PMS: Often Joked About, But Not A Laughing Matter
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What is Not PMS?

Sometimes it is easier to describe what something is not, rather than what it is.  First and foremost, PMS is not funny, it is not "weak", and it is certainly not "all in your head".  It is not a mental illness.  It is a legitimate medical condition with physical and psychological symptoms and consequences. 

Interestingly, while menstrual cramps or painful periods are very common, they are not part of the diagnostic criteria for PMS.  This is a separate medical diagnosis called "dysmenorrhea".  Many women have menstrual cramps without PMS; many women have PMS without menstrual cramps.  The good news is that these cramps are generally treatable with non-prescription nonsteroidal anti-inflammatory medicines (e.g. Advil©, Nuprin©, Motrin©, etc.).  There are also more potent prescription medicines available in this class.  In many cases, physicians recommend taking oral contraceptives to reduce cramping.  In women with severe cramps before menses (or on the first day only), endometriosis must be considered.  This is essentially a misplaced out-growth of the lining of the uterus, which is painful and responds to cyclical changes.  While endometriosis is often a difficult diagnosis, it is worth evaluating and treating:  endometriosis is a very common cause of infertility as well as pain, disability, and discomfort.  It is also common to have dysmenorrhea or endometriosis along with PMS.

Moodiness and irritability are generally considered the hallmark symptoms of PMS, but legitimate anger or appropriate emotional outbursts when a woman happens to be in the second half of her menstrual cycle are more likely to be related to the incident than to PMS.

Many women have severe, throbbing headaches, often on one side of the head, often associated with nausea, vomiting or visual changes that begin 1-3 days before their periods.  These are most likely menstrual migraines, which some women get monthly.  Even though they occur before the menstrual period, they are not part of the PMS symptom complex.  The good news is that they are treatable with several different migraine medicines. Yes, it is possible to have menstrual migraines as well as PMS.  If you are one of these patients, your doctor will probably recommend resolving the migraines first and then looking at a revised PMS Diary.

Finally, PMS is not the same thing as a relatively new psychiatric disorder called premenstrual dysphoric disorder, or PMDD, which represents a subset of PMS in which marked mood disturbances predominate.  Fewer than 5 of every 100 women with premenstrual symptoms could be classified in this category.