Pregnancy or PMS? How to tell the difference

Is it PMS or am I pregnant? It’s one of the most-asked questions in the two week wait, because so many early pregnancy symptoms feel exactly like the days before a period.

Why they feel the same

It’s not fully understood why PMS happens, but it’s thought to be linked to changing hormone levels during your menstrual cycle. Some people are more sensitive to those changes than others.

If you’re pregnant, your hormones keep changing, and once the pregnancy hormone hCG starts to kick in you may notice early pregnancy symptoms. That usually happens around 4 to 6 weeks of pregnancy, counted from your last period, which is around the time your period is due. So in the days before a period, your body can feel much the same either way.

How common PMS is

The Royal College of Obstetricians and Gynaecologists (RCOG) says nearly all women have some symptoms before their period, usually in the 2 weeks before it. Between 2 and 4 in 100 have symptoms severe enough to stop them getting on with daily life.

Symptom by symptom

Sore or tender breasts

Both. Breast tenderness is a common PMS symptom, and in early pregnancy your breasts may get larger and feel tender, just as they might before a period. What points more to pregnancy is other breast changes: Tommy’s says the veins may be more visible, and your nipples may darken and stand out.

Tiredness

Both. PMS can cause tiredness or trouble sleeping. Early pregnancy tiredness is often described as feeling extremely tired after your usual daily activities, and Tommy’s says it isn’t like ordinary tiredness.

Mood changes

Both. PMS can bring mood swings and feeling irritable, anxious, upset or low. In early pregnancy, you might feel lots of different emotions, laughing one minute and crying the next.

Cramps

Both. Cramping is a common PMS symptom, and early pregnancy can bring cramping a bit like period pains. If you could be pregnant, get urgent advice if the pain is severe, on one side, or doesn’t ease with rest.

Bloating

One of the most common PMS symptoms. Bloating isn’t on the NHS list of early pregnancy signs, though constipation is. See pregnancy or bloating?

Food cravings and appetite

Both. Changes in appetite and food cravings are common with PMS. In early pregnancy, you might crave new foods or lose interest in foods you usually enjoy.

Headaches

Both. Headaches are a common PMS symptom, and the NHS says they can be common in early pregnancy too. Drinking plenty of fluids can help.

Spots and greasy hair

Both are on the NHS list of PMS symptoms, but not on its list of early pregnancy signs, so they don’t point towards pregnancy.

Feeling or being sick

Points more to pregnancy. It isn’t one of the usual PMS symptoms. In pregnancy it can happen at any time of day, and most people start noticing it at around 4 to 6 weeks.

Taste and smell

Points more to pregnancy. Some people notice a metallic taste in their mouth, or become sensitive to certain smells.

Needing to pee more often

Points more to pregnancy, if there’s no pain or discomfort. Pain or burning when you pee can be a sign of a urine infection. If you might be pregnant and have symptoms of one, ask for an urgent GP appointment or call NHS 111.

Discharge

More vaginal discharge, without soreness or irritation, points more to pregnancy. See pregnancy vs period discharge.

Bleeding

A period that arrives and is a normal flow for you points to PMS. No period, if your cycle is regular, is the clearest sign of pregnancy. Some people have light spotting instead of a period around the time it’s due. This is often called implantation bleeding, though it isn’t certain that implantation is what causes it. If you could be pregnant, get any bleeding checked.

Clues that point more to PMS

PMS symptoms usually get better once your period starts. If you get the same symptoms at the same point in most cycles, that’s a strong hint it’s PMS.

A symptom diary helps. The NHS and RCOG suggest writing your symptoms down for at least 2 menstrual cycles in a row. Once you know your usual pattern, it’s easier to notice when something’s different.

Does pregnancy feel the same as PMS?

Early on, it can feel almost identical. Some people say it just feels ‘different’ in a way they can’t describe, and others notice nothing at all. Neither tells you much on its own.

The only way to know

Some early tests can be used from 5 days before your period is due (the packet may say ‘6 days before your missed period’), but they won’t pick up every pregnancy that early. Testing from the day your period is due is more reliable, though a negative can still be wrong if there isn’t enough hCG yet. If your period doesn’t come, test again a few days later.

See how early can I take a pregnancy test? If you’re having fertility treatment, test on the date your clinic gives you. Testing early may give a false result.

Getting help with PMS

Things that can help include regular exercise, a healthy, balanced diet, eating smaller meals more often, getting plenty of sleep, and finding ways to reduce stress, like yoga or meditation. Don’t smoke, and cut down on alcohol. If you’re trying to get pregnant or could be pregnant, the NHS recommends not drinking at all.

See your GP if self-help hasn’t worked or your symptoms affect your daily life. Treatments include hormonal medicines such as the combined pill, cognitive behavioural therapy (CBT) and antidepressants. If you’re trying to get pregnant, tell your GP, as it affects which treatments suit you.

A more severe form of PMS, called premenstrual dysphoric disorder (PMDD), has symptoms that are much more intense and can have a much bigger effect on everyday life. Some people with PMDD feel very low or suicidal. If you feel suicidal, call 999 or go to A&E. Don’t drive yourself: ask someone to take you, or call 999 for an ambulance. If you think you might have PMDD, speak to your GP.

Questions people ask

How many days before a period does PMS start?

The RCOG describes PMS as symptoms in the 2 weeks before your period. They usually get better once your period starts.

Can you have PMS symptoms and still be pregnant?

Yes. Many early pregnancy symptoms are the same as PMS symptoms, so you can feel exactly as you usually do before a period and still be pregnant. A test is the only way to know.

Is it PMS or pregnancy if I have cramps but no period?

It could be either. Mild cramping is common before a period and in early pregnancy. Take a test, and get urgent advice if the pain is severe, on one side, or doesn’t ease with rest. See implantation cramps.

Do PMS symptoms feel stronger if you’re pregnant?

Some people say early pregnancy feels stronger or different, but others notice nothing. There’s no reliable way to tell from how strong your symptoms are.

When to get help

Mild cramps that ease with rest are usually nothing to worry about. But if you’re pregnant, or think you could be, get urgent advice from your maternity unit, an early pregnancy unit or NHS 111 if you have:

any bleeding or spotting, even if it’s light
tummy pain that’s severe, on one side, or hasn’t eased after resting for 30 to 60 minutes
pain in the tip of your shoulder

Call 999 if you have bleeding along with severe tummy pain, pain in your shoulder, or feeling sick, faint or dizzy, or if the bleeding is heavy (soaking a pad soon after putting it on). Also call 999 if you have sudden, sharp and intense tummy pain and you feel very dizzy or faint, feel sick or look very pale. These can be signs of an ectopic pregnancy or a miscarriage that need treating straight away.