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PMS squared: what is PMS and how to deal with it?
PMS squared: what is PMS and how to deal with it?

PMS is an unpleasant period for many women, especially if it is accompanied by mood swings, pains, including headaches, and a desire for everything to end as soon as possible. But some are even less fortunate - and they find premenstrual dysphoric disorder (PDS). What is it and what is the threat? Specialists - a gynecologist and a psychiatrist - answer.

PMS squared: what is PMS and how to deal with it?
PMS squared: what is PMS and how to deal with it?

PMS is an extreme version of PMS with symptoms similar to those of clinical depression. It is also tied to the menstrual cycle, but strongly affects school, work, personal life, and overall ability to function normally for a week or two before menstruation.

What causes PDS?

Like many disorders associated with women's health, PDS is not yet well understood. The most popular theory is the connection with hormonal surges in the menstrual cycle. Changes in hormone levels affect the production of serotonin, which helps regulate physical and emotional well-being. The hormones produced by the ovaries affect the functioning of the brain, or rather, the pituitary gland and hypothalamus, which are responsible for mood. Experts emphasize that a woman with PDS does not necessarily have very high or low hormone levels or any ovarian problems. It's about how sensitive the body is to hormonal fluctuations.


A recent study showed that 3-8% of menstruating women meet the diagnostic criteria for PDS. For the first time this diagnosis was made in the United States in 2013, which allowed women to more accurately and clearly explain why they need sick leave. Research is ongoing.

To receive this diagnosis, rather than “normal” PMS, a woman must have severe mood swings along with a strong effect on her ability to function normally. So, anxiety, a feeling of loneliness, problems with concentration, appetite, sleep, digestion, and so on are often present.

PDS and depression

The symptoms of these ailments are similar. PDS is more difficult to diagnose because it is similar to many mental disorders, in particular depression and anxiety. An important difference from them: the PDS is rigidly tied to the menstrual cycle, and does not constantly bother.

Doctors look at symptoms that occur during ovulation (around the 14th day of the cycle) and go away when the critical days begin. To do this, patients record their symptoms in real time or retrospectively. If symptoms are present all the time, but the condition worsens before menstruation, the specialist will more likely indicate depression or panic disorder in the diagnosis than PDS. There will also be questions about family medical history and changes in contraception to dismiss other causes.

PDS treatment

As with depression, antidepressants are often prescribed for PDS, but they will need to be taken on certain days of the cycle. At the same time, they begin to act faster than with a permanent mental disorder - after 1-2 days. This effect is apparently due to the fact that antidepressants can interfere with hormones and prevent them from suppressing mood. In addition, oral contraceptives containing drospirenone (a synthetic version of progesterone) may be prescribed. Other recommendations may include quitting smoking and alcohol, and reducing caffeine and sugar intake.

In any case, you do not need to cope with the PDS yourself. Contact your doctor for the correct treatment regimen!

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