A Simple Menstrual Cycle JournalYour 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.
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 CriteriaThe 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
- 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
- Social withdrawal
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 PMDDPMDD 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
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