Is It PMS, or Something More Serious?

Debilitating cramps, Hulk-like rage, crying at work—sometimes it's more than PMS.

1 / 10

Do you feel like living under your blankets for one or two weeks every month? Are tornado-like emotions and intense physical symptoms forcing you into hiding whenever you’re on your period?

PMS, or premenstrual syndrome, could be to blame, but not necessarily. We spoke with Christopher Manipula, MD, an OBGYN from Chippenham Hospital in Richmond, Virginia, about the conditions that are often mistaken for PMS.

Medically reviewed in January 2020.

What exactly counts as PMS?

2 / 10 What exactly counts as PMS?

PMS is a collection of symptoms that women tend to experience around the time of their period. “PMS usually starts a few days before and may end up to four days after menstruation,” says Dr. Manipula. “The symptoms are categorized as emotional or physical, but many women have both.”

Emotional symptoms include irritability, angry outbursts, crying spells and anxiety. Physical symptoms extend to breast tenderness, bloating, headaches, gastrointestinal problems and dizziness.

One of the big challenges with PMS is that the symptoms are often vague and generalized, says Manipula. That can make it difficult to tell PMS apart from other conditions. Here are six health issues that are often mistaken for PMS.


3 / 10 Depression

“Depression and anxiety disorders are the most common conditions that overlap with PMS,” says Manipula. “In fact, about a half of all women who seek treatment for PMS have one of these two disorders.”

Here are some of the symptoms that could signal depression:

  • Loss of interest in the activities you once enjoyed
  • Feelings of hopelessness
  • Weight gain or loss
  • Sleeping too much or too little
  • Trouble concentrating

How can you tell whether it’s depression or PMS? “With PMS, the symptoms tend to ease up about four or five days after your cycle is over. With depression or anxiety, the symptoms are present all month long, whether or not you're on your cycle.”

The transition to menopause

4 / 10 The transition to menopause

The average age that women hit menopause is about 51. However, the transition to menopause—called perimenopause—can start years before that. Many women experience intermittent periods during perimenopause.

Since the symptoms are similar to PMS and may overlap, women might not realize they’re still ovulating and have sex without birth control. They also might suffer through menopause symptoms—such as sleep disturbances, depressed mood, low libido and foggy thinking—that are highly treatable.

“Once your cycle stops for over a full year, you’ve likely completed the transition,” says Manipula. Until then, work with your OBGYN to treat any bothersome symptoms and to find a birth control that’s right for you. 


5 / 10 Endometriosis

Endometriosis, or “endo,” affects around 5 million American women, but researchers believe that number’s higher since it’s often ignored or brushed off as PMS.

“Many of the symptoms are the same,” says Manipula. “Like bloating, pain and cramping. I think that’s why people—even healthcare providers—sometimes overlook endometriosis.”

Endo involves the growth of uterine tissue, or endometrium, outside of your uterus, usually on other organs in your abdomen. The tissue bleeds each month with your period, no matter where it is. The pockets of blood can cause severe pain, including pain during sex, urination or bowel movements. If you have debilitating periods, it’s not “just part of being a woman;” ask your OBGYN if endo could be to blame.

Ovarian cancer

6 / 10 Ovarian cancer

About 14,000 women will die of ovarian cancer in 2017, predicts the American Cancer Society—even though it’s highly treatable when found early. That’s because if there are any noticeable symptoms, they’re often blamed on PMS, constipation or another common condition. Symptoms include:

  • Abdominal pain
  • Bloating
  • Feeling full quickly
  • Frequent urination

“The challenges with ovarian cancer are that there’s no screening test for it, and the symptoms are so vague that it’s easily dismissed,” says Manipula. “By the time symptoms worsen, and a woman goes to her doctor, it’s often advanced.”

If your symptoms last longer than two weeks, happen frequently, aren’t consistent with your normal periods or you’re simply concerned, call your OBGYN.

Premenstrual dysphoric disorder (PMDD)

7 / 10 Premenstrual dysphoric disorder (PMDD)

“PMDD, or premenstrual dysphoric disorder, is a severe form of PMS,” says Manipula. "It’s diagnosed when a woman has at least five symptoms, such as frequent crying, anger that leads to conflict, a lack of interest in favorite activities, appetite changes, headaches, muscle pain, bloating and others."

To help make a diagnosis, your doctor might ask you to keep a journal for one to three months to learn more about your symptoms. You may be asked to record:

  • What you were doing before/after each symptom started
  • Your exercise and eating habits
  • Sleep schedule
  • Any medications, teas or supplements you take

PMDD treatments include hormone therapies, antidepressants and talk therapy.


8 / 10 Dysmenorrhea

The terms PMS and dysmenorrhea are often used interchangeably, but they aren’t the same thing. Dysmenorrhea refers to especially painful periods, usually involving cramps in the lower back and abdomen. Cramping typically lasts for around 12 to 72 hours around the start of menstruation.

Pain may be caused by your period itself, called primary dysmenorrhea, or by another condition like endometriosis, secondary dysmenorrhea. Keep period pain to a minimum by:

  • Taking ibuprofen as soon as it starts
  • Placing a heating pad over the painful area
  • Avoiding caffeine, nicotine and alcohol
Is PMS contagious?

9 / 10 Is PMS contagious?

Do your close friends all experience PMS at the same time each month? Has everyone in your group synced up with one “alpha uterus?” It’s widely believed that women in close quarters will end up with synchronized menstrual cycles. One study from the 1970s, which tracked the periods of women sharing college dorms, supported this theory. However, the study’s drawn criticism for flawed methods over the years.

To demystify the “alpha uterus” urban legend, researchers from the University of Oxford teamed up with the period-tracking app Clue. They collected data from Clue users who reported that their periods lined up with other females, and then followed 360 pairs of women over the course of at least three cycles. Shockingly, the women were actually more likely to desynchronize, or experience greater differences over time, and living together didn’t have an effect. In fact, the average distance between cycles was 10 days at the start of the study, 38 days by the end.

Still convinced your uterus rules them all? It could be due to chance, or the fact that period symptoms are simply present for large chunks of every month, so there’s bound to be some overlap. 

When to get help for PMS

10 / 10 When to get help for PMS

If PMS is disrupting your job performance, the way you interact with family and friends or your ability to function in daily life, make an appointment with your OBGYN. Not sure if you’re experiencing PMS or something else?

“My mantra, or philosophy for all of my patients is, if you're concerned about anything, just come see me,” says Manipula. "If something is on your mind, give your doctor a call because we’re worried about whatever is worrying you."

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