If you've ever been told "it's bipolar" when describing your PMDD symptoms, you're not alone. The two conditions can look eerily similar on the surface....mood swings, irritability, depression, bursts of energy or rage. But here's the thing: they're fundamentally different, and getting the right diagnosis matters.
Let's break it down in a way that actually makes sense.
The Timing Is Everything
This is the biggest clue. I suppose the only good thing about PMDD, is that PMDD is like clockwork. It's tied to your menstrual cycle. Symptoms typically show up in the luteal phase (the week or two before your period) and disappear within a few days after your period starts. It's predictable, cyclical, and often feels like you're two different people depending on where you are in your cycle. PMDD is very much a Jekyll and Hyde situation.
Bipolar disorder on the other hand, doesn't follow your cycle. Mood episodes (manic, hypomanic, or depressive) can last weeks or even months, and they don't magically lift when you get your period. The timing is random, not hormonal.
The Nature of the Mood Changes
PMDD: Your mood shifts are intense but they're reactive and often tied to emotional and environmental sensitivity. You might feel rage over something small, deep sadness, anxiety, or like you're crawling out of your skin. You may fantasize about ending your life or be convinced that everyone in your life and maybe even the entire world, would be better off without you, But the mind is a liar. We'll get to that another day.
Bipolar: Mood episodes can happen without any trigger at all. Mania or hypomania might make you feel invincible, need less sleep, talk rapidly, or take risks you normally wouldn't. Depression can be crushing and persistent with bouts of rage and irritability. These aren't just "bad days". They're distinct episodes with their own patterns.
Why Do Doctors Get It Wrong?
Here's the frustrating part: many doctors don't track cycles or ask the right questions. PMDD has been known about since 2013 and may doctors graduated long before that, so perhaps that is a small part of the issue. But...willful ignorance is a thing and it's very frustrating when you're begging for help. And if you've been begging for help and coming up short, I see you and I understand completely. Let me remind you that your rage directed towards that...is valid. Let's move on before we crash out over it.
If you show up during your luteal phase feeling depressed and irritable, doctors might see "mood instability" and jump to bipolar. Or they might dismiss it as "just PMS" without understanding how debilitating PMDD actually is. Silly rabbits. Too bad they can't experience it just for a little while, first hand ...so they can finally truly understand.
This is partly why tracking your symptoms is so important. Use a calendar, an app, whatever works...just document when your symptoms happen in relation to your cycle. Bring that data to your appointments. It's hard to argue with a pattern that repeats every single month. The more months of data the better, but 3 should be plenty if the pattern is truly cyclical.
Can You Have Both?
Unfortunately, yes, it's possible (though not common) to have both PMDD and bipolar disorder. In that case, you might notice that your bipolar symptoms get worse during your luteal phase. This is called "premenstrual exacerbation" and it's another reason why tracking is crucial.
Treatment Differences Matter
PMDD can respond well to SSRIs (especially when taken just during the luteal phase), hormonal treatments, or lifestyle changes. Bipolar disorder typically requires mood stabilizers. For those with bipolar, SSRIs can sometimes trigger manic episodes.
Getting the wrong diagnosis means getting the wrong treatment and that can make things worse, not better.
The Bottom Line
If your symptoms follow your cycle like an aggressive shadow, disappearing and reappearing on schedule, that's PMDD. If your mood episodes last for weeks regardless of where you are in your cycle, that's more likely bipolar.
You know your body. You know your patterns. Don't let anyone dismiss what you're experiencing, and don't be afraid to advocate for the right diagnosis. You deserve treatment that actually works.
Check out our advocacy scripts in PMDD Resources.
