When is it more than a mood swing?
When is it Premenstrual Syndrome (PMS) and when is it something else? This is a question many menstruators have. Data from Harvard Medical School suggests that an approximate 5% of menstruators of childbearing age are diagnosed with Premenstrual Dysphoric Disorder (PMDD) annually. But if it is so common, why is it that we haven’t heard of it? Or if we have heard of it, why is it so controversial? Good questions!
PMDD has not been included in the past editions of the Diagnostic and Statistical Manual (DSM). The DSM, for those of you that don’t know, is a large book that acts as an encyclopedia of all currently diagnosable mental disorders. The DSM is used by medical and mental health professionals to diagnose conditions of the brain. For example, the DSM provides a standardized definition of depression, anxiety, and personality disorders.
Until the most recent edition of the DSM, the DSM-5, PMDD had been categorized under “depressive disorders not otherwise specified”. This essentially meant that it was something that professionals knew occurred, but were unable to acknowledge it with a formal diagnosis. There are many theories as to why PMDD has gone so long without a formal diagnosis, but most pervasive is the opinion that pathologizing menstruation is sexist. In other words, thinking about the negative side-effects and conditions associated with menstruation stigmatizes those that menstruate (in many cases, women). By suggesting that there is something medically wrong with mood swings, depression, and other symptoms associated with PMS and PMDD says that the natural way that menstruators behave is somehow unhealthy.
Historically, well before PMDD became an official diagnosis, the manifestations of PMDD were often stigmatized as “hysteria” and other gendered diagnoses. Nowadays, many folks see PMDD as a significant and life-changing condition that can affect any menstruator.
There is still, however, not a continuous or ongoing dialogue about PMDD. It often goes undiagnosed, or misdiagnosed as the more benign PMS. So what is PMS anyway? Generally speaking, PMS is a series of symptoms that occur before a person begins menstruating. It is brought on by hormones and can be self-diagnosed. The most common symptoms of PMS reported by menstruators are physical and include cramping, bloating, and irritability. PMS, or some symptoms of PMS, affect as many as 75% of menstruators according to the Mayo Clinic. But how is it different from PMDD?
PMDD occurs much less frequently, affecting an estimated 3 to 8% of the menstruating population according to the American Psychological Association. Symptoms are often more mental and emotional, and include significant changes in appetite, sleep, and depression. PMDD is not the same as depression or major depressive disorder, nor is an exacerbation of another mental health condition. It occurs independently of other conditions, and symptoms are present after ovulation until menstruation begins.
So how can a person know for sure whether their symptoms can be attributed to PMS or PMDD? We can’t answer that question for everyone, but for most, it will be determined by a marked severity. Most folks will be able to determine if their symptoms are a mere nuisance, or if they are so severe that they take over one’s life. If you’re still not sure? Ask yourself these questions: Do my symptoms affect my daily activities? Are there things I am not getting done or missing out on because of my symptoms? Am I (pretty much) able to lead my regular/preferred life?
If you have further questions about symptoms of PMS versus PMDD, speak with a doctor or medical professional. They may be able to help you find treatment and alleviate any suffering you may be experiencing.
Though many still believe that PMDD is not real (or a mere exaggeration of normal menstrual symptoms), we at PERIOD believe that it is real if it feels real. There is no reason that we can think of for a menstruator to suffer through something to prove a point. We must support each other to destigmatize mental health and menstrual health. The most important thing isn’t the title of the disorder or the diagnosis in the book, but rather, the alleviation of any suffering that interferes with happiness and the ability to live one’s life. You deserve to feel good! There should be no reason for a person to suffer in the name of “womanhood” (Or whatever that means…).
Take care of yourselves! Happy periods!
Until next time,
PERIOD.
Author: Ruth Sheldon, Health Educator
Reviewer: Dr. Namrata Mastey, MD, OB/GYN
The information provided here is intended as a generalized overview of period health and does not substitute for medical advice. The content of this article is part of a separate campaign called Ask Me About Periods. It is not a product of The Rag. To learn more about Ask Me About Periods, please visit www.period.org/chapters. If you have questions about Ask Me About Periods, please email eira@period.org
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