a considerable challenge due to the prevalence of common premenstrual syndromes, as well as the overlap these symptoms have with other conditions.

Doctors and psychologists have worked together to outline specific criteria to differentiate premenstrual dysphoric disorder from other disorders. However, despite these guidelines, the subjective nature of these symptoms to each woman often leads to misinterpretation.

In light of the struggles in diagnosing premenstrual dysphoric disorder, research from the Archives of Women's Mental Health offers a Daily Record of Severity of Problems Scale—a self-report measure that allows women to record their premenstrual symptoms. By providing a daily log of symptoms over multiple cycles, the tool allows clinicians to discern whether a woman suffers from PMDD, PMS or other conditions.

To use the tool, women report on each of the following symptoms regarding how severe their experience of each was on a scale from "not at all" (1) to "extreme" (5):

1. Felt depressed or sad.
2. Felt hopeless.
3. Felt worthless or guilty.
4. Felt anxious or tense.
5. Had mood swings.
6. Feelings were more easily hurt.
7. Felt angry or irritable.
8. Had conflicts with people.
9. Had less interest in activities.
10. Had trouble concentrating.
11. Felt tired or lacked energy.
12. Had increased appetite.
13. Had food cravings.
14. Slept more or had trouble waking up.
15. Had trouble getting to sleep or staying asleep.
16. Felt overwhelmed.
17. Felt out of control.
18. Had breast tenderness.
19. Had breast swelling or weight gain, or felt bloated.
20. Had headache.
21. Had joint or muscle pain.
22. At least one of the problems noted above caused reduced productivity at work, school or home.
23. At least one of the problems noted above interfered with hobbies or social activities.
24. At least one of the problems noted above interfered with relationships with others.

Research published in Women and Therapy shows that menstruation has been pathologized for centuries, with societal attitudes often framing it as an inherent burden associated with "what it means to be a woman." The prevailing notion has been one of resignation; this historical perspective has contributed to a normalization of menstrual suffering, wherein women have been conditioned to accept the physical and emotional toll as an inevitable aspect of their lives.

Women, conditioned to believe that their experiences are a universal norm, endure menstrual challenges without questioning the impact on their overall well-being. However, contemporary psychological research and tools like the Daily Record of Severity of Problems mark a pivotal shift in this narrative, offering a transformative perspective.

If you'd like to use the Daily Record of Severity of Problems and receive your results, click here: Daily Record of Severity of Problems

A similar version of this article can also be found on Forbes.com, here.