PMDD vs Bipolar Disorder

Mood swings happen to all of us sometimes. But if you feel like your emotions are taking over your life, messing with work, relationships, or your ability to just feel steady, it might be something more than everyday stress. Two conditions that can look a lot alike are Premenstrual Dysphoric Disorder (PMDD) and Bipolar Disorder. Both can cause intense mood changes, but they’re very different and need different approaches.

In this post, I’ll break down what PMDD and bipolar disorder are, what they share, and how they’re different. Most importantly, you’ll learn what to do next so you can get a proper diagnosis and the right kind of help.

PMDD vs Bipolar Disorder

Key Differences at a Glance

Key Aspects

🌸PMDD

⚡Bipolar Disorder

😰Symptoms

Mood swings and irritability tied to the menstrual cycle. You might feel like a different person before your period starts.

Mood swings involving episodes of mania and depression. These are distinct periods of extremely high or low mood.

⏰Timing

Always linked to your cycle, especially the 1-2 weeks before your period. It's predictable like clockwork.

Happens randomly, completely unrelated to periods. Episodes can be triggered by stress or occur without warning.

📅Duration

Usually lasts 1–2 weeks each month, then you feel relief when your period starts.

Mood episodes last weeks or months, with stable periods in between episodes.

💊Treatment

Antidepressants (often SSRIs), birth control to regulate hormones, lifestyle changes, and therapy

Mood stabilizers (like lithium), antipsychotics when needed, and talk therapy for long-term management

💡 Remember: Both conditions are real, treatable, and deserve professional support. This chart is for educational purposes only.

What is PMDD?

PMDD is basically a more intense version of PMS. It affects up to 10% of women and people assigned female at birth during their reproductive years. If you have PMDD, your symptoms usually show up in the week or two before your period (the luteal phase) and then improve once your period starts.

While PMS and PMDD share things like bloating, fatigue, breast tenderness, and sleep or appetite changes, PMDD takes those mood symptoms to another level. The mood swings, anxiety, and depression can feel so intense that they seriously disrupt daily life.

No one knows the exact cause, but it’s linked to hormonal changes that happen after ovulation. You might be more likely to have PMDD if you’ve experienced:

• A history of anxiety or depression

• Strong PMS symptoms

• A family history of PMS, PMDD, or mood disorders

• Trauma or major stress in your past

DSM-5 Criteria for PMDD

According to the DSM-5, PMDD is classified as a depressive disorder with very specific timing requirements. Criteria proposed for DSM-5 include the occurrence of at least five symptoms in most menstrual cycles during the past year, such as affective lability, irritability, depressed mood, anxiety, loss of interest, lethargy, changes in appetite or sleep, loss of control, or bloating.

Timing is Everything: Symptoms must occur during the luteal phase (the week before menstruation) and resolve shortly after menstruation begins. The diagnosis of both PMS and PMDD require that symptoms only "occur during the luteal phase and resolve shortly after the onset of menstruation."

Core Emotional Symptoms: At least one of these must be present:

• Marked mood swings or emotional lability

• Marked irritability or anger

• Markedly depressed mood or feelings of hopelessness

• Marked anxiety or tension

PMDD Symptoms

PMDD symptoms tend to ease up within a few days of starting your period. Here’s what they might include, on top of typical PMS symptoms:

• Mood swings

• Irritability or anger

• Anxiety or panic attacks

• Depression, including suicidal thoughts

• Trouble sleeping

• Feeling overwhelmed or tense

• Difficulty concentrating

• Fatigue

• Headaches

• Changes in appetite, including binge eating

What is Bipolar Disorder?

Bipolar disorder is a mood disorder that causes dramatic swings in energy, mood, and behavior. These shifts happen in distinct episodes, lasting days or even weeks at a time.

Bipolar episodes can go from emotional “highs” (mania or the milder hypomania) to intense “lows” (depression). Everyone has ups and downs, but bipolar symptoms are so intense they interfere with your ability to function.

DSM-5 Criteria for Bipolar Disorder

To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania. The disorder comes in different types:

Bipolar I Disorder: Requires at least one full manic episode (lasting at least one week or requiring hospitalization)

Bipolar II Disorder: Requires at least one hypomanic episode and one major depressive episode

Cyclothymic Disorder: Involves numerous periods of hypomanic and depressive symptoms that don't meet full criteria for episodes

The key feature is that these mood episodes occur independently of any external triggers like menstrual cycles.

Symptoms of Mania

Mania can feel good at first — like you’re unstoppable — but it can quickly become uncomfortable or even dangerous. A manic episode lasts at least a week and can require hospitalization. Some common signs include:

• Extreme euphoria or irritability

• Risky or reckless behaviors

• Sleeping very little

• Racing thoughts

• Talking more or faster than usual

• Trouble focusing

• Poor judgment (like overspending or driving dangerously)

Symptoms of Hypomania

Hypomania is similar but less severe. It usually lasts a few days. You might feel super productive and energized, which can seem positive, but people around you might notice you’re acting differently.

Symptoms of Depression

On the flip side, depressive episodes are more intense than everyday sadness and last at least two weeks. You might notice:

• Feeling deeply hopeless or sad

• Losing interest in things you normally enjoy

• Low energy or constant fatigue

• Sleeping way more or way less

• Changes in appetite

• Trouble concentrating

• Feeling worthless or overly guilty

• Thoughts of suicide or death

Can You Have Both?

It’s definitely possible to have both PMDD and bipolar disorder, though it’s not clear how common that is. These conditions might interact — for example, PMDD can worsen bipolar symptoms, and bipolar disorder might make you more sensitive to hormone changes.

Because their symptoms can overlap, it’s easy to get misdiagnosed, so getting a thorough evaluation is really important.

How to Figure Out What’s Going On

If you’re dealing with big mood swings, here’s what you can do to help your provider get a clearer picture:

• Track your moods — when do they happen, and how severe are they?

• Watch for patterns tied to your period

• Talk openly with a qualified mental health professional

Key Differences Between PMDD and Bipolar Disorder

Timing and Patterns

PMDD: Symptoms follow a predictable monthly pattern, appearing in the luteal phase and disappearing with menstruation. It's like clockwork—you can literally mark it on your calendar.

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: Manic episodes last at least one week (or require hospitalization), while depressive episodes typically last at least two weeks. There may be stable periods between episodes.

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.

How They Might Overlap

Here's where it gets tricky—some symptoms can look similar:

• Both can involve severe irritability

• Both can include periods of depression

• Both can significantly impact relationships and daily functioning

• Both can involve mood swings

PMDD and bipolar disorder aren't the same condition. They do, however, have similar symptoms. During a depressive episode in bipolar disorder, you may feel irritable or like you're losing control.

Additionally, it's possible to have both conditions. Some women with bipolar disorder notice their symptoms worsen during certain phases of their menstrual cycle, which can complicate diagnosis.

Getting an Accurate Diagnosis

Because these conditions can appear similar, getting the right diagnosis is crucial. Here's where to go for accuracy:

Primary Care Physician

Your family doctor can be a good starting point, especially for PMDD. They can rule out other medical conditions and may refer you to specialists.

Psychiatrist

A psychiatrist is essential for bipolar disorder diagnosis and can prescribe medications. They're trained to differentiate between mood disorders and can conduct comprehensive evaluations.

Gynecologist

For PMDD, a gynecologist familiar with mood-related menstrual disorders can be particularly helpful, as they understand the hormonal components.

Mental Health Professionals

In Texas, licensed mental health professionals such as LPCs, LMFTs, LCSWs, and psychologists can diagnose mood disorders, including Bipolar Disorder and PMDD, using DSM-5 criteria. For Bipolar Disorder, therapists can assess symptoms, provide a formal diagnosis, and develop a treatment plan that may include collaboration with a psychiatrist for medication management if needed. Because PMDD is tied to the menstrual cycle and may overlap with medical or hormonal conditions, therapists can diagnose it but often coordinate with a physician to rule out other gynecological causes and ensure a comprehensive approach. Always check your own state’s licensing rules, as diagnostic authority and scope of practice can vary depending on where you live or work.

Treatment Approaches

Medications for PMDD

• Selective Serotonin Reuptake Inhibitors (SSRIs)

• Hormonal contraceptives

• Anti-anxiety medications (short-term)

• Diuretics for physical symptoms

Medications for Bipolar Disorder

• Mood stabilizers (lithium, anticonvulsants)

• Antipsychotic medications

• Antidepressants (used carefully with mood stabilizers)

• Anti-anxiety medications

Important Note: As therapists, we don't prescribe medications, but we work closely with medical professionals to ensure you're getting comprehensive care.

How Sagebrush Counseling Can Support You with Counseling

At Sagebrush Counseling, we know how stressful it feels to be stuck wondering what’s wrong. You deserve answers and support that is respectful and judgment-free.

Our virtual therapy services are available across Texas, so you can get care without leaving home. We have experience working with mood disorders like PMDD and bipolar disorder, and we can partner with your medical team to make sure you get well-rounded, thoughtful care.

Here’s what we can help you with:

• Tracking your mood and symptom patterns

• Offering evidence-based therapy

• Supporting you through the evaluation process

• Helping you build healthy coping strategies

• Communicating with your loved ones about what you’re experiencing

If you're experiencing symptoms that might be PMDD or bipolar disorder, you don't have to figure it out alone. The path to wellness often involves both medical and therapeutic support, and there's no shame in needing both.

Remember:

• Accurate diagnosis takes time and careful observation

• Both conditions are treatable with the right approach

• Therapy can be incredibly beneficial alongside medical treatment

• You deserve support that honors your unique experience

Please note: This blog post is for educational purposes only and is not intended to replace professional medical or mental health advice. If you're experiencing thoughts of self-harm or suicide, please seek immediate help by calling 988 (Suicide & Crisis Lifeline) or going to your nearest emergency room.

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

2. Eisenlohr-Moul, T. A., Kaiser, A., Weise, C., Schmalenberger, K. M., Kiesner, J., Drane, H. R., ... & Huffman, K. J. (2017). Are there temporal subtypes of premenstrual dysphoric disorder?: Using group-based trajectory modeling to identify individual differences in symptom change. Psychological Medicine, 47(3), 485-496. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5205545/

3. Cleveland Clinic. (2023). Premenstrual Dysphoric Disorder (PMDD): Causes & Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/9132-premenstrual-dysphoric-disorder-pmdd

4. National Center for Biotechnology Information. (2023). Bipolar Disorder - StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK558998/

5. American Academy of Family Physicians. (2023). Don't Miss the Diagnosis of Premenstrual Dysphoric Disorder. Retrieved from https://www.aafp.org/pubs/afp/afp-community-blog/entry/dont-miss-the-diagnosis-of-premenstrual-dysphoric-disorder.html

6. PsychDB. (2023). Premenstrual Dysphoric Disorder (PMDD). Retrieved from https://www.psychdb.com/mood/pmdd

7. Eisenlohr-Moul, T. A., DeWall, C. N., Girdler, S. S., & Segerstrom, S. C. (2016). Toward the reliable diagnosis of DSM-5 premenstrual dysphoric disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS). American Journal of Psychiatry, 174(1), 51-59. Retrieved from https://psychiatryonline.org/doi/10.1176/appi.ajp.2016.15121510

8. Epperson, C. N., Steiner, M., Hartlage, S. A., Eriksson, E., Schmidt, P. J., Jones, I., & Yonkers, K. A. (2012). Premenstrual dysphoric disorder: evidence for a new category for DSM-5. American Journal of Psychiatry, 169(5), 465-475. Retrieved from https://psychiatryonline.org/doi/10.1176/appi.ajp.2012.11081302