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Premenstrual syndrome (PMS) encompasses a range of potential physical and emotional symptoms in the weeks leading up to menses (the period).

Some females are more likely to experience physical symptoms, whereas others may be likelier to experience emotional or mental issues, including some that may resemble the symptoms of depression.

According to the Office on Woman’s Health, around 90% of females report experiencing some symptoms of PMS, which can include:

However, around 5–10% of females develop premenstrual dysphoric disorder (PMDD). PMDD is a severe form of PMS in which there is a greater likelihood of experiencing mood disturbances that can affect personal relationships.

PMDD often comes with symptoms similar to those of clinical depression or anxiety. Read on to learn more about these symptoms, as well as the causes of PMDD, some treatment options, and how to differentiate between PMS, pregnancy, and depression.

PMDD is a more severe form of PMS. Though someone may still experience bloating and other physical symptoms of PMS, if they have PMDD, the emotional and mental symptoms are much more severe and can cause additional symptoms of clinical depression or anxiety.

Someone experiencing PMDD may have one or more of the following symptoms:

  • shifts in mood
  • irritability
  • depressed mood
  • anxiety

They may also experience:

  • hopelessness, feelings of worthlessness, or sadness
  • mood shifts, with frequent tearfulness
  • persistent anger or irritability
  • decreased interest in their normal activities
  • tension or anxiety
  • feeling overwhelmed or out of control
  • trouble concentrating
  • fatigue, a lack of energy, or lethargy
  • excessive sleeping or difficulty sleeping
  • over or undereating
  • headaches
  • swelling and tenderness in the breasts
  • weight gain
  • joint or muscle pain

One of the key differences between PMDD and clinical depression is that PMDD occurs at a specific time of the month. Symptoms will typically start 1–2 weeks before a period and end when the period begins. In the other weeks of the cycle, there are usually no symptoms of PMDD at all.

Females with an underlying mental health condition, such as depression or anxiety, may experience some symptom relief during certain parts of the menstrual cycle. This can cause some to believe that they have PMDD when they are actually experiencing clinical depression, anxiety, or similar mental health conditions.

They can speak to their doctor if they experience any symptoms of depression that affect their interactions with others or their ability to engage in their usual activities.

Although health professionals do not yet know the exact cause of PMDD, the consensus is that symptoms develop as a result of hormonal fluctuations due to the natural menstrual cycle. Fluctuating levels of estrogen and progesterone may affect chemicals in the brain, including serotonin, which affects mood.

However, this is not likely the only cause. Females who experience PMS or PMDD have similar estrogen and progesterone levels as those who do not. The most likely explanation is that those who experience PMDD are more susceptible to such hormone fluctuations.

Anyone experiencing symptoms of depression or anxiety that seem to come and go with the menstrual cycle should talk to a doctor or other healthcare provider.

A doctor can diagnose PMDD by discussing the symptoms and finding out when they occur.

To receive a diagnosis of PMDD, in general, females must:

  • display both physical and emotional symptoms that are typical of PMS or PMDD
  • only experience symptoms during the premenstrual portion of the cycle
  • see symptom relief for at least a few days to weeks of the cycle

Often, a doctor will suggest keeping track of various symptoms over the course of a month. The recorded information can help them understand whether the symptoms are due to PMDD, clinical depression, or something else.

A conservative treatment plan for PMDD generally consists of at-home remedies. These can include:

  • consistent exercise
  • vitamin and mineral supplements
  • relaxation therapy

If these remedies do not have the desired effect, a doctor may suggest additional treatment options, including medication. They may prescribe one of the following:

  • Selective serotonin reuptake inhibitors: These are effective in treating the emotional symptoms of PMDD and PMS. Examples include Zoloft and Prozac.
  • Birth control pills: Some females find symptom relief when using birth control pills, whereas others may find that their symptoms increase.
  • Gonadotropin-releasing hormone agonists: These medications can temporarily prevent the ovaries from making progesterone or estrogen.

Some dietary supplements — such as fatty acids, essential oils, and ginkgo biloba — might also provide relief from the symptoms of PMDD. However, more research is needed to determine their efficacy for this purpose.

One study also found that calcium supplementation can be an effective treatment for conditions such as depression and anxiety during PMS.

Read more about nondairy calcium-rich foods here.

It is important to speak with a doctor before trying any of these, however, as some can have interactions with other medications.

Calcium supplements are available for purchase online.

It can sometimes be difficult to tell the difference between the symptoms of PMS, depression, and early pregnancy. Mood shifts, irritability, and several other symptoms can all occur in all three conditions.

Often, the only way to detect pregnancy for sure is to take a pregnancy test after missing a period. It is possible to do this at home, but it is better to see a doctor to confirm the results.

One of the indicators of PMDD is that symptoms completely clear during certain parts of the menstrual cycle. This means that there should be at least a few days during each cycle when there is complete relief from symptoms.

By contrast, if someone is experiencing depression, the symptoms may heighten during PMS but will not fully go away during the other portions of the cycle.

If unsure or concerned about the symptoms, it is best to speak with a doctor or healthcare provider. They will be able to determine whether the symptoms are signs of early pregnancy, PMDD, or clinical depression.

Learn more about the differences between the symptoms of PMS and pregnancy here.

PMS can cause symptoms similar to those of depression. Some may even interfere with normal daily life. It is best to speak with a doctor or healthcare provider if someone experiences any symptoms of depression that seem to come and go throughout the normal menstrual cycle.

Also, try to record any symptoms that develop during the month. Knowing this can help doctors determine whether or not there is a link between the symptoms and the menstrual cycle.

There are some lifestyle changes that might help, such as getting more exercise, and certain medications can also help improve the symptoms.

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