diagnosis of premenstrual syndrome (PMS)
Last edited 09/2018
diagnosis of premenstrual syndrome (PMS)
When clinically reviewing women for PMS, symptoms should be recorded prospectively, over two cycles using a symptom diary, as retrospective recall of symptoms is unreliable.
- several patient-rated questionnaires are available which can be used to record the symptoms
- Daily Record of Severity of Problems (DRSP)
- most widely used and is simple for patients to use
- provide a reliable and reproducible record of symptoms
- Premenstrual Symptoms Screening Tool (PSST)
- it is retrospective and has been validated for screening but not diagnosis
- gonadotrophin-releasing hormone (GnRH) analogues may be used for 3 months for a definitive diagnosis if the completed symptom diary alone is inconclusive (specially in those patients with variant pre menstrual disorders)
- this is to allow a month for the agonist to generate a complete hormonal suppressive effect, as well as providing 2 months' worth of symptom diaries (1,2)
Laboratory studies may also be conducted in order to screen for medical conditions e.g. thyroid function tests, complete blood cell count and follicle-stimulating hormone level (3)
Once patient records menstrual symptoms and effect on daily life for two consecutive menstrual cycles, they may have:
- physiological (mild) premenstrual disorder
- symptoms cyclical an relieved by menstruation
- symptom-free week
- no influence on quality of life
- core premenstrual disorder (premenstrual syndrome or premenstrual dysphoric disorder)
- symptoms cyclical and relieved by menstruation
- symptom-free week
- affects quality of life
- premenstrual exacerbation
- symptoms cyclical and relieved by menstruation
- no symptom-free week
- affects quality of life
- existing non-menstrual condition
- premenstrual disorder with absent menstruation
- symptoms cyclical
- symptom-free week
- affects quality of life
- no menstruation
- progestogen induced premenstrual disorder
- symptoms cyclical and relieved by menstruation
- symptom-free week
- affects quality of life
- underlying psychological disorder, not premenstrual disorder
- non cyclical symptoms
- no symptom-free week
- constant influence on quality of life (1)
Reference:
- (1) Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG. 2017;124(3):e73-e105.
- (2) Rapkin AJ, Lewis EI. Treatment of premenstrual dysphoric disorder. Women's Health. 2013;9(6): 537-556
- (3) Khajehei M. Aetiology, Diagnosis and Management of Premenstrual Syndrome. J Pain Relief. 2015:4: 193