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At least 75 percent of women with regular menstrual cycles experience unpleasant physical and emotional changes around the time of their period. For most women, these symptoms are mild and tolerable; for many others, these symptoms can be disabling and may cause significant disruption in their lives.

Premenstrual syndrome

Premenstrual syndrome (PMS) is a broad term that typically refers to a general pattern of physical, emotional and behavioral symptoms occurring one to two weeks before your period begins. PMS is common, affecting 30 to 80 percent of women of reproductive age. The most common physical symptoms include abdominal bloating, headaches, muscle and joint pain, and breast tenderness. The behavioral symptoms most commonly observed in women with PMS are fatigue, forgetfulness, poor concentration, and mild mood changes – including irritability and depressed feelings.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome affecting 3 to 8 percent of women in their reproductive years. In contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance. The most common symptom is irritability; however, many women also report depressed feelings, anxiety or mood swings. These symptoms also occur one to two weeks prior to your period and usually resolve completely by the time your period starts. By definition, this mood disturbance results in severe social or occupational impairment.

PMDD is a psychiatric diagnosis that typically emerges in women in their 20s and may worsen over time; it has been observed that some women may experience worsening premenstrual symptoms as they enter into menopause. Risk factors for PMDD include psychiatric history of a mood or anxiety disorder, family history, stress and age (typically late 20s to mid 30s).


Depression or anxiety disorders can worsen during the premenstrual period and may mimic PMDD. Medical illnesses such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome and migraine disorder can also have similar symptoms to PMDD.

Our recommendation is to keep a monthly mood chart – this can be informative and even therapeutic for many women. In addition to helping with the diagnosis, many women feel better if they can identify the relationship between their cycles and mood and also anticipate days that they may be at risk for mood changes. Lifestyle changes such as decreasing alcohol, nicotine, caffeine, sugar and sodium can help. Also, getting adequate exercise and sleep can be beneficial to managing PMDD.

If you are concerned about PMDD, you don’t have to suffer through it alone. Talk to your Novant Health doctor to find out how to manage your symptoms.