What symptoms really mean you have PMS? Many reliable sources suggest there are over 150 PMS symptoms. Academic studies typically rely on a mere 17 symptoms that are often considered to be the true PMS symptoms. Most women have some idea of what most of those 17 are, including cramping, bloating, irritability, anger, headaches, crying easily, and the like.
A 2011 paper published in the Journal of Women's Health followed 1,081 women who were seeking conventional medical treatment for PMS and attempted to determine which of their symptoms were the most accurate predictors of PMS. That is, which symptoms really distinguished PMS from "not-PMS"? Keep reading and you'll find out what they discovered!
This might seem like a waste of time. After all, if you get crabby and crampy every month a week before your period, you have PMS, right? The problem is two-fold: it turns out that when people have to remember and record symptoms, their memory and accuracy are less than perfect. Apparently, we all have trouble comparing how we feel now to how we felt before; and our criteria for what a symptom is, or what its severity is or was, shifts continuously. So, it's important for researchers to be able to distinguish true PMS from "not-PMS."
An illustration might be in order: let's say our patient "Chantal" has actual clinical depression. It makes her lose interest in her usual activities and she has a tendency to withdraw from others when she's feeling down. And, like almost everyone with some depression, some days are better than others. Let's also say that, for cultural reasons, it's difficult for Chantal to admit depression (many cultures have a social taboo against psychological illness) but easier to admit to a condition that tends to be considered physical, like PMS. Since Chantal's symptoms are worse on some days than others, it's fairly easy to pay closer attention before the period and conclude that that is when the symptoms are occurring the most. Chantal probably isn't aware of her own cultural bias either, so she does not have an objective view of her own symptoms.
A doctor or researcher, who wants to help other doctors and researchers treat and investigate PMS, needs to have a way to distinguish PMS from clinical depression that could be mistaken for PMS. In conventional medicine, most treatments are drugs that have side effects and have the potential to cause bigger problems than they solve, so it's important to get the right fit between the diagnosis and the treatment. And, suggesting therapy or counseling to someone who has PMS—a biochemical disorder—rather than depression might end up being pretty frustrating for everyone!
So, back to the study. These researchers found that just six symptoms worked as well as the full 17 symptoms to distinguish PMS from "not PMS."
Those six symptoms: food cravings; cramps; anxiety/tension; mood swings; decreased interest in usual activities; and aches. These symptoms probably sound very familiar to anyone who has, or has had, PMS. Interestingly, this study found that food cravings were the most reliable indicator of PMS.
Does this mean that if your symptoms aren't on this list, you don't have PMS? Not at all. If you have (to pick a few symptoms that were not part of the six) premenstrual headaches, fatigue, irritability, and sadness most months, and these symptoms interfere with your life, you almost certainly do have PMS. What this research tells us is that those six symptoms, when they occur before the period, are very accurate predictors of PMS.
You might have read all this, and still think: "This is silly. What does it matter which six or nine or 18 symptoms I have? They happen every month before my period, so it must be PMS. Duh!" To that, we can only say, this is how medical research works. It's not perfect. It never correctly predicts anything with 100% accuracy. Over time, though, if enough studies can look at a similar set of circumstances from several different angles, we end up with a very accurate sense of what is going on.