Real Talk: What’s the Difference Between PMS and PMDD?

The cramps are legit. The menstrual migraines can knock me out for hours, if not an entire day. But there is one symptom of PMS I never ever can deny: commercial crying. And by crying, I don’t mean a single tear streaming slowly and gracefully down my cheek. No, girls. I mean full on ugly cry, verging on sobbing right there in front of the television. 

There is one commercial in particular and if I’m being honest, I have a total love-hate relationship with it. Sarah McLaughlin’s voice pines away singing the heart-wrenching lyrics of “Angel” as lonesome animals look longingly into your soul right through the screen. 

If you haven’t seen the American Society for the Prevention of Cruelty to Animals commercial I’m talking about, you’re missing out on a good healthy and healing cry, particularly when you’re premenstrual. (Fair warning, grab the Kleenex because you’re going to need it).

As a proud dog mom myself, I see the incredible value in helping these animals find their forever homes. But also, holy crap with the emotional toll a quick few minutes can take on my premenstrual heart. Anyone else cry uncontrollably when you’re PMS? Because you, friends, are my people.

That being said, there are things to consider when we talk about the hormonal roller coaster ride that revolves around that time of the month. Put on your seatbelts, ladies! It’s time to talk PMS! 

What is PMS?

PMS, or premenstrual syndrome, is experienced by more than 90 percent of women who experience periods on a regular cycle during their reproductive years. 

Described as a “general pattern of physical, emotional, and behavioral symptoms occurring 1-2 weeks before and remitting with the onset of menses,” PMS is a relatively normal occurrence that accompanies Aunt Flo’s monthly visit.

Anger, anxiety, depression, irritability, overall sensitivity and social withdrawal are among the most common psychological symptoms. Add to that the physical symptoms of abdominal bloating, hunger and cravings, breast tenderness, muscle aches, swelling and more and you’ve got the recipe for a girl who just needs to be left alone with a heating pad, some gummy bears, and an entire season (or two) of Sex in the City.

Why does PMS happen?

While the root cause of PMS is unknown, the science of what’s happening in your body comes into play. Hormonal changes that occur regularly throughout your menstrual cycle contribute to any and all of the above symptoms. 

Many researchers point to the changes in sex hormones in particular, as well as serotonin levels, at the beginning of your cycle as contributing factors to PMS.

Understanding PMS is among the reasons why your OB-GYN asks you about your family health history, as family history with PMS or depression can contribute to developing the symptoms as well. 

When should you see your doctor?

First of all, it’s always a good idea to mention any of the above issues with your doctor at your regular well visit. However, there are situations when it is advisable to reach out to your doctor more urgently. 

If you experience a change in frequency or severity of PMS symptoms, or they begin to seriously interfere with your everyday life, it’s time to call your doctor.

It’s important to act quickly to rule out other issues that could be causing the symptoms, including anemia, endometriosis, thyroid issues, irritable bowel syndrome and others.


There are a number of conditions that your doctor may discuss with you surrounding your PMS symptoms, including Premenstrual Dysphoric Disorder (PMDD). 

Much less common than PMS, PMDD affects between 3 and 8 percent of women and is, in laywoman’s terms, severe PMS. 

PMDD is PMS intensified, with most symptoms being similar but much more extreme with how they impact your everyday life. Depression may be present, but also may give way to suicidal thoughts. 

Anxiety is also on deck, but may evolve into panic attacks and angry mood swings. The tears that are common with PMS transform into crying spells that overtake you. You may struggle with insomnia, ability to focus, and basically want to just “check out” for a few days.

Hormones and serotonin levels do also play a role just as they do with PMS.

What can you do about PMS and PMDD?

First of all, and most importantly, always share any changes or anything that seems abnormal with your cycle to your OB-GYN. 

There’s nothing to be embarrassed about, and I’m guessing many would agree with you and admit to crying during commercials when they are PMS-ing too. 

But the best part about being honest with us is there are things we can recommend to help put at least some of the symptoms at ease. Regular exercise, dietary supplements, less caffeine intake, counseling, and stress management are all helpful aides in beating down Aunt Flo’s powerful forces.

There are cases when hormonal or other behavioral drugs can be prescribed to help manage the hormonal changes that occur throughout your cycle as well. 

The bottom line is we are here to help. And, especially when your OB-GYN is a woman, we get it. Because we’ve been there, on the couch, crying uncontrollably because there’s just something about Sarah McLaughlin’s voice and all of those big, sad puppy dog eyes on the screen.

Trust me, I’ve been there. And I’m here for you always if you have questions or need to talk about it!