This subgroup of PMS is characterized by weight gain (greater than three pounds), abdominal bloating and discomfort, breast congestion and mastalgia, and the occasional swelling of the face, hands and ankles. These symptoms are due to an increased extracellular fluid volume which is in turn due to an excess of aldosterone which causes increased fluid retention. Aldosterone excess during the luteal phase of PMS-H patients may arise due to any of the following factors:

• Stress - aldosterone is secreted by the adrenal cortex under the control of ACTH, which is secreted by the pituitary in response to stress, high serotonin levels and angiotensin II
• Estrogen Excess - estrogen increases hepatic excretion and production of angiotensinogen, the precursor to angiotensin II
• Dopamine Deficiency - a relative dopamine deficiency has been demonstrated in PMS-H patients. Dopamine suppresses aldosterone formation in the adrenal glands and, in the kidneys, is naturetic and diuretic.