Is it PMS, PMDD or Perimenopause?

Before we commence, let’s take a moment to applaud women! Why, you may ask? Because being a woman is no easy feat. From puberty to menopause, women experience a range of psychological, behavioural, and physical symptoms. Up to 47.5% of women experience predictable symptoms month after month in the run-up to their period, also known as PMS (Premenstrual Syndrome). This phase can bring a variety of temporary emotional and physical changes that disrupt daily life.

A more intense form of PMS is called PMDD (Premenstrual Dysphoric Disorder), where menstruating women face more severe and dramatic symptoms, adding more difficulty to an already challenging time.

But what happens when a woman enters perimenopause, the transitional phase leading up to menopause, while also experiencing PMDD and premenstrual symptoms? Does perimenopause bring in additional challenges due to the uneven levels of reproductive hormones like oestrogen and progesterone? Keep reading to understand the key differences between PMS, PMDD, and perimenopause, how they interact, and how they can be managed naturally.

Understanding common premenstrual symptoms

One minute you may have crying spells, the next you’re craving a calorie-loaded dessert, and before long you’ve lost your calm over something trivial. Then comes the inevitable question: ‘Am I PMSing?’ Premenstrual Syndrome (PMS) is a chronic yet temporary condition marked by cyclical patterns of physical, emotional, and behavioural symptoms. These occur during the luteal phase of a normal menstrual cycle (the phase between ovulation and the onset of your period), and they typically fade once menstruation begins.

With over 150 possible symptoms, premenstrual symptoms can vary and look distinct from one another. To simplify, they’re often characterised by a common cluster of symptoms, which mostly include: 

• Breast tenderness

• Abdominal cramps

• Back pain

• Intense food cravings

• Bloating

• Diarrhoea or constipation

• Headache

• Acne 

• Mood swings

• Insomnia

• Nausea

• Impaired cognitive functions 

While experts haven’t identified a single root cause, hormonal fluctuations, particularly changes in oestrogen and progesterone, are believed to contribute to this condition. Furthermore, symptom severity varies widely. Some women may sail through life without any difficulties through their cycles, while others face mild discomfort, and some experience significant disruption. Genetic predisposition, lifestyle habits, and overall hormonal health can all influence how common premenstrual symptoms affect you.

How normal PMS feels vs something more serious

Remember, common premenstrual symptoms range from mild to moderate and typically fade once your period begins. Mild abdominal discomfort, food cravings, and occasional irritability are normal PMS experiences.

However, don’t assume that all symptoms are harmless. If you experience extreme period cramps, or your mood shifts from fleeting irritability to deep feelings of remorse two weeks before your period, it may not be ‘just PMS’. Severe pain can be a warning sign that is trying to signal something more serious, like endometriosis. Persistent dysmenorroea is your body’s cue to identify the underlying cause and seek professional help.

PMDD symptoms vs PMS: What sets them apart?

Premenstrual Syndrome (PMS) is an uncomfortable condition where symptoms typically begin one to two weeks before menstruation and disappear at the onset of menstruation. It involves both physical (somatic) and psychological symptoms that occur during the luteal phase of the menstrual cycle. While PMS can cause distress and disrupt daily life activities, the symptoms are generally mild to moderate and manageable.

Common PMS symptoms include: 

• Irritability, mild mood swings. 

• Intense food cravings 

• Bloating

• Mild cramps 

• Slight difficulty concentrating 

Premenstrual dysphoric disorder (PMDD), on the other hand, is a chronic condition and a more severe form of PMS, affecting around 5%-8% of menstruating women. Indian women experience a high prevalence of PMDD and intensified perimenopausal symptoms, yet stigma and limited awareness often lead to delayed diagnosis and management. PMDD can be characterised by debilitating symptoms that can impair daily functioning and significantly disrupt both professional and personal life. 

Some of the noticeable PMDD symptoms include: 

• Intense mood swings

• Having suicidal and self-depracating thoughts

• Experiencing extreme feelings of remorse

• Extreme anxiety and tension

• Persistent lethargy, tiredness and extreme fatigue 

• Loss of appetite 

• Sleep changes 

• Difficulty concentrating and thinking becomes foggy

• A sense of feeling out of control or overwhelmed 

• Bloating or significant weight gain from water retention. 

All in all, the key difference between PMS and PMDD lies in the severity of symptoms and the profound impact they have on overall health and well-being. PMS symptoms are uncomfortable but generally manageable, while dealing with PMDD could be life-altering. 

Early signs of perimenopause that are mistaken for PMS

When you think of perimenopause, the years leading up to menopause, you might think of physical symptoms like hot flashes, night sweats and vaginal dryness. However, the impact extends far beyond that. There is a range of psychological and behavioural perimenopause symptoms that commonly include: 

• Brain fog, trouble concentrating: Many women experience a decline in cognitive functions, such as memory lapses and forgetfulness, due to the plummeting levels of oestrogen and serotonin during perimenopause. 

• Anger issues with severe mood swings: Fluctuating hormones can lead to rapid shifts in mood, swinging from irritability to depression. 

• Persistent low mood: Low levels of serotonin, also known as the “good hormones” responsible for regulating the mood, can contribute to prolonged periods of low mood or a sense of hopelessness. 

• Panic attacks: Some women experience increased panic or anxiety attacks during perimenopause. 

• Excessive hair growth: Clinically called hirsutism, some women may experience excessive hair growth in unwanted areas such as the face, chest or abdomen due to hormonal fluctuations. 

• Vaginal dryness: When your oestrogen levels drop, the vaginal walls become thinner, drier, and less elastic. This leads to discomfort and sometimes even decreased sex drive. 

• Unexplained weight gain: Changes in metabolism and fat distribution can contribute to weight gain, especially around the abdomen region. 

For women already dealing with PMS or PMDD, entering the transitional phase of perimenopause can feel like being ambushed with additional symptoms as hormone levels zigzag out of control. Some may notice that PMS or PMDD symptoms persist or even intensify during this stage. Interestingly, many premenstrual symptoms are also considered the early signs of perimenopause. 

Because of their overlapping nature, differentiating PMS from perimenopause can feel a bit challenging. However, certain key differences help us distinguish between the two. 

Cycle irregularity and symptom shift with age

As women age, hormonal imbalance is in constant flux. From puberty onwards, the body moves through different reproductive stages from premenopause (regular menstrual cycles) to perimenopause (the transition leading up to menopause), and finally to menopause, marking the end of the reproductive years. 

Your menstrual cycle patterns help indicate the stage you’re in. When cycles become irregular, specifically in your late 30s or early 40s, it often signals the arrival of perimenopause. Common age-related changes include:

• Cyclical irregularities, such as shorter or longer periods, lighter bleeding, or occasionally skipped cycles.

• Symptoms like hot flashes, vaginal dryness, insomnia, and decreased sex drive due to fluctuating oestrogen and progesterone levels.

• Changes in body composition, often leading to weight gain, are linked to hormonal shifts.

Navigating these changes with grace, confidence, and a renewed sense of wisdom can help you embrace the next chapter of life more fully.

How to identify what you’re really experiencing?

It is well established that distinguishing between PMDD, PMS, and perimenopause symptoms can be distressing. However, tracking your menstrual cycles can help you identify what stage you’re in and what you’re experiencing. Here are some key differences: 

• Timing: PMS and PMDD symptoms occur only during the luteal phase and gradually decline once menstruation begins, whereas perimenopause symptoms can appear at any point in the cycle and are not restricted to the luteal phase. 

• Cycle changes: PMS and PMDD occur with regular menstrual cycles, without changes in cycle length or bleeding patterns, while perimenopause is often marked by shifts in menstrual flow, duration, or skipped periods.

• Age: PMS and PMDD occur only during the reproductive years after puberty, while worsening symptoms and hormonal changes in the late 30s or early 40s may signal the transition towards menopause.

Understanding the complexities of these symptoms and recognising the signs helps us navigate the journey with more ease and make smart, informed decisions.

Change the narrative

All in all, we know that dealing with these symptoms is no easy task. The repercussions, circumstances, and disruptions that come with cyclical changes can be both exhausting and distressing.

But it’s time to change the narrative. Remember, you hold the reins of your experience. Dwelling on the difficulties of PMS, PMDD, or perimenopause symptoms will bring no relief or happiness. Instead, by shifting your mindset, equipping yourself with reliable information, and fostering a supportive community, you lay the foundation for a journey filled with energy, growth, and newfound wisdom.

Frequently Asked Questions

1. Can PMS or PMDD symptoms get worse during perimenopause?

Yes. Hormonal fluctuations in perimenopause can intensify premenstrual symptoms, making mood swings, fatigue, and other discomforts more pronounced.

2. What are the earliest signs of perimenopause?

Early signs often include irregular menstrual cycles, changes in flow, hot flashes, night sweats, mood changes, and sleep disturbances. These can occur years before your final period.

3. Can lifestyle changes help manage PMS, PMDD, or perimenopause symptoms?

Yes. Regular exercise, balanced nutrition, adequate sleep, stress management, and support networks can reduce symptom severity. However, if the symptoms persist, it is advisable to consult a healthcare provider. Traditional approaches such as Ayurveda and yoga are commonly used for symptom relief, but robust clinical trials supporting their effectiveness in PMDD and perimenopause remain limited.