What you should know about Period Pain - PMS and PMDD

"I have had really bad days when I have been curled up in bed crying because of abdominal period pain, associated bloating and tender breasts. Emotionally as well, it's a rollercoaster, one moment you are crying for no apparent reason and another moment you wonder why that happened. It's something I don't understand completely so you can imagine that it completely catches your partner off-guard as well. I crave sweets especially chocolate closer to my period. Experiencing period pain and these symptoms every month is really exhausting as it can and has disrupted my daily life and the symptoms are unpredictable."

This personal description of a woman's symptoms before her period is a perfect example of what is called Premenstrual syndrome (PMS). If you have experienced some or all of these symptoms, you are not alone as it is experienced by 80% of women. While the syndrome manifests in its mild form in some women, it can become intolerable in others. The severe form of PMS, called Premenstrual dysphoric disorder (PMDD) is a chronic condition that can disrupt a woman’s quality of life.

What is PMS and PMDD?

PMS is a group of behavioral, emotional, and physical symptoms that occurs one to two weeks before the onset of menstruation. Commonly described as period pain, the symptoms include cramping, breast tenderness, bloating, anxiety, depression, and headache. It can often be treated with lifestyle changes and relaxation therapies. The symptoms usually cease once the period begins.

PMDD is the severe form of PMS, most often characterized by irritability and prominent mood reactivity. Like PMS, the symptoms of PMDD also commence 7 to 14 days before the period and gradually fades once the period starts. Symptoms are similar to PMS but much worse. It occurs in less than 3% to 8% of women of childbearing age.

What causes it?

The exact cause of PMS and PMDD is not very clear. Some studies state that a rise and fall in the levels of reproductive hormones might influence a chemical called serotonin in the brain, which affects mood.

However, it is not yet clear as to why PMS and PMDD affect some women and not others. The most likely explanation for PMDD could be this: women who develop PMDD are highly sensitive to normal fluctuations in hormone levels.


Physical – Cramping, backaches, breast tenderness, headache, bloating, muscle ache, fatigue, sleep and appetite disturbance, and swelling of extremities before the period.

Psychological – Anger, depression, irritability, anxiety, and social withdrawal

Behavioural – Forgetfulness, poor concentration, and fatigue

Though the symptoms of PMS and PMDD are similar, PMDD is very severe. If the symptoms impact one’s daily activities to a large extent, it may be worth talking to your doctor about a PMDD diagnosis.