The 200+ Symptoms of PMS You Might Not Know About
Premenstrual syndrome (PMS) is often dismissed as “bloating and mood swings.” But in reality, PMS can involve more than 200 documented symptoms—ranging from physical to emotional and behavioural changes.
For some, these symptoms are mild and manageable. For others—especially women with premenstrual dysphoric disorder (PMDD)—they can be severe, disabling, and life-disrupting.
Knowing which symptoms are part of normal PMS variation and which are included in the PMDD diagnostic criteria can make all the difference in getting the right diagnosis and treatment.
Physical Symptoms: From Bloating to Headaches
PMS can affect almost every system in the body. Common physical PMS symptoms include:
Abdominal bloating and water retention
Breast tenderness or swelling
Headaches or migraines
Joint and muscle aches
Fatigue or low energy
Changes in appetite (including food cravings)
Gastrointestinal issues (constipation, diarrhoea, nausea)
Skin changes (acne, oily skin, flare-ups of existing conditions)
Sleep disturbance
These symptoms are bothersome but are not part of the PMDD diagnostic criteria, which focuses on emotional and cognitive changes.
Emotional and Behavioural Symptoms
This is where the biggest distinction lies between PMS and PMDD.
Emotional/behavioural symptoms common in PMS:
Irritability
Mood swings
Anxiety or tension
Tearfulness
Brain fog and difficulty concentrating
Symptoms included in the DSM-5 diagnostic criteria for PMDD:
To be diagnosed with PMDD, a woman must have at least 5 symptoms in total, including at least one of these core mood symptoms:
Marked mood swings (sudden sadness, tearfulness, or increased sensitivity to rejection)
Marked irritability or anger (frequent conflicts)
Marked depressed mood, hopelessness, or self-critical thoughts
Marked anxiety, tension, or feeling on edge
Other PMDD criteria symptoms can include:
Decreased interest in usual activities
Difficulty concentrating
Fatigue or low energy
Changes in appetite, overeating, or specific cravings
Hypersomnia or insomnia
Feeling overwhelmed or out of control
Physical symptoms such as breast tenderness, bloating, or joint pain (as above, but only count if accompanied by emotional/behavioural symptoms)
Symptoms must:
Occur in the luteal phase (week before menstruation)
Improve within a few days after menstruation starts
Be absent or minimal post-menstruation
Cause significant distress or impairment in daily life
Why Symptoms Vary Between Women
Not every woman experiences PMS in the same way. Sensitivity to hormonal fluctuations—rather than absolute hormone levels—appears to drive symptoms. Genetics, stress, lifestyle, and co-existing conditions (like thyroid disease or endometriosis) all play a role.
This explains why one woman may mainly experience physical discomfort, while another struggles with mood-related symptoms severe enough to meet the criteria for PMDD.
How Symptoms Can Change Over Time
PMS and PMDD symptoms can shift across the lifespan:
Teens: Irregular cycles can make PMS unpredictable.
20s–30s: More stable, though pregnancy or contraception can alter symptoms.
40s (perimenopause): Symptoms often intensify, with overlap between PMS/PMDD and perimenopausal changes.
PMDD vs Bipolar Disorder: Why They’re Sometimes Confused
Because PMDD involves intense mood changes, some women are mistakenly told they may have bipolar disorder. Both conditions can cause depression, irritability, and difficulty functioning.
The difference lies in the pattern of symptoms:
PMDD: Symptoms are tightly linked to the luteal phase of the menstrual cycle and resolve shortly after menstruation begins.
Bipolar disorder: Mood episodes last weeks or months, and are not connected to the menstrual cycle.
Tracking symptoms with an app like Me v PMDD or Flo can help distinguish between the two, and a specialist consultation can prevent misdiagnosis.
Final Thoughts
PMS can involve over 200 symptoms, but only a specific cluster of emotional and behavioural symptoms make up the diagnostic criteria for PMDD. Recognising this distinction is crucial to avoid under- or misdiagnosis.
If you suspect your symptoms go beyond PMS, accurate diagnosis and treatment can be life-changing. If PMS or PMDD symptoms are disrupting your life, don’t dismiss them as “just part of being a woman.” Book a consultation with Dr Georgina Standen at Sirona Health for evidence-based, compassionate care.
FAQ
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Physical symptoms include bloating, breast tenderness, headaches, fatigue, and joint or muscle pain. Many women also experience changes in appetite, sleep, or digestion.
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Emotional and behavioural symptoms can include irritability, mood swings, anxiety, low mood, crying spells, poor concentration, or social withdrawal. In PMDD, these symptoms are more severe and can significantly affect daily life.
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To diagnose PMDD, a woman must experience at least five symptoms, with at least one being a core mood symptom (such as depressed mood, marked irritability/anger, mood swings, or anxiety). These must occur in the luteal phase of the cycle, resolve after menstruation starts, and cause significant impairment.
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Yes. Both conditions involve mood changes, but the timing is different. PMDD symptoms are strictly cyclical—appearing before a period and resolving when it begins—whereas bipolar episodes last weeks to months and are not tied to the menstrual cycle.
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Hormonal sensitivity differs from person to person. Genetics, stress, lifestyle, and underlying health conditions can all influence the type and severity of symptoms experienced.
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Using cycle-tracking apps such as Me v PMDD or Flo can help you spot patterns, distinguish PMS/PMDD from other conditions, and support a more accurate diagnosis.
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If your symptoms are severe or affecting your quality of life, book a consultation with a healthcare professional. At Sirona Health, Dr Georgina Standen offers expert support, cycle mapping, and evidence-based treatment options tailored to your needs.