You may think PMS is common and recognizable, but don’t by so-called typical symptoms. They all have more than culprit.

Do you have breast pain and tenderness? Sure, it may but it can also be fibrocystic breasts, pregnancy, too much in your diet, or even muscle strain. Bloating and nausea? be irritable bowel syndrome, lactose intolerance, or the stomach Do you suffer from raging headaches? Maybe they’re caused posture, too much time spent staring at a computer, carbohydrate binges, or over-reliance on pain relievers.

Additionally, our habits and health conditions often work in concert so that PMS symptoms can become more severe and more extensive, but their exact causes can be tough to pin down. A stressful job may cause not only physical pain (headache and backache, for example), but also drive you to eat poorly and not exercise, so that you’re bloated, constipated, have low energy, and generally feel unwell—on top of having PMS! Severe PMS can make you depressed and having depression exacerbates PMS symptoms. If you’re older, what you think is PMS might actually be perimenopause.

If you’re not entirely sure you have PMS, something else, or both, here are some things to think about:

• Do the people in your life say you have PMS? If the symptoms are mild and there are other issues in your life that cause you stress or pain, you may not even realize your symptoms are cyclical. However, your family or friends might give you better perspective.

• Does your weight fluctuate every month?

• Are you sleeping well? Sleep problems are one sign of PMS.

• Have your periods been regular, or have you missed a cycle recently? Irregular cycles for older women are one sign perimenopause.

• At what point in your cycle do your symptoms appear? At ovulation? Just before your period?

• Do your symptoms abate after your period?

• Are your symptoms primarily physical, emotional, or cognitive? Do you have a combination of symptoms?

• Do you have the same symptoms every month, or do they vary from month to month? PMS symptoms can fluctuate from cycle to cycle, but if your symptoms suddenly shift, it could indicate another cause.

• How long have you suspected PMS?

• Has your PMS gotten worse over time?

Going to the Doctor

Your family physician or gynecologist is a good first point of contact. He or she can help you decipher what's going on with your body, identify possible causes, and suggest ways to relieve pain. He will also be able to refer you to other experts for further help However, it helps to go to the doctor prepared.

You should expect not only to ask questions but to answer as well. If you have severe PMS symptoms and want treatment the time of your first visit, you may be in for an unpleasant Medical doctors will only diagnose PMS if you chart your symptoms for two to three months, and their first course of action is usually prescribe self-care, such as exercise or diet changes.

PMS is diagnosed when symptoms occur regularly and in luteal phase of a woman’s cycle. The American College of Obstetrics and Gynecology uses the following diagnostic criteria:

• At least one affective or somatic symptom during the before menses in each of the three previous cycles symptoms include depression, angry outbursts, anxiety, confusion, social withdrawal; somatic symptoms include breast tenderness, abdominal bloating, headache, swelling of extremities)

• Symptoms are relieved from days four through thirteen menstrual cycle (Day One is the first day of bleeding.)

If you haven’t begun to chart your symptoms or don’t keep of your periods, now is the time to start. (Chapter 13 explains to keep both menstrual and PMS diaries and provides examples what they might look like.)

Once you see your medical provider, use the appointment time initiate a conversation about PMS: describe the symptoms, your medical history, and any stressors that impact your life. When talking your doctor, here are some of the questions you might want to ask:

• Are my symptoms consistent with PMS? (What you consider a PMS symptom may not be, or it may be caused by some other condition.)

• Can stress be causing my symptoms? (Be prepared describe your symptoms, as well as to describe how often and how severely you experience them, and expect to list the things, events, or people in your life that cause you stress.)

• Is it my diet? (The kinds of food you eat may cause mood swings and bloating.)

• Is it a nutritional deficiency? (Calcium, magnesium, and vitamins D and E have all been implicated in PMS. Keep a food diary or describe your diet to your physician.)

• What treatments are available?

• Will birth control pills help? (For some women, oral contraceptives relieve PMS symptoms; other women experience worsening symptoms.)

• Can I take over-the-counter pain relievers?

• How will they interact with my medications?

Your doctor will want to know when in your cycle your symptoms appear, when they disappear, and when they are mildest severe. The more detail you can provide, the better your are of getting effective treatment. In addition, since some PMS-symptoms may be related to irregular periods, it’s important if you ovulate regularly. (Chapter 13 covers how to keep menstrual and PMS diaries.)