Is it Pregnancy or PMS?

Cramping. Fatigue. Breast tenderness. The symptoms of premenstrual syndrome mimic those of pregnancy so well, it can be difficult to tell the difference. Hoag OB/Gyn, Nura S. Sobhanian, M.D., offers some helpful tips to help you decode what your body is trying to tell you.

“PMS symptoms overlap with symptoms of pregnancy, so when it comes to deciphering between the two, it’s important to look at the timing and the reason for the following symptoms,” Dr. Sobhanian said.

Cramps. About 90% of women experience some degree of uterine cramping five days before their period. But women can also experience cramping in the first and even second trimester as their uterus prepares for their baby. So, when it comes to cramping, is it PMS or pregnancy?

“Not every woman has cramping in pregnancy, but a good majority of women experience cramps prior to their period,” Dr. Sobhanian said. “When a pregnant woman has cramps, it can often feel like a period cramp. The symptoms are the same, but the timing is different. Most of the time, the cramping experienced in pregnancy will come five to six weeks after pregnancy – or one to two weeks after a missed period. If the cramping cannot be addressed with Tylenol, hydration and rest, I would recommend seeing a physician for further evaluation. If you are unsure if cramping is due to your period or pregnancy, there is no harm in taking a pregnancy test.”

Mood shifts. The abrupt drop in our estrogen can also lead to drops in serotonin, dopamine and melatonin. For some women, this can be seen as mood swings, and for others, this can be mood shifts that can meet criteria for depression. The latter is less common and definitely a reason to see your doctor. For women with mood swings, it's important to avoid inflammatory foods, hydrate well and get a good night's sleep.

“Again, timing is a differentiator. Mood swings during PMS typically happen two weeks after ovulation, while pregnancy mood swings can occur throughout pregnancy and can also be caused by physical discomfort,” Dr. Sobhanian said. “Assess how much your mood swings are affecting your daily life and consider avoiding caffeine and make sure to get good sleep.”

Nausea, cravings and food aversions. While most people associate nausea and food cravings (or aversions) with pregnancy, digestive discomfort can be a symptom of PMS as well. The important thing to remember about nausea is that not everyone experiences it during pregnancy.

“The movies always show a woman vomiting to indicate that she’s pregnant, but not everyone has symptoms to that degree,” Dr. Sobhanian said. Most people will have bloating and fatigue, which can also overlap with premenstrual symptoms. The nausea associated with pregnancy tends to occur closer to six weeks of pregnancy (for >80% of women) and is due to the rise in HCG hormone. The nausea that can occur in PMS is typically due to high amounts of prostaglandins which can lead to nausea and more common symptoms like cramping. It's less common for every woman to have nausea leading up to their period. The bloating and fatigue of PMS will be in the days leading up to a period. In the case of pregnancy, you will usually have bloating and fatigue after missed menses. This may then prompt someone to take a urine pregnancy test. If you are more than a week late, that is a sign that you might be pregnant. Not everyone will have symptoms like nausea, bloating, fatigue and food cravings, but everyone will have a missed period.

For a complete list of OB/GYN providers, please visit Find a Doctor | Hoag Hospital.