Diagnosis of premenstrual syndrome and premenstrual dysphoric disorder

Premenstrual syndrome (PMS) is characterised by somatic and psychological symptoms during the luteal phase of the menstrual cycle. These symptoms remit within a few days of menstruation and are absent in the follicular phase of the cycle.

Psychological symptoms of PMS include irritability, mood swings, anxiety, depression, general dysphoria, and a sense of loss of control and inability to cope. Physical symptoms include bloating, headaches and breast discomfort. Chronic conditions (eg epilepsy, migraine, asthma) may be exacerbated in PMS. Up to 80% of individuals who have menstrual cycles experience some form of PMS. Symptoms are moderately severe in 20 to 40% of individuals, and disabling in 2 to 9%; individuals with disabling symptoms may be considered to have premenstrual dysphoric disorder (PMDD), the severe form of PMS.

As there is no diagnostic test for PMS or PMDD, prospective daily charting of symptoms over two menstrual cycles is highly desirable for assessment¹. Charting also helps to identify alternative diagnoses such as premenstrual exacerbation of concurrent depression or anxiety. The diagnosis of PMSS or PMDD is supported if charting shows symptoms during the luteal phase that improve at menstruation and are absent for at least one week per cycle. Exclude other causes including thyroid disorders and, if relevant, menopause.

The cause and pathophysiology of PMS and PMDD remain unclear—this makes it difficult to target and evaluate treatment. Treatment choice is guided by the severity of symptoms, patient preferences and circumstances or lifestyle factors.

Patient information sources include:

• The Jean Hailes website 
• The Better Health Channel.