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6 PMS symptoms that are (and aren’t) normal

Some PMS symptoms should never be ignored.

Many women have been dealing with premenstrual symptoms since they were teenagers first getting their periods. Most of the time, we can shake off light cramping, headaches and a bit of fatigue by popping a Midol, turning in early and reminding ourselves that our monthly torture will be over in a few days. But there are some symptoms that we may be associating with PMS that aren’t normal and warrant a trip to the gynecologist.

We spoke with two women’s health experts who weighed in on six common PMS symptoms, four of which could be cause for concern.

1. Spotting between periods

If you’re spotting once in a while, it can be the normal result of physical or emotional stress, says Dr. Sherry Ross, OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. But if you are having three or more months of erratic and heavy spotting, Ross says it is an important time talk to your health care provider to see if it’s due to a hormonal disorder, a sexually transmitted infection or another organic reason. Generally speaking, spotting between periods is not a common or normal symptom of PMS.

2. Extreme fatigue right before your period and around ovulation

PMS symptoms begin one to two weeks before your period, Ross says, and emotional changes such as mood swings, depression, crying spells, irritability and anxiety are the most common symptoms. Physical changes include bloating, breast tenderness, weight gain, food craving and acne. Although extreme fatigue can occur as a result of some of these types of symptoms, Ross says it’s not a typical symptom of PMS and should be discussed with your health care provider. Extreme fatigue around ovulation is not typical, according to Dr. Gerardo Bustillo, OB-GYN at Orange Coast Memorial Medical Center in Fountain Valley, California, who says you should visit a doctor to be evaluated for anemia or thyroid dysfunction.

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3. A pinching sensation in the abdomen

This is a common symptom associated with period cramping, but if it’s severe, you should visit your doctor.

4. Nausea

Again, if all else checks out, feeling slightly nauseous and turned off by food before your period isn’t a cause for alarm. “[This is] a normal symptom unless it does not resolve with the menses or is accompanied by fever, diarrhea, weight loss, or severe abdominal or pelvic pain,” Bustillo says.

5. Depression or sadness

Good news for anyone who can’t be in the same room as a Lifetime movie during their periods: Ross says emotional changes such as mood swings, depression and crying spells are completely common and normal symptoms of PMS. “As long as these emotional symptoms are manageable through lifestyle changes and are not affecting your work or personal life, they are not a cause for concern,” Ross says.

6. Gas and digestion issues

Again, it’s common to experience bloating and gas during your period, but Bustillo says if it isn’t resolved with your period or is accompanied by fever, severe pain or diarrhea, visit your doctor ASAP.

If you suffer from extreme PMS, you may be one of the 2 percent of women who are diagnosed with premenstrual dysphoric disorder (PMDD).

“Patients suffering from at least five symptoms, physical and behavioral, during the week prior to menses and whose symptoms resolve within a few days after the onset of menses may be classified as having PMDD,” Bustillo says. “It is important also to document that these symptoms have been present for most of the preceding year. First-line treatment includes medications in the category of selective serotonin re-uptake inhibitors (SSRIs), which are also used for depression and anxiety. Oral contraceptives may also be beneficial. Medical treatment is generally quite effective for PMDD.” 

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Age is also a factor when it comes to PMS. “As we age, there are more life stressors from work, marriage, children, divorce, hormonal changes and illness,” Ross says. “Women in their 30s may have less of these life stressors and can manage their PMS symptoms through lifestyle and behavioral changes. Women in their 40s may be affected by more of these life stressors and may have a more challenging time managing their PMS symptoms.”

Hormonal imbalance, which Ross says starts to peak between 45 to 55, also adds confusion as to whether PMS symptoms are actually PMS or are associated with perimenopause. “A health care provider may be the best source to understand exactly what the cause of your symptoms is and know what medication is recommended,” Ross says. “The average age of menopause is 51, so many emotional and physical changes occurring during this time represent this next chapter in a woman’s life.” 

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