There’s Not Just One Kind of PMS

A cursory search on the Internet will bring up a list of different of PMS: anxiety, depression, bloating, cravings, and headaches. of these types has several associated symptoms and, of course, remedies to relieve those symptoms. However, it’s important understand that dividing PMS into specific types is a popular, than a medical, practice. Many health-care practitioners and who discuss PMS types advocate alternative medicine rather than conventional Western medicine.

Is it PMS?

You may be convinced that your breast pain, mood swings, and bloating are caused by your oncoming period, but you may be wrong.

There are a number of conditions with symptoms that resemble mimic those of PMS, such as an unrecognized pelvic inflammation or thyroid disorders. These conditions are unrelated to PMS but are often confused with it, and women seeking treatment for PMS feel stymied when their symptoms don’t seem to be relieved. These conditions include:

  • Fibrocystic breast condition (which is also subject to premenstrual magnification)

  • Endometriosis, which can cause lower abdominal pain

  • Unrecognized pelvic inflammation

  • Dysmenorrhea (cramps that can also cause nausea and diarrhea)

  • Diabetes (which causes excessive thirst and hunger)

  • Endocrine disorders such as an overactive thyroid

  • Mood disorders

However, grouping PMS symptoms into clusters can be useful:it allows women to better understand their own experience, helps narrow treatment choices that address their specific symptoms, and may open alternatives to standard medicine, should they wish to try them.

Two Schools of Thought

There are two schools of thought on PMS types: conventional and alternative. The first does not divide PMS into types, while the second does.

Most conventional experts— generally, these include physicians, psychiatrists, and psychologists— prefer to speak about a range of PMS symptoms, as opposed to dividing PMS into distinct types. Conventional medicine does divide PMS symptoms into groups, which generally include physical, behavioral, and psychological symptoms. However, depending on the study author or the professional medical group, the names of the symptom groups, as well as the specific symptoms they include, can vary and may confuse the average person.

For example, a 1998 article in the journal American Family defines four groups of PMS symptoms: affective, cognitive/fluid retention, and general somatic.


Somatic is a term that means “of or pertaining to the body.” In the terms somaticor physical can be used to describe the same symptoms. Somatic/physical symptoms include dizziness, fatigue, nausea, and insomnia.

An article in 2003 by a different author in the same journal only three groups of symptoms: behavioral, psychological, and physical. For the average woman, this inconsistency means she needs to be vigilant when it comes to learning about understanding PMS to avoid confusing herself or her caregiver describing her symptoms.


What are the differences between affective, cognitive, and symptoms?

Affective symptoms impact mood, while cognitive symptoms impact reasoning, perception, and understanding. Psychological symptoms include both affective and cognitive components. So, for example, depression is considered both an affective symptom and a psychological symptom. In contrast, confusion or forgetfulness is a cognitive and psychological symptom.

As far as conventional medicine is concerned, grouping symptoms is not considered central to successful treatment and treating one set of symptoms often yields improvement in another set symptoms. Unlike the four or five popular types of PMS that exist, the only official medical subtype of PMS is PMDD.

Who Defines Types?

Unlike conventional PMS experts, many nutritionists and practitioners or proponents of alternative medicine promote the notion that there are different kinds of PMS based on clusters of symptoms. They also tend to identify the culprits responsible for each type PMS, such as an imbalance of hormones (a low ratio of progesterone compared with a high level of estrogen), mineral deficiencies, poor diet.


In 1980, Guy Abraham, an obstetrician/gynecologist who founded Optimox, Inc., a nutritional supplement company in Torrance, California, divided PMS into four different types: Type A: Anxiety, Type C: Carbohydrate or Cravings, Type D: Depression, and Type H:Hyperhydration.

Indeed, the bulk of the literature about PMS types is from alternative medicine experts, as well as from nutritional supplement companies. These individuals and groups often promote natural remedies, such as herbs, to combat the specific group of symptoms in each type of PMS. Women interested in alternative therapies may find the information useful, but individuals interested in conventional medical treatment must be aware that the descriptions of PMS and its causes vary widely depending on the viewpoint and treatment philosophy of each “expert.”

Opposing Views

Are these two views inherently contradictory? The evidence is unclear. One question centers around whether PMS symptoms in any given woman are consistent enough from month to month to be considered a “type” of PMS? To successfully treat a “type” of PMS, the practitioner would have to demonstrate that the symptoms appear month in and month out in a given woman. To date, there is research to support both sides of the story: that symptoms are stable and that they shift.

For example, a 1997 study of sixteen women found that over three cycles, the women's physical and mood symptoms showed remarkable stability from cycle to cycle. The study participants reported not only the same symptoms but ranked them similarly in terms of severity. Mood symptoms such as anxiety, irritability, and mood lability were the least likely to change from month to month and were also the most disabling.


What is mood lability?

Lability is the quality of shifting or changing rapidly. PMS researchers refer to mood lability to describe unstable or quickly changing moods.

According to this study’s findings, a woman who feels bloating, and fatigue in one month, with anxiety as the most symptom, is very likely to report those same symptoms in cycles and will continue to say anxiety is the most severe.

However, a 1999 study found less symptom stability, especially for turmoil (agitation), fluid retention, somatic symptoms, and arousal symptoms. In general, researchers are less able to prove that symptoms like food cravings and breast tenderness consistently appear month after month and that they are equally severe in every cycle— and without consistency, treating PMS becomes more difficult.

Common Versus Uncommon Symptoms

Consistency aside, there is also the issue of the sheer range PMS symptoms. Studies have documented some 200 different PMS symptoms, ranging from acne, asthma, vertigo, frequent urination, and rhinitis (inflammation of the nose), to heart palpitations, panic attacks, hot flashes, and in rare cases, even delusions and hallucinations. There are even some desirable PMS symptoms, although they are not widely discussed.


Up to 15 percent of women experience positive or desirable symptoms during their premenstrual phase. These symptoms include increased activity, heightened sexuality, improved performance on certain types of tasks, and feeling energetic.

It would be difficult to divide the entire body of 200 symptoms into discrete types, especially since some symptoms are related other health issues besides PMS. However, there are a number PMS symptoms that are more common than others, and for this reason; it is valuable to look at them as types of PMS.

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