Is It PMS, or Something More Serious?

Do you feel like living under your blanket for a week or two every month? Is a tornado of emotions and intense physical symptoms forcing you into hiding whenever you’re on your period?

Premenstrual syndrome (PMS) could be to blame, but not necessarily. Here’s what you need to know.

Medically reviewed in December 2020.

PMS is a collection of symptoms that women tend to experience around the time of their period. It usually starts a few days before menstruation.

“The symptoms are categorized as emotional or physical, but many women have both,” explains Christopher Manipula, MD, an OBGYN from Chippenham Hospital in Richmond, Virginia.

Emotional symptoms include irritability, crying spells and anxiety. Physical symptoms extend to:

• Breast tenderness
• Bloating
• Headaches
• Gastrointestinal problems
• Dizziness

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

“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 period is over. “With depression or anxiety, the symptoms are present all month long,” he explains. They may also worsen around the time of your period.

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

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

“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 birth control that’s right for you.

Endometriosis, or “endo,” is known to affect around 5 million American women. Many researchers believe the real number is higher, however, since it’s often ignored or brushed off as PMS.

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

Endometriosis 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.

Endo 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.

Even though it’s highly treatable when found early, the American Cancer Society predicts 13,770 women will die of ovarian cancer in 2021. That’s because if there are any noticeable symptoms, they’re often blamed on PMS, constipation or another common condition.

These symptoms include:

• Abdominal or pelvic pain
• Bloating
• Feeling full quickly
• Frequent or urgent 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.

“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 healthcare provider (HCP) might ask you to keep a journal for one to three months to learn more about your symptoms. It may include:

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

PMDD treatments include hormone therapies, antidepressants and talk therapy. If you are having thoughts of suicide, go to an emergency room right away, reach out to your HCP or dial the National Suicide Prevention Lifeline at 1-800-273-8255.

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 12 to 72 hours around the start of menstruation.

Pain may be caused by your period itself, called primary dysmenorrhea. In this case, your HCP may prescribe pain relivers or birth control pills. You can help minimize your period pain by:

• Taking ibuprofen as soon as it starts
• Placing a heating pad over the painful area
• Avoiding caffeine, nicotine and alcohol
• Exercising
• Getting sufficient sleep (seven to nine hours nightly for average adults in good health)
• Reducing stress

Your pain may also be caused by another condition, such as endometriosis or fibroids. This is called secondary dysmenorrhea, and requires treatment of the primary condition.

If PMS is disrupting your job performance, your relationships or your daily function, 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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