Premenstrual Syndrome - Complications

Diagnosis

During a doctor's visit, the patient may be asked about her symptoms or to fill out a questionnaire.

The only method for obtaining a clear picture of premenstrual syndrome, however, is for the woman to chart her symptoms over 2 - 3 months. The following is an example of such a process:

• Divide symptoms into physical (such as bloating, headaches, weight gain, aches and pains, breast tenderness) and emotional and mental (such as depression, anger, changes in sexual drive, irritability). Note: Menstrual cramps are NOT part of PMS.
• Begin recording symptoms on day 1 of the cycle, which is the day bleeding begins.
• Record symptom severity using an index from 1 - 4, with 1 being no symptoms and 4 being the most severe.
• Include any medications taken or events that might contribute to emotional or physical responses. (For example, taking oral contraceptives may worsen PMS and cause symptoms that confuse the diagnosis.)

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The American College of Obstetricians and Gynecologists asks that a pattern of symptoms:

• Be present in the 5 days before a woman's menstrual period for a least three cycles in a row and
• Within 4 days after the beginning of the menstrual period
• Interfere with normal daily activities

Ruling Out Other Conditions

If the symptoms consistently resolve at the onset of menstruation, they are most likely caused by hormonal fluctuations. If they persist, however, or do not appear to be associated with a regular cycle, other conditions may be causing them. Among the possible conditions that mimic some PMS symptoms are:

• Psychiatric disorders (depression or anxiety that persists suggests serious mood disorders that are unrelated to PMS)
• Eating disorders
• Anemia
• Thyroid disorders
• Diabetes
• Endometriosis
• Chronic fatigue syndrome
• Side effects of oral contraceptives
• Perimenopausal symptoms in women over age 40 (these can include breast tenderness, headaches, sleep disturbances, and mood swings)

Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).