From Tracee Cornforth,
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Considering that at least three of out of every four menstruating adolescent girls and adult women have PMS or premenstrual syndrome, there’s a good chance that you, also, have PMS. Before you can be sure that you have PMS, you need to journal your symptoms each day for at least two or three months. A diagnosis of PMS is possible only when both physical and mental or behavioral symptoms are present.

A Simple Menstrual Cycle Journal

Your menstrual cycle calendar exposes your symptoms so that their cyclic nature is clearly visible to your health care provider. Once you have kept track of your symptoms for two or three months, make an appointment at your gynecologist to show her your calendar.

You can use any type of journal or paper you want to use; however, it’s easier to see a pattern developing if you use a standard calendar with plenty of space for writing on each date. Your word processing program should have a calendar template you can print and use, if you don’t want to use your regular calendar.

• The first day you see any amount of bleeding, write Day 1 on your calendar. You may also want to print a list of the physical and behavioral symptoms of PMS that follows, as well as the information about the diagnostic criteria for PMDD or premenstrual dysphoric disorder, the most severe form of PMS.

• Next, take note of any symptoms that occur on any days of the month and rate each symptom you experience on a scale of from 1 to 10, with 1 meaning very mild or hardly noticeable symptoms, and 10 denoting any symptom severe enough to disrupt your daily routine.

Women whose symptoms of PMS are mild usually see the disappearance of their symptoms on Day 1, while women with more severe symptoms may have PMS or PMDD symptoms that last into Days 3 or 4 of their next menstrual cycle.

Note: True symptoms of PMS do not begin until after Day 13, any symptoms you experience earlier in your cycle may have another cause. However, you should still include any symptoms you experience on Days 1 to 13 on your menstrual cycle calendar.

PMS Diagnostic Criteria

The most commonly used and accepted diagnostic criteria for PMS is one developed by the University of California, San Diego. To meet these diagnostic criteria for PMS, a woman must self-report at least one physical symptom and one mental symptom during the five days preceding menstruation. These symptoms are:

The Physical Symptoms Of PMS

• Sore, tender breasts
  
• Headache
  
• Abdominal bloating (the most common physical symptom)
  
• Swelling of the extremities

Mental Symptoms of PMS

• Fatigue (the most common mental symptom)
  
• Angry outbursts or mood swings
  
• Irritability
  
• Confusion
  
• Social withdrawal
  

The next requirement for a diagnosis of PMS is that these symptoms must disappear by Day 4 and not recur until Day 14.

Finally, these symptoms must be present in the absence of any pharmacological treatments, hormone ingestion, or drug or alcohol use.

Social or economic performance must also be identifiably dysfunctional by one of the following for true diagnosis of PMS.

• Marriage or relationship issues, confirmed by the partner of the woman seeking diagnosis

• Parenting problems

• Decreased work or school performance or attendance (including being late)

• Decrease in normal social activity

• Legal issues

• Contemplating suicide

• Seeking medical attention for physical symptoms

Diagnostic Criteria for Premenstrual Dysphoric Disorder or PMDD

PMDD is a severe form of PMS that includes severe symptoms of depression, anxiety, and irritability before menstruation begins. These symptoms must occur during the last week before menstruation starts. Approximately three to eight percent of menstruating women experience PMDD. According to the DSM-IV, the accepted diagnostic criteria for PMDD must include at least five of the following symptoms:

• Feeling sad, hopeless, or suicidal

• Severe feelings of stress, tension, or anxiety or having panic attacks

• Mood swings that include bouts of crying

• Constant irritability or anger that affects other people

• Loss of interest in usual daily activities and relationships

• Problem with ability to concentrate or focus

• Fatigue or loss of normal energy

• Food cravings or bingeing

The previous symptoms must occur in addition to the required physical and mental symptoms required for PMS diagnosis for diagnosis of PMDS to occur.

Sources: The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, DC, American Psychiatric Association 1994

Robert F Casper, MD. Patient information: Premenstrual syndrome and premenstrual dysphoric disorder (PMDD), Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder, UpToDate [online]. Accessed on October, 24, 2006