How to tell the difference between PMS and Premenstrual Dysphoric Disorder (PMDD)

A lot of jokes are made about temper and mood swings around ‘that time of the month’.

But PMS, or premenstrual syndrome, is no laughing matter.

A shift in hormones in the lead-up to menstruation can cause undesirable emotional and physical symptoms, ranging from mild sadness to raging aggression, known as premenstrual dysphoric disorder (PMDD).

Sadly, millions of people suffer with these symptoms each month, often thinking they have no choice but to live with it.

Severe PMS and PMDD can wreak havoc on work commitments, relationships, social activities, and self-esteem. But there are natural ways to take back control of your hormones and restore harmony to your monthly cycle.

PMS and PMDD explained

About 80 percent of menstruating people experience PMS - the collective term given to a range of symptoms in the luteal, or premenstrual phase, but only about half of them seek support. These symptoms typically begin 5 to 10 days before menstruation and taper off once the bleed begins. People with PMS often report feeling tired, grumpy, short-tempered, frustrated, emotional, sensitive, quick to cry, and ‘not themselves’.

But the symptoms of PMDD are more severe, and more likely to include episodes of irrational rage, fighting with loved ones, being unable to concentrate, feelings of hopelessness, suicidal thoughts, and being too tired or unmotivated to even get out of bed. It’s estimated that up to 10 percent of menstruating people experience PMDD and 30 percent of them will attempt suicide in their lifetime. Various factors can contribute to the development and expression of PMS and PMDD, linked to a surge in oestrogen and progesterone levels which increase in the luteal phase to prepare the uterus for potential implantation and pregnancy. Signs and Symptoms of PMS

Tension or anxiety

Depressed mood

Crying spells

Mood swings and irritability

Appetite changes and food cravings

Trouble falling asleep (insomnia)

Social withdrawal

Change in libido

Joint or muscle pain


Weight gain related to fluid retention

Signs and Symptoms of PMDD

Sudden rage, often unexplained or irrational

Depressive, suicidal thoughts, self-harm

Highly sensitive


Excessive crying, crying for no reason

Strong feelings of overwhelm

Fear of rejection and judgment, paranoia

Difficulty concentrating

Brain fog

Common and conventional PMS treatments

PMS has become so common in western society that it is considered ‘normal’ by many, and is likely to go untreated. If conventional medicine practitioners are approached for treatment of PMS or PMDD, they are likely to offer a couple of options- the oral contraceptive pill, or antidepressants taken for two weeks before the menstrual bleed. Both of these treatment options carry side effects that may outweigh the benefits for some, and fail to address the root causes of the conditions. As a result, when hormonal intervention such as the contraceptive pill is ceased, the symptoms return. Hormonal contraception can also stunt reproductive development from the onset of commencement, which may cause long-lasting issues, especially when the pill is taken from a young age.

Causes of PMS and contributing factors.

Although no single cause of PMS has been established, hormonal fluctuations that occur during the week or two before the period contribute to the symptoms.

We can see from the data that heightened inflammation in the body also plays a role in premenstrual symptom severity, as some studies have found increased levels of high-sensitivity C-reactive protein in individuals with PMS.

Other factors that can contribute to PMS are:

Poor nutrition

Lack of exercise and activity

Environmental toxins


Poor sleeping habits

PMDD appears to be linked to a heightened sensitivity to the hormones oestrogen and progesterone as well as a genetic link.

The Integrative Nutrition Clinic Approach to PMS

At the clinic our practitioners use functional testing to assess hormone and inflammation levels and investigate imbalances during the lead up to the menstrual period.

The signs they are looking for include:

High oestrogen

Low progesterone

Decreased serotonin

Increased prolactin

Low endorphins

Increased inflammation

Electrolyte imbalance

Our practitioners will then provide a tailored treatment plan addressing each of these factors, which may include:

Reducing inflammation: Anti-inflammatory foods, herbs and supplements have been found to provide relief from some PMS symptoms, including tumeric, omega 3, probiotics, and foods rich in healthy fats like fish, healthy fats (avocado oil, EVO and coconut oil) nuts and seeds.

Support hormone balance: Food-based nutritional supplements such as cruciferous veg, broccoli sprouts can support oestrogen detoxification pathways in the liver, while supplements like DIM can also be very helpful to clear oestrogen in the body.

Tracking symptoms: Tracking symptoms and how they change throughout the cycle can be very valuable for the treating practitioner in determining the best approach.

Reduce histamine: Avoiding and eliminating allergens and aggravating foods like alcohol, dairy and caffeine may help to reduce mast cell activation symptoms in PMS and PMDD.

Nutritional therapy: Vit 6 and Vitamin D deficiency has also been linked to PMS and restoring Vitamin D to healthy levels assisted in the resolution of symptoms.

Lifestyle: Supporting hormonal balance and lowering inflammation also depends strongly on lifestyle factors. Ensuring sufficient sleep and finding ways to manage stress levels is critical to keeping those stress hormones and inflammatory markers in check. Regular exercise, meditation, yoga, work-life balance, and social connection with the community and loved ones can also be helpful in improving the symptoms.

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