When I was in college, my menstrual cycle felt like it regularly grabbed me by the throat. I’d turn into a werewolf woman the week before my period. But instead of fur sprouting from my body or claws jutting from my fingers, my emotions and outlook on life transformed. Suddenly, I was sure all of my friends hated me, my chosen major was a complete mistake, or my partner was obviously plotting to leave me. This went on for three-ish years until I eventually discovered I wasn’t experiencing typical PMS symptoms. My doctor suspected I had premenstrual dysphoric disorder (PMDD), a clinical disorder—characterized by mood swings, pain, and irritability beyond PMS symptoms—that disrupts one or more areas of life.

It took a long time (and a prescription medication), but my PMDD has been “in remission” for a solid half-decade. This, however, is not everyone’s experience. Although PMDD is characterized as a mood disorder in the DSM-V, a lack of awareness can make diagnosis and treatment difficult. Below, experts break down what PMDD is, the key differences between PMS and PMDD, and treatment options that might help people regain some balance.

What is PMDD

PMDD is a chronic, severe form of PMS that affects people that menstruate, according to Johns Hopkins University. There is a long list of symptoms of this disorder, but some of the most common symptoms include irritability, nervousness, lack of control, insomnia, concentration trouble, anxiety, crying spells, anger, depression, poor self-image, paranoia, etc. It often requires treatment to manage symptoms that can be debilitating and dangerous. Additionally, PMDD includes other non-psychological symptoms like severe menstrual pain, skin irritation, headaches, muscle spasms, heart palpitations, and fainting.

PMDD and PMS might look very similar, but the most significant difference is how much symptoms impact your life, according to Johns Hopkins University. When something like PMS starts to impact your relationships, work, school performance, or self-image—it warrants a closer look. To diagnose the condition, your provider will look for the prevalence of symptoms, but they’ll also examine how frequently you experience them and the intensity at which they occur, according to Johns Hopkins University.

“PMDD can be really disabling and interfere with your life and relationships,” says Amy Roskin, MD, OB/GYN, medical advisor for the reproductive health startup Favor. It’s not uncommon for people to have spells of emotions that include suicidal ideation, harmful thoughts, bursts of anger at loved ones, and general distress that is really hard to cope with, according to a 2014 study published in the journal of Social Psychiatry and Psychiatric Epidemiology.

What causes PMDD

Currently, there isn’t one identifiable cause of PMDD. It does appear that it could possibly run in families, though, according to a 2017 study from the National Institutes of Health (NIH). A 2016 literature review Current Psychiatry Reports (CPR) laid out some possible causes related to hormone fluctuation before menstruation. Progesterone, a reproductive hormone, increases during the luteal phase of the menstrual cycle. Then it plummets right before you start your period; the literature suggests some people who menstruate could be more prone to emotional and physical symptoms of this hormone shift.

What’s the difference between PMS and PMDD

“The core differentiating factors for PMDD are mostly psychological and include an overwhelmed feeling of no control, increased depressed mood, sleep disturbances, mood swings, social withdrawal, and sudden sadness,” says Kenosha Gleaton, MD, OB/GYN medical advisor of Natalist. She stresses that the defining difference is the chronic interruption of multiple areas of your life when you menstruate.

What options are available to people with PMDD

“A major misconception about PMDD is that it’s just really bad PMS, and there’s nothing you can do,” says Dr. Roskin. “There are treatment options available even if some people, or even professionals, aren’t familiar with them— the most important thing is for providers not to minimize the condition,” she says. Finding a provider, either a primary care provider, OB/GYN, or psychiatrist well-versed in the subject, who listens to your troubles and understands what you’re saying is a great place to start.

Some treatments for PMDD include antidepressant medications like selective serotonin reuptake inhibitors (SSRIs), anti-anxiety medications, and localized treatment for other physiological symptoms, Johns Hopkins University says. Dr. Gleaton adds that it’s important to be evaluated for any underlying mental health conditions because untreated depression could worsen during your period. So ruling out or managing other mental health conditions can help you hone in on what is going on.

On the other hand, it is important not to be dismissed or misdiagnosed. As CPR reports, many people are misdiagnosed with bipolar because symptoms are cyclical and intense. However, bipolar medication is not currently utilized in treating PMDD and could have adverse effects, the CPR article adds.

If you have PMDD, you’ll likely need support and understanding from family and friends. This condition can impact your life in many different ways, so educating your loved ones on the condition could help them understand what is going on with you. This can look like sharing more about PMDD and also updating people you care about (and trust) on where you are in your cycle. If you’re close to “that time of the month,” it might be useful for loved ones to know before you have a dip in your mood or start to feel bad.

All in all, it can be tough to manage a condition with an unpredictable timeline and intense symptoms. That difficulty can intensify when a condition isn’t broadly known or understood. The first step to improving things, though, according to Dr. Gleaton, is to get some trusted loved ones and a thoughtful provider on board when developing a care strategy.

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