Premenstrual Syndrome - Diagnosis

Highlights	Risk Factors	Other Treatments
Introduction	Complications	Medications
Symptoms	Treatment	Resources
Diagnosis	Lifestyle Changes	References
Causes	Therapy

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 two or three 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 one of the cycle, which is the day bleeding begins.
Record symptom severity using an index from one to 4, with one 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 exacerbate PMS and can cause symptoms that confuse the diagnosis.)

The Premenstrual Shortened Form

A number of questionnaires are used for identifying PMS. A simple scoring system called The Premenstrual Shortened Form is often useful during an office visit. The woman is asked to rate the following symptoms on a score of 1 to 6, with 1 equal to no change and 6 equal to very severe.

In order to be diagnosed with PMS a woman must score a 5 or 6 on at least five of the symptoms and at least one of the symptoms must be numbers 2, 3, 4, or 5.

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Ruling Out Other Conditions Causing Similar Symptoms

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

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 40. (These can include breast tenderness, headaches, sleep disturbances, and mood swings.)

Breast pain that is not cyclical can be due to the following:

Injury.
A previous biopsy (pain can last for two years after this event).
Lung infection.
Arthritis.

Costochondritis. With this condition the region between the ribs and breastbone is inflamed, which can cause chest pain that seems to be in the breast. Costochondritis should be suspected if pain is triggered by pushing down on the breastbone near the rib or by taking a deep breath.