Most of us know it's coming.  We might feel cranky, crampy and gloomy; maybe a headache and a little water retention.  No big deal—we pick up some tampons and a pint of ice cream and wait for our period to start.  For some women, however, the days and even weeks leading up to their period make them so angry, irritable, or sad that it affects their ability to lead a normal life.  These women may have premenstrual syndrome (PMS), but they may have something else.

According to the American College of Obstetrics and Gynecology (ACOG), "Premenstrual syndrome can affect menstruating women of all ages and backgrounds. The cause of PMS is unclear. However, the symptoms can [often] be managed. . .. Symptoms of other conditions can mimic PMS. For instance, premenstrual dysphoric disorder (PMDD). PMDD affects a small percentage of women with PMS."

But wait, there's more: Other conditions sometimes confused with PMS include depressive and anxiety disorders, migraines, chronic fatigue syndrome, irritable bowel syndrome, menopause, and endocrine problems.

Why the confusion? 

Many of the symptoms associated with PMS overlap with those of other disorders.  For example, women with PMS, PMDD, depression and menopause may all experience irritability, insomnia, restlessness, headaches, angry outbursts, crying spells, anxiety, and inability to participate fully in their normal lifestyle.  Migraines manifest with a variety of symptoms and are challenging to diagnose. Symptoms leading up to a migraine often include sleepiness, irritability, fatigue, depression, euphoria, and cravings for sweet or salty foods. 

Keep a record

ACOG recommends women help their physicians sort out their diagnosis and treatment by keeping a symptom record. 

Write your symptoms on a calendar, or create a chart that includes the date your period begins each month and a list of symptoms you experience.  Log how you feel every day for two or three months.  Rate each symptom daily on a scale of 0-10. If you have no symptoms on a particular day or the symptom is minor, write "0."  Save "10" for your most severe symptoms and days. 

Take Control

If your doctor diagnosis PMDD, a depressive or anxiety disorder, or menopause, medications have been proven to help.  Additionally, diet and lifestyle changes help many women cope without or in addition to pharmaceutical intervention.  These include:

Exercise. Studies show that women who exercise at least 30 minutes per day, most days of the week experience fewer symptoms of depression, anxiety and PMS.  Other studies show major improvement of menopausal symptoms in women who exercise.

Diet. Eliminating salt, alcohol, caffeine and sugar helps many women deal with both the physical and emotional symptoms of PMS, PMDD, menopause, anxiety, and depression.

Counseling - Research published in Science Daily indicates that psychological interventions may help PMS and suggests that cognitive behavioral therapy significantly reduces both anxiety and interference of symptoms on daily living.  Individual counseling, group counseling, and stress management (like yoga and meditation) may also help.

Antidepressants. Science Daily also reports that low doses of certain antidepressants taken two weeks before their period helps some women with moderate-to-severe PMS.  Ask your doctor which ones may be appropriate for you.