Millions of women experience mood changes that can feel overwhelming and hard to understand. Knowing the differences between PMDD (Premenstrual Dysphoric Disorder) and bipolar disorder is important for getting the right help and treatment. This article will help you understand the differences, similarities, and treatment options for both conditions.
What Is PMDD?
PMDD is a serious mood condition that happens to some women during certain times of their monthly cycle. Around 1.6% of women and girls have symptomatic Premenstrual Dysphoric Disorder (PMDD).
PMDD is much more severe than regular PMS (Premenstrual Syndrome). PMDD (premenstrual dysphoric disorder) is a more intense form of PMS (premenstrual syndrome).
Common PMDD Symptoms
People with PMDD may experience:
Severe mood swings that feel out of control
Deep sadness or hopelessness
High levels of anxiety or feeling on edge
Extreme irritability or anger
Loss of interest in normal activities
Trouble focusing or remembering things
Feeling overwhelmed or out of control
Physical symptoms like bloating, breast pain, or headaches
To make the diagnosis of PMDD, symptoms must be present only in the week or two before your period, and they must subside within a few days of starting your period as quickly as they come on.
What Is Bipolar Disorder?
Bipolar disorder is a mental health condition that causes big changes in mood, energy, and behavior.
An estimated 2.8% of U.S. adults had bipolar disorder in the past year. Past year prevalence of bipolar disorder among adults was similar for males (2.9%) and females (2.8%). The median age of onset for bipolar disorder is 25 years.
There are two main types of bipolar disorder:
Bipolar I Disorder
This includes at least one manic episode that lasts a week or more. Manic episodes involve:
Feeling extremely high or euphoric
Having lots of energy and needing less sleep
Talking very fast or having racing thoughts
Making risky decisions without thinking
Feeling like you can do anything
Bipolar II Disorder
This includes hypomanic episodes (less intense than full mania) plus major depression. Hypomanic episodes are similar to mania but shorter and less severe.
Both types also include depressive episodes with symptoms like:
Feeling very sad or empty
Having no energy or motivation
Losing interest in things you used to enjoy
Having trouble sleeping or sleeping too much
Feeling worthless or guilty
How Common Are These Conditions?
PMDD Prevalence
Around 1.6% of women and girls have symptomatic Premenstrual Dysphoric Disorder (PMDD), according to a new review of global studies. However, 3.2% had provisional diagnoses, where the condition is suspected but symptoms had not been measured for a sustained period of time to meet criteria for a confirmed diagnosis.
Bipolar Disorder Prevalence
An estimated 2.8% of U.S. adults had bipolar disorder in the past year, with an estimated 4.4% of U.S. adults experience bipolar disorder at some time in their lives.
Differences Between PMDD and Bipolar Disorder
Timing
PMDD: Symptoms happen on a very predictable schedule. Symptoms must occur during the luteal phase (the week before menstruation) and resolve shortly after menstruation begins.
Bipolar Disorder: Episodes can last weeks to months and don't follow menstrual patterns. They can be triggered by stress, sleep disruption, or occur seemingly randomly.
Duration of Symptoms
PMDD: Symptoms typically last 1-2 weeks per month, with complete or near-complete relief during the follicular phase (after menstruation).
Bipolar Disorder: Episodes can last much longer. PMDD symptoms are cyclical and typically last for a specific duration each month. In Bipolar Disorder, mood episodes can last for weeks to months, and the length of stable periods between episodes can vary.
Types of Mood Changes
PMDD: Primarily involves irritability, mood swings, depression, and anxiety that are severe enough to interfere with daily functioning.
Bipolar Disorder: Includes distinct manic or hypomanic episodes characterized by elevated or irritable mood, increased energy, decreased need for sleep, grandiosity, racing thoughts, and poor judgment.
What Causes Each Condition
PMDD: PMDD is thought to stem from increased sensitivity to normal hormonal fluctuations, not abnormal hormone levels. This sensitivity leads to alterations in the brain chemicals and neurologic pathways that control your mood and your general sense of well-being.
Bipolar Disorder: The exact cause is not fully understood, but it involves complex brain chemistry changes that are not tied to the menstrual cycle. Several factors – including biological (e.g. genetic), psychological, social and structural factors – may contribute to its onset, trajectory and outcomes.
Can You Have Both PMDD and Bipolar Disorder?
Yes, it is possible to have both conditions at the same time. Studies suggest a link between bipolar disorder and PMDD, but it's not a causal relationship (meaning that one condition doesn't cause the other). A 2021 systematic review found that people with bipolar disorder, especially bipolar II disorder, may be more likely to experience PMDD than the general population.
When someone has both conditions:
PMDD symptoms may make bipolar symptoms worse during certain times of the month
Around 60% of people with mood disorders may experience premenstrual exacerbation (PME), where existing symptoms worsen before menstruation. This is distinct from comorbid PMDD.
Treatment becomes more complex and requires careful management
How Are These Conditions Diagnosed?
PMDD Diagnosis
DSM-5 requires prospective daily symptom ratings across at least two menstrual cycles to confirm PMDD. A provisional diagnosis can be made earlier.
Bipolar Disorder Diagnosis
Bipolar disorder is diagnosed based on the presence of manic or hypomanic episodes, along with depressive episodes. A mental health professional will look at your complete history of mood episodes.
Treatment Options
PMDD Treatment
Common treatments for PMDD include:
Antidepressants, especially SSRIs (selective serotonin reuptake inhibitors)
Hormonal birth control to regulate hormone levels
Lifestyle changes like regular exercise and stress management
Nutritional supplements like calcium and magnesium
Bipolar Disorder Treatment
Bipolar disorder treatment usually includes:
Mood stabilizers like lithium or anticonvulsants
Antipsychotic medications during manic episodes
Antidepressants (carefully used with mood stabilizers)
Psychotherapy, especially cognitive behavioral therapy
Lifestyle management including sleep hygiene and stress reduction
Antidepressants (including SSRIs) should not be used without a mood stabilizer in bipolar disorder, as they may trigger mania or hypomania.
Important Treatment Considerations
The treatment of PMDD and Bipolar Disorder may involve medications that interact with each other. For example, selective serotonin reuptake inhibitors (SSRIs), which are commonly used to treat PMDD, can potentially impact the mood stability of individuals with Bipolar Disorder and may need to be managed carefully.
When to Seek Medical Attention
See a healthcare provider if you experience:
Mood changes that significantly impact your daily life
Thoughts of self-harm or suicide
Symptoms that follow a monthly pattern (suggesting PMDD)
Extreme mood swings that last weeks (suggesting bipolar disorder)
Difficulty maintaining relationships or work due to mood symptoms
Getting the Right Help
It is very important to get the diagnosis right because the treatments are often very different for PMDD from the other mood disorders. Unfortunately, it is all too common for women with PMDD to be incorrectly diagnosed with bipolar disorder.
Medical Disclaimer
This article is for educational purposes only and does not constitute medical advice. The information provided should not replace consultation with a qualified healthcare provider. Individual responses to medications can vary significantly, and what applies to one person may not be safe for another.
Always consult with your doctor or pharmacist before making any decisions about medication changes, discontinuation, or interactions with other substances. If you're experiencing concerning symptoms or side effects, please seek professional help from a healthcare provider. In case of a medical emergency, contact your local emergency services immediately or call 911. For mental health emergencies, contact the National Suicide Prevention Lifeline at 988.
Important: This information is not a substitute for professional medical advice. Never stop taking prescribed medication or make changes to your treatment plan without consulting your healthcare provider first. Your safety and well-being are the top priorities.
Sources
Healthline - Bipolar Disorder and PMDD: Risk Factors, Research, Symptoms
PMC - Comorbid Premenstrual Dysphoric Disorder and Bipolar Disorder: A Review
Harvard Health - Premenstrual dysphoria disorder: It's biology, not a behavior choice
University of Oxford - New data shows prevalence of Premenstrual Dysphoric Disorder
Depression and Bipolar Support Alliance - Bipolar Disorder Statistics
PMC - Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges
PubMed - The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis
