September 23, 2021

PMS & PMDD 101

Many people who menstruate will experience symptoms at some point in their life, but they are often mild and do not recur every single month. Many of these are normal and to be expected. For example, as the uterus contracts to expel its lining each month, many people will feel a cramping sensation. Temporary normal symptoms often are not a cause for concern. But when they are severe or persistent, they can pose a legitimate problem.

PMS, or premenstrual syndrome, is the name given to a group of symptoms that occur cyclically with a menstrual cycle. They can be physical, psychological, or a combination of both. In addition to occurring right before menstruation, the symptoms go away within a few days of your period. PMDD, or premenstrual dysphoric disorder, is a more severe group of symptoms that significantly impact daily life. While PMDD symptoms can be both physical and psychological as well, PMDD responds excellently to medications that promote the neurotransmitter serotonin.

Unfortunately, research on menstruation is historically underfunded and underperformed. That translates to a limited number of verified and valid treatment options and leaves the door open for unregulated supplement and influencer industries to prey on vulnerable people.

The good news is regardless of symptom severity, there are options and legitimate treatments to help you feel better and live your best life.

PMS & PMDD

Though some symptoms associated with menstruation are normal and expected, when they begin to interfere with your daily life it is time to check in with your doctor. There are two disorders that you may be experiencing.

PMS, or premenstrual syndrome, is defined as cyclical symptoms that occur before the start of, and end shortly after, menstruation begins. They have an impact on a person’s life and can be emotional, physical, or both. The American College of Obstetricians and Gynecologists states that for symptoms to be considered PMS they must:

  • start in the 5 days leading up to a period, for 3 or more cycles in a row
  • end within 4 days of the period starting
  • interfere with aspects of your daily life

While many people have premenstrual or menstrual symptoms, only about 3-8% of menstruators are thought to have significant PMS. PMS has been seen all over the world in many different communities and cultures at similar rates.

The most common symptoms of PMS are:

  • bloating
  • back pain
  • breast tenderness
  • cramps
  • irritability

PMDD, or premenstrual dysphoric disorder, is less common, affecting about 2% of people who menstruate. The diagnosis of PMDD is made based on criteria from the Diagnostic and Statistical Manual 5 (DSM-5). The diagnosis requires a total of five symptoms that occur with most cycles over the year, ranging from sleep changes and mood swings to appetite changes and anger. The most common symptom people with PMDD experience is irritability.

PMS can mimic other disorders, so it’s important to talk to your doctor to make sure there isn’t another underlying problem. For example, problems with your thyroid, untreated or undertreated anxiety and depression, and IBS may present similarly to PMS. Some people have migraines or seizures that also can occur with their menstrual cycle, so it is important to get those symptoms checked and treated.

For many years, women were excluded from clinical trials. There were many political reasons for this, and one was a concern that women could become pregnant during clinical trials. Women were less likely to work in science and medicine, so their voices were not heard. Unfortunately, this means women were excluded from important studies about drugs and their reactions, which have proven to be different amongst the sexes. In addition to resulting in various reactions and adverse events in women, this translated to an overall lack of research on women. Historically, funding is higher for males and their unique problems-ever noticed there is still not a female Viagra? In the late 80s, the National Institute of Health recommended including women in research trials, but it wasn’t until the early 90s that this was signed into law. Now, research trials are required to be equitable across gender and race. While this is promising, there is still ground to make up and important areas of women’s health that still need to be rigorously studied.

PMS is likely multifactorial and influenced by your genes, your environment, and your own hormones. Current research suggests serotonin and GABA are two neurotransmitters likely involved in causing symptoms of PMS. Unfortunately, there is no good way to test for this by bloodwork or scans, so more research is needed before we know exactly what causes PMS, and then maybe we can come up with a better way of diagnosing it.

Tips to help you feel better

Regardless of your symptom severity or frequency, there are things you can do to feel better.

First things first-track your symptoms. Both PMS and PMDD rely on an accurate clinical picture, and your doctor will want to know all about your symptoms. The Emme App keeps track of your pill (if you take one), your flow (if you have one), physical symptoms (gas, bloating, acne, headaches, etc.), your sex drive, and your mood. This way you can expertly coordinate exactly what symptoms happen when and for how long. It is also a great way to get to know your body and what is normal for you. Everyone is different, so once you start tracking your symptoms you’ll recognize right away if something is off from your normal.

Many people have suggested dietary supplements or changes to help with menstrual symptoms. The only herb that has been shown to possibly be somewhat effective for mild symptoms is chasteberry. Things like vitamins B6 and E, magnesium, and calcium are often recommended. Unfortunately, studies have shown these to all be ineffective, and higher doses of these supplements may actually cause serious health problems like kidney stones and nerve damage. If you’re still interested, ask your doctor if you are getting enough of these nutrients in your diet or if you may benefit from a supplement.

Relaxation techniques, as well as exercise, may be helpful for symptoms. They are recommended in general for a healthy life, and preliminary research shows they may also be helpful for PMS. The American College of Obstetricians and Gynecologists recommends aerobic exercise for at least 30min on most days. In addition to yoga, meditation, and other traditional relaxation techniques, don’t forget to get enough sleep!

When in doubt-pay a visit to a doctor. It is normal to have mild symptoms from time to time, but it is not normal to have severe symptoms that significantly interfere with your daily life each month. If you’re having symptoms, get checked.

PMDD responds well to the drug class selective serotonin reuptake inhibitors or SSRIs. These drugs help the neurotransmitter serotonin that your body produces stay around long enough without getting degraded. There are many options of what pill and how you take it-some people take them just when they get symptoms, just for the second half of their menstrual cycle, or every day.

Both PMS and PMDD are often treated with hormonal therapy, frequently combined oral contraceptive pills or OCPs. These work double duty by alleviating symptoms and providing contraception. The Emme smart case can help track your pill and correlate it to your symptoms so you never have to worry about remembering to keep track!

Takeaways

  • While some symptoms are common, PMS and PMDD are real conditions that can negatively impact your life if left untreated. Go to your doctor if your symptoms persist-you are your body’s best advocate.
  • Know your body. Tracking your symptoms will help you learn what is your own personal normal, and know when anything changes.
  • Support your body to be as healthy as possible-exercise, eat well and sleep!
  • There are many pharmacologic options, and birth control pills may be an easy and affordable option to help—check with your doctor to see if they are right for you.

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