Photography by Claire McWeeney

PMS & PMDD

The top 3 PMS myths

Symptoms vs. syndrome: Debunking misconceptions of the premenstrual experience

by Lisa Kennelly, Former Head of Marketing at Clue; Mike LaVigne, Former Writer at Clue; Kayleigh Teel; and Erica Avey, Former Writer at Clue
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When you hear the three letters P-M-S, odds are your gut reaction is a four-letter word. The typical perception is, if you have premenstrual syndrome (PMS), you become a bloated, emotional mess for a few days every month. While that may be accurate for some people, it doesn’t capture the true range of premenstrual experiences — and there is much more to PMS than the stereotypical pool of bad symptoms (1).

PMS is a cultural catch-all for everything from eating a whole tub of ice cream to discrediting women in places of power. PMS is given unfounded weight to validate certain behaviors and make people victims of their biology. In reality, the premenstrual experience varies dramatically from person to person, ranging from one or two mild complaints to several near-debilitating symptoms.

Clue created a tool to help people learn about their bodies and dispel myths and misinformation about the menstrual cycle. PMS is one of the biggest misconstructions.

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First, let’s clarify what we mean when we say PMS. 

What is PMS, really?

PMS is a cluster of physical, behavioral, and emotional changes in the time before menstruation that recur with most or all menstrual cycles and affect a person’s normal life (2). Medical diagnostic criteria for PMS requires symptoms that:

  1. Are present during the 5 days before the period starts for at least three menstrual cycles 

  2. End within 4 days of when the period starts

  3. Interfere with normal activities (2)

To make a clinical diagnosis of PMS, your healthcare provider will consider the number, type, and severity of your symptoms. Approaching your premenstrual symptoms with this in mind is helpful in assessing your own experience.

Myth #1: All women and people with cycles have PMS.

This myth comes from the popular misconception that  any symptoms that occur before the period are directly related to PMS. In truth, just because a person experiences some premenstrual symptoms does not mean they have PMS.

Premenstrual syndrome is a medical diagnosis (ICD-10-N94.3) of multiple symptoms including both emotional and physical discomforts (3). While some people might experience premenstrual symptoms of low to moderate intensity, if they don’t have a significant negative effect on a person’s life, this is not considered PMS (from a medical perspective) (4).

Reported rates of PMS vary so widely that it’s nearly impossible to say how many people experience it. This is probably because PMS is sometimes used as a catch-all term for experiencing any premenstrual symptoms, and not only the diagnosis of PMS.

Many people who use the phrase “PMS” to define their premenstrual experiences are referring to their cluster of individual symptoms, rather than a medical diagnosis. For example, a headache that happens a few days before a person’s period might not have a significant negative impact on their day-to-day functioning, even though it’s uncomfortable. In this case, the headache is a mild premenstrual symptom.  A recurrent experience of depression, insomnia, and extreme fatigue, on the other hand, might significantly impact someone’s well-being and therefore meet the criteria for PMS or even premenstrual dysphoric disease (PMDD) (5).

Fact #1: The experience of premenstrual symptoms is not the same as premenstrual syndrome.

Myth #2: The premenstrual phase is all about bad moods.

Science supports that the premenstrual experience is not inherently negative for everyone, despite what culture, society and media suggest. Culturally and socially it’s more common to talk about negative premenstrual experiences, but this limits the true experience of the premenstrual phase, because it includes positive factors as well (1).

Current research has primarily connected negative moods to biologic mechanisms, like hormone fluctuations (1). Most PMS research has deduced a linear relationship between biology and behavior, and failed to reflect the real experience of  PMS within a socio-cultural context (6).

Researchers have pointed out that many of the studies of PMS suffer from major methodological errors. It was reported that in many studies, research participants were asked about their mood but were given a list to choose from that only included negative options. If researchers only study negative moods, it doesn’t accurately reflect the experience of PMS (1).

Without clear scientific evidence, why is the idea of negative premenstrual mood so pervasive? It boils down to cultural  perceptions of menstruation. People who are socialized to expect a negative premenstrual experience are primed to report more problems, contributing to negative attitudes towards the cycle (1).

PMS is not a one-size-fits all experience, rather, each person’s experience is filtered through social and cultural beliefs that influence how they process symptoms.

Fact #2: Bad moods and the premenstrual experience do not go hand in hand for everyone.

Myth #3: Bad moods in your premenstrual phase can be blamed exclusively on hormone fluctuations.

Hormones play a major role in an individual’s menstrual cycle (7), but aren’t the only reason for bad premenstrual moods. Overall mental and physical health have a greater impact on mood than menstrual cycle phase.

Participants of a recent study (7) tracked daily mood and health data over six months to test a commonly stated fact amongst researchers that the premenstrual phase is the source of depressed, irritable moods and mood swings (8-11). The study tracked both positive and negative moods, collected data from every cycle phase (not just the premenstrual phase) and followed several consecutive menstrual cycles.

The conclusion was surprising; data did not support the idea of a negative mood prevailing in the premenstrual phase. Social support, physical health, and perceived stress were more significant as predictors of daily mood than menstrual cycle phase (12)

Still, it could be true that hormones may be the cause of premenstrual syndrome for some people. Lower levels of estradiol in the premenstrual phase may cause decreased levels of serotonin and dampened mood (13).

Fact #3: Physical and emotional health have a greater impact on your daily mood than your menstrual cycle.

What is PMDD?

Premenstrual dysphoric disorder, or PMDD, is a more recent entry into the medical lexicon. PMDD, like PMS, is a diagnostic label given when the experience of premenstrual symptoms is very severe, but it is considered a psychiatric diagnosis rather than a gynecological one. A PMDD diagnosis requires at least five symptoms during the luteal phase that are present 5-7 days before menstruation and improve within four days of menstruation (14).    

Take note: the existence of PMDD is controversial. Some scientists contend that classifying severe PMS as a psychiatric disorder is a dangerous precedent, and that PMDD was created to justify a new pharmaceutical market and representative of the over-medicalization of women’s reproductive biology (15). Whatever we name this extreme form of PMS, studies estimate the prevalence to be 2–8% (14).

What does PMS mean for you?

True PMS is a medical diagnosis given by a healthcare provider after considering the number, type, and severity of a person’s premenstrual symptoms. In order to start the PMS conversation with a healthcare provider, a person can record and report the characteristics of their premenstrual symptom pattern. Carefully tracking your cycle in the Clue app can help you track how you feel both emotionally and physically each day, to help you determine your pattern of premenstrual symptoms.

Symptom tracking is a valuable tool even if you don’t feel the need to have a PMS conversation with your healthcare provider. Getting familiar with your premenstrual symptom pattern can be useful for letting you know where you are in your cycle, helping you plan ahead to mitigate uncomfortable symptoms , and identifying triggers that exacerbate symptoms and/or selecting relief strategies.

While you’re tracking your symptoms, remember to:

  • Record data every day as you experience it. (Rather than recalling how you felt several days ago, which can be less accurate.)

  • Track for several (not just one) complete menstrual cycles. This will help capture cycle-to-cycle variation.

  • Track data in every cycle phase, not just the premenstrual phase. If you only collect data in one phase, it won’t be possible to compare and then conclude that one phase is different from another.

  • Record both positive and negative symptoms.

  • Provide life context. Include notes about stress, skin problems, diet, relationships, and other important factors because your cycle is just one of many things that can affect you and your well-being (12).

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How to know if you have PMS

Once you’ve tracked several cycles of data, it’s time to evaluate. Here are the basic steps:

Visualize your premenstrual phase: Count back 14 days before each period began. That span of time, from ovulation to the start of your period, is roughly your luteal phase. Clue will identify this phase for you.

Look for patterns: Do any symptoms regularly come up in the premenstrual phase? Or are they distributed throughout your cycle? You might be surprised to learn that the constipation or mood swings you thought only occurred premenstrually are actually happening throughout your cycle.

Assess severity: Are any symptoms severe enough to impact your life in some way? Missing work or school may indicate a moderate/severe case of PMS.

Tracking your premenstrual symptoms with Clue can help you get an overall picture of your cycle health. Having this powerful information all in one place can help you make healthcare decisions. If you’re concerned about how PMS might be impacting you, and what you can do about it, talk to your healthcare provider.

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