Premenstrual Syndrome Diagnosis

  • Diagnosis

    Premenstrual syndrome (PMS) encompasses a wide range of physical, emotional, and behavioral problems that occur cyclically in association with menstrual periods.

    Most people use the term premenstrual syndrome (PMS) somewhat loosely to describe a wide variety of mild and moderate symptoms. PMS occurs during the second half of the menstrual cycle (the premenstrual period) when certain hormonal changes occur. Symptoms typically involve physical discomfort such as breast tenderness and swelling, weight gain, and pelvic pain. Food cravings and mood changes such as irritability, anxiety, or depression are also common with PMS. Symptoms usually develop after midcycle ovulation and resolve within a day or two of the onset of menstrual bleeding.

    Most women are affected by PMS at some point during their reproductive years. Approximately 20% to 40% of women experience mild symptoms, while 2% to 10% experience symptoms that are severe enough to interfere with their work, social activities, or relationships. There are a variety of treatment options for the relief of PMS symptoms, including exercise, stress reduction, dietary changes, and medications.

    A related premenstrual disorder, called premenstrual dysphoria disorder (PMDD), has more distinct and severe signs and symptoms than PMS. Marked emotional disturbances that are severe enough to interfere with usual activities must be present for a diagnosis of PMDD. These emotional disturbances may include moodiness, anger or irritability, anxiety, and depression.

    PMS is likely caused by many factors.

    Because numerous symptoms have been attributed to PMS, clinicians consider it likely that the syndrome has several causes. Monthly hormonal changes certainly play a part; however, no hormonal abnormalities have been identified in individuals who suffer from PMS. In fact, no differences in hormone levels have been detected between women who suffer from PMS and women who don't. It appears instead that women with PMS have an abnormal response to the normal hormonal changes that occur each month.

    Some studies suggest that calcium levels, in addition to the fluctuating hormone levels in the premenstrual phase of a woman's cycle, may interfere with serotonin in the brain. Serotonin is a chemical that, when not utilized properly by nerves in the brain, may affect mood, anxiety, and sleep. Some success has been reported in using antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) to ease PMS symptoms. When SSRIs are used to treat depression, the medication must be taken every day, and it may take several weeks before symptoms improve. When SSRIs are used to treat PMS, the medication may only need to be taken during the premenstrual phase of a woman's cycle, and can begin to ease symptoms within 1 or 2 days of treatment.

    Researchers have also noticed familial patterns of PMS, which suggests a genetic (inherited) predisposition to PMS in some cases.

    PMS includes a variety of symptoms that occur cyclically in association with menstrual periods Table 01.

    A wide range of symptoms have been attributed to PMS. They most often develop in the days leading up to a period, although some women notice symptoms associated with ovulation (egg release) midcycle. Symptoms usually go away within hours to days after menstrual bleeding starts.

    Long-standing conditions such as depression, anxiety, migraines, and epilepsy may also get worse in the days preceding periods. Mild PMS is usually characterized by physical symptoms and fatigue, whereas more severe PMS involves emotional symptoms such as irritability, mood swings, anxiety, and depression Table 01.

    Physical symptoms are common to most women during the premenstrual phase of their cycle.

    Most women experience some breast tenderness and bloating in the days before their period. Many notice weight gain, constipation, abdominal discomfort, and ankle swelling. Some women suffer headaches, back pain, and general aches and pains.

    Emotional changes may be the most distressing symptom for some women with PMS.

    Women are most likely to seek medical help for the emotional symptoms of PMS. Many women feel depressed, irritable, moody, and emotionally sensitive. Some report being prone to crying with little cause or becoming angry over small matters during the premenstrual phase of their cycle. Additional emotional symptoms may include anxiety or tension, decreased energy, and preoccupation with physical symptoms.

    Food cravings may occur with PMS.

    Many women eat more in the days leading up to a menstrual period. Some women especially crave sweets and other high-carbohydrate foods. Some report drinking more alcohol during these times. Other behavioral changes may include sleep problems, decreased motivation, forgetfulness, and difficulty concentrating.

    Table 1.  Common PMS Symptoms

    Physical symptoms Emotional symptoms Behavioral symptoms
    Breast tenderness Bloating Ankle swelling Headaches Aches and pains Migraines Depression Irritability Anxiety Moodiness Increased appetite Increased alcohol consumption Decreased motivation Forgetfulness Insomnia

    PMS affects most menstruating women to some degree.

    Most women experience at least mild changes in the days near the onset of their periods. Studies indicate that about one third of women have symptoms that can be regarded significant enough to be classified as PMS, at least during some months. About 5% of women are affected severely enough to disrupt their normal activities.

    A woman's age contributes to her likelihood of suffering from PMS.

    Symptoms of PMS commonly occur in late adolescence, but become more severe in a woman's late twenties to mid-thirties. PMS symptoms tend to go away as women enter menopause.

    Your clinician will ask about the severity, timing, and duration of physical and psychological symptoms associated with PMS Table 02.

    The timing of your symptoms is the key factor that sets PMS apart from other possible underlying disorders, such as depression, anemia, or a thyroid problem. Use a menstrual cycle diary or calendar to keep a record of your symptoms throughout the month Table 02. This record should include changing moods, behavior, and other PMS symptoms, as well as the dates of the beginning and end of your period. Also indicate if symptoms were mild, moderate, or severe. Chart your symptoms for at least two cycles (months) so that your clinician can check for any patterns. Charted symptoms can also help you and your clinician focus on which of the problems are most bothersome and should be treated first.

    Your clinician will ask about your relationships at work and home, eating habits, any alcohol or substance use, and your family medical history.

    Predictable monthly disruptions of social, domestic, or work relationships point to the possibility of PMS. However, many women who work outside the home and also have domestic duties become fatigued and overwhelmed. By asking certain questions, a clinician can evaluate whether your symptoms are due to PMS or to a particular overwhelming situation.

    Your clinician may need to perform a physical exam to rule out gynecological conditions that could be causing your physical symptoms.

    Some conditions of the female reproductive organs, such as dysmenorrhea, endometriosis, or pelvic inflammatory disease, may cause physical symptoms similar to PMS. It is important for your clinician to rule out these conditions, since their treatments differ from that of PMS.

    Your clinician may perform lab tests to rule out other conditions that could be responsible for your PMS symptoms.

    While there are no lab tests specific for diagnosing PMS, your clinician may run blood tests to rule out thyroid problems, anemia, or other medical conditions that may be causing your symptoms.

    A daily chart of your basal body temperature can determine if you are ovulating and having true periods.

    A woman who is not ovulating and who is not having true menstrual periods cannot have PMS. Monitoring basal body temperature (your body's temperature at rest) helps to detect subtle temperature fluctuations throughout your monthly cycle that can provide information about ovulation and menstruation.

    You can take your own basal body temperature using a thermometer that is sensitive enough to measure small changes in temperature. You should take your basal temperature each morning before you get out of bed. Try to move as little as possible before taking your temperature, since even mild activity can raise your basal temperature. You can measure your temperature orally, vaginally, or rectally, as long as you take it the same way every day. Write down your temperature each day on a calendar or chart. Your clinician will study this information to determine if you are ovulating normally.

    Table 2.  Menstrual Cycle Diary

    Record a score for each symptom every day: 0 = no or minimal symptom1 = mild symptom (annoying, but does not interfere with your normal activities)2 = moderate symptom (continually bothers you and/or interferes with normal activities 3 = severe symptom (incapacitating, definitely interferes with activities)
    Week beginning:???????
    Menstruating? (check if yes)???????
    Outbursts of anger???????
    Sense of being tense,?overwhelmed???????
    Avoidance of usual activities???????
    Trouble?concentrating???????
    Feelings of?sadness, worthlessness, or tearfulness???????
    Change in appetite, food cravings???????
    Irritability???????
    Mood swings???????
    Withdrawal from social activities, feeling lonely???????
    Sleep problems???????
    Tire easily, lack of energy???????
    Abdominal cramps or bloating???????
    Swelling or aches in arms or legs???????
    Swollen or tender breasts ???????
    Headache or?dizziness???????
    Weight gain or water retention???????
    Total points for each day???????
    Comments (anything unusual?):
  • Prevention and Screening

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