PMDD or PMS? Signs of PMDD and how it is treated

PMS is common. It can cause mild mood changes, bloating or tender breasts before your period. PMDD is less common and much more serious. It causes severe sadness, anxiety or anger that can make it hard to work or get along with people.

PMDD symptoms start in the week or two before your period and usually go away 2 to 3 days after your period starts. Many women with PMDD also have anxiety or depression.

Signs of PMDD include:

• Anger or feeling cranky that lasts and affects other people
• Feeling sad or hopeless, or even having thoughts of suicide
• Feeling tense or anxious
• Panic attacks
• Mood swings or crying often
• Losing interest in daily activities and in people
• Trouble thinking or focusing
• Feeling tired or low on energy
• Food cravings or binge eating
• Trouble sleeping
• Feeling out of control
• Body symptoms, like cramps, bloating, tender breasts, headaches, and joint or muscle pain

To be diagnosed with PMDD, you need 5 or more of these symptoms, and at least one of them has to be about mood.

There is no blood test for PMDD. Your doctor will ask you to rate your symptoms every day, on a paper chart or in an app, for at least 2 cycles. This shows whether your symptoms come in the week or two before your period and ease after it starts. A doctor may still check for other problems that can cause similar symptoms, like thyroid disease.

If your low mood or worry lasts all month, it may be depression or anxiety instead. That needs different care.

• Antidepressants called SSRIs. The FDA has approved three of them for PMDD: sertraline, fluoxetine and paroxetine. Sertraline can be taken every day, or only in the 2 weeks before your period.
• A birth control pill. The FDA has approved one type of birth control pill to treat PMDD.
• Over-the-counter pain medicine, like ibuprofen or naproxen, for cramps, headaches, backaches and tender breasts.
• Healthy habits, like getting more exercise, eating healthy foods, cutting back on salty and sugary foods, and finding ways to lower stress.
• Counseling (talk therapy).

Many people do best with more than one of these.

SSRIs can cause side effects, like an upset stomach, loose stools, less appetite, sweating, shakiness or a lower sex drive. In people 24 and younger, antidepressants can raise the chance of suicidal thoughts and actions. Tell your doctor right away about new or worse sadness, worry or thoughts of hurting yourself.

If you have thoughts of hurting yourself, or that you would be better off dead, call or text 988 right away, or call 911. You can reach 988 any time, day or night.

If you are in Virginia or West Virginia, you can start a visit online at any time. It is for adults 18 to 49 whose periods come about every 21 to 35 days. Your symptoms start in the week before your period and are mild or gone in the week after it. You have at least 5 symptoms, at least one about mood, and they hurt your work, school or relationships.

Before the visit, you rate your symptoms every day for at least 2 cycles, and you upload your ratings.

A board-certified physician reviews your answers and your tracking. If it is right for you, the doctor may prescribe sertraline (Zoloft), a daily pill the FDA approved for PMDD. Everyone has a check-in at 2 weeks to see how it is working and to watch for side effects, and that first check-in is free. If you are 18 to 24, we also reach out to you after 1 week.

It is not the right fit if you:

• Have thoughts of hurting yourself, or that you would be better off dead (call or text 988, or call 911)
• Have low mood or worry that lasts all month (use our anxiety and depression visit instead)
• Have periods that are not regular, have stopped, or are changing as you get older
• Are pregnant, might be pregnant, or are breastfeeding
• Have narrow-angle glaucoma that is not treated
• Are allergic to sertraline (Zoloft)
• Have had mania, hypomania, bipolar disorder or psychosis, or take a mood stabilizer like lithium
• Have liver disease
• Take a blood thinner, like warfarin or apixaban, or phenytoin
• Have long QT syndrome, or take a medicine that can change your heart rhythm
• Take an MAOI, linezolid, methylene blue or pimozide
• Drink heavily or use drugs

Your first visit starts at $59. The 2-week check-in is free, and each later check-in is $39. You pay the pharmacy for the medicine. You do not need insurance.