PMS vs. pregnancy symptoms: How to tell the difference

Fatigue, cramping and mood swings—are they signs of premenstrual syndrome (PMS) or early pregnancy? If you’re trying to conceive, it can be confusing when symptoms overlap.

Here’s how to understand the differences and what steps to take next.

What is PMS?

Premenstrual syndrome refers to physical and emotional symptoms that begin a week or two before your period and sometimes stick around for the first day or two. These symptoms can impact your daily life and often recur with most cycles.

Common PMS symptoms include:

• Abdominal cramping or pain
• Bloating and water retention
• Breast tenderness
• Changes in appetite or food cravings
• Fatigue
• Headaches
• Mood changes such as irritability, anxiety or sadness
• Skin problems, like acne
• Trouble sleeping
• Weight gain

If your symptoms are severe enough to interfere with your daily activities, it can be helpful to keep a symptom log to share with your healthcare provider. It’s also important to rule out other conditions like depression, chronic fatigue, irritable bowel syndrome (IBS) and thyroid disorders that can sometimes mimic PMS.

Early pregnancy symptoms and signs to watch for

The most obvious sign of pregnancy is a missed period. However, some people experience light bleeding or spotting in early pregnancy that can be mistaken for a period.

Once you’ve missed your period, you might notice:

• Breast tenderness or fullness
• Fatigue
• Food aversions or sudden cravings
• Frequent trips to the bathroom
• Light cramping
• Light spotting, known as implantation bleeding
• Mild bloating
• Mood swings
• Nausea or morning sickness

Sound familiar? That’s because many early pregnancy symptoms overlap with PMS, which is exactly why it can be so hard to tell the difference between PMS symptoms and pregnancy symptoms based on how you feel alone.

PMS vs. pregnancy symptoms

While many symptoms of early pregnancy overlap with PMS, a few clues can help you distinguish between PMS and pregnancy symptoms.

Timing

PMS symptoms typically show up one to two weeks before your period and fade shortly after it starts. Pregnancy symptoms begin after a missed period and continue as the pregnancy progresses. Some people say they’ve felt pregnancy symptoms within a week of conception, about one week before a missed period.

Nausea

While some people feel queasy during PMS, persistent nausea—especially in the morning—is a stronger indicator of pregnancy.

Breast changes feel different

Both PMS and pregnancy can cause breast tenderness, but pregnancy-related changes often feel more intense and last longer. Your breasts also may feel fuller or heavier and you may notice changes in your nipples in early pregnancy.

Fatigue

Feeling tired is common with both PMS and pregnancy, but pregnancy-related fatigue tends to be more extreme. With PMS, your energy usually bounces back once your period begins, whereas with pregnancy, the exhaustion sticks around.

Cramping without bleeding

Mild cramping can happen with both PMS and early pregnancy. The difference? PMS cramps are typically followed by menstrual bleeding, while pregnancy cramps are not. If you are experiencing persistent abdominal pain after a confirmed pregnancy test or pain associated with symptoms such as bleeding, lower back pain or unusual vaginal discharge, be sure to contact your healthcare provider.

How to know if you’re pregnant

The only definitive way to tell the difference between PMS and pregnancy symptoms is to take an at-home pregnancy test. Modern tests are highly accurate and can detect pregnancy as early as the first day of your missed period.

If the pregnancy test is negative and your period still hasn’t shown up, wait one week and test again. Sometimes hormone levels need a bit more time to rise to detectable levels.

If your pregnancy test is positive, you are in the very early stages of pregnancy. Start taking prenatal vitamins if you haven’t done so already and schedule an appointment with your OBGYN to start your maternity care. Most providers see people around seven to nine weeks after their last menstrual period, but if you have specific concerns or symptoms, most will see you sooner.

When to reach out to your healthcare provider

Whether you’re experiencing PMS or wondering if you might be pregnant, contact your healthcare provider if:

• Your symptoms are severe or interfering with your daily life
• You’ve taken multiple pregnancy tests with conflicting or confusing results
• You have questions or concerns about fertility or preconception health
• You’re experiencing unusual symptoms like heavy bleeding or severe pain
• If you have a previous history of ectopic pregnancy or other pregnancy complications, reach out to your doctor sooner to determine if you should be seen earlier than the typical first pregnancy appointment.

Your provider can help rule out other conditions, confirm a pregnancy and support you wherever you are in your wellness journey.

Think you might be pregnant? Find an OBGYN to get the care and guidance you need.