The first step toward effective treatment is to confirm that your symptoms actually are caused by PMS. This is usually done by process of elimination, as there are no reliable tests to diagnose the condition.
Your doctor may first recommend some simple laboratory tests, such as blood tests or urinalysis, to rule out other conditions with similar symptoms, particularly diabetes or thyroid problems. If you regularly experience pelvic pain, your doctor may check for the presence of sexually transmitted diseases such as gonorrhea or chlamydia. You should also receive a thorough physical examination, including breast and pelvic exams, to rule out other undiagnosed medical conditions.
| Collecting the Evidence Mark your calendar on the day your period starts as Day 1. Number each subsequent day and use a letter code such as "A" for anger, "B" for breast tenderness, "C" for cravings, or "F" for fatigue to record any symptoms on the days they occur. You can use capital letters if the symptoms are severe and small letters if they're moderate, or use letters in combination with a rating scale of 1 to 10 to indicate mild to severe. Additional details to record include your daily weight and, to pinpoint when ovulation occurs, your basal temperature, taken after you wake up but before you get out of bed. Your local pharmacy should stock a basal thermometer. Alternatively, design a simple chart that lists all of your symptoms down one side of a page and the days of your menstrual period across the top. Fill in the boxes that correspond with a given symptom and the day of your cycle in which it occurs. On days that you experience only mild symptoms, color in half the box. |
The next step in establishing a diagnosis is to record your symptoms over a period of time to verify their appearance, severity, and duration. In fact, the only way PMS can be accurately diagnosed is by keeping a careful record of when each symptom appears each month. Simple record-keeping can be done with an ordinary calendar. See the nearby box on "Collecting the Evidence" for two methods.
It also helps to keep a diary that describes not only your symptoms but also their effect on your daily activities. Feelings of social withdrawal, outbursts at family members or co-workers, or difficulties in coping can be more thoroughly described in such a journal.
It's important to maintain your records for at least three menstrual cycles. Record your entries every day, while the symptoms and their effects are fresh in your mind. You and your doctor can then review the charts and journal to help determine whether you have PMS and the extent to which it affects your life.
| Spelling Out PMDD Listed below are the official criteria for a diagnosis of "premenstrual depression." "Luteal phase" refers to the second half of the menstrual cycle, following release of an egg. "Follicular phase" refers to the first half of the cycle. "Dysphoric" is medical jargon meaning "unhappy." Criteria for Late Luteal Phase Dysphoric Disorder A. In most menstrual cycles during the past year, symptoms in B occurred during the last week of the luteal phase and remitted within a few days after onset of the follicular phase. In menstruating females, these phases correspond to the week before, and a few days after, the onset of menses. (In nonmenstruating females who had a hysterectomy, the timing of luteal and follicular phases may require measurement of circulating reproductive hormones.) B. At least 5 of the following symptoms have been present for most of the time during each symptomatic late luteal phase, at least one of the symptoms being 1, 2, 3 or 4:
C. The disturbance seriously interferes with work or with usual social activities or relationships with others. D. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as major depression, panic disorder, dysthymia (chronic mild depression), or a personality disorder (although it may be superimposed on any of these disorders). E. Criteria A, B, C, and D are confirmed by prospective daily self-ratings during at least two symptomatic cycles. (This diagnosis may be made provisionally prior to this confirmation.) Source: American Psychiatric Association, Washington, DC. |
